title: How pragmatic or explanatory is the randomized, controlled trial? The application and enhancement of the PRECIS tool to the evaluation of a smoking cessation trial.
abstract: BACKGROUND
  Numerous explanatory randomized trials support the efficacy of chronic disease interventions, including smoking cessation treatments. However, there is often inadequate adoption of these interventions for various reasons, one being the limitation of generalizability of the explanatory studies in real-world settings. Randomized controlled trials can be rated as more explanatory versus pragmatic along 10 dimensions. Pragmatic randomized clinical trials generate more realistic estimates of effectiveness with greater relevance to clinical practice and for health resource allocation decisions. However, there is no clear method to scale each dimension during the trial design phase to ensure that the design matches the intended purpose of the study.
  
  
  METHODS
  We designed a pragmatic, randomized, controlled study to maximize external validity by addressing several barriers to smoking cessation therapy in ambulatory care. We analyzed our design and methods using the recently published 'Pragmatic-Explanatory Continuum Indicatory Summary (PRECIS)' tool, a qualitative method to assess trial design across 10 domains. We added a 20-point numerical rating scale and a modified Delphi process to improve consensus in rating these domains.
  
  
  RESULTS
  After two rounds of review, there was consensus on all 10 domains of study design. No single domain was scored as either fully pragmatic or fully explanatory; but overall, the study scored high on pragmatism.
  
  
  CONCLUSIONS
  This addition to the PRECIS tool may assist other trial designers working with interdisciplinary co-investigators to rate their study design while building consensus.
authors: Addictions Program, Centre for Addiction and Mental Health, 100 Stokes St,, 33 Russell Street, Toronto, ON M6J 1H4, Canada. peter.selby@camh.ca
authors: Peter
authors: P
authors: Selby
authors: Gerald
authors: G
authors: Brosky
authors: Paul I
authors: PI
authors: Oh
authors: Vincent
authors: V
authors: Raymond
authors: Suzanne
authors: S
authors: Ranger
mesh_terms: D000553:Ambulatory Care; D001521:Behavior Therapy / Q000379:methods*; D006801:Humans; D018722:Nicotinic Agonists; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012107:Research Design; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices
chemical_list: D018722:Nicotinic Agonists