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The following is a summary of “Application of stepped-wedge cluster-randomized controlled trial study designs in oncology settings: A systematic review,” published in the January 2025 issue of Oncology by Jongebloed et al.

Stepped-wedge cluster-randomized trials (SW-CRTs) have emerged as a valuable design for conducting implementation research within healthcare settings, particularly in oncology. Their structured, phased rollout of interventions offers distinct advantages in assessing complex healthcare strategies. This review examines the use of SW-CRT design in oncology, focusing on trial design features, protocol deviations, the nature of the interventions tested, and their implementation aspects. A comprehensive search across five databases, from inception to July 2023, identified 3,395 unique records, resulting in 15 trials reported across 49 publications. These trials encompassed both efficacy (n = 8) and implementation (n = 7) studies, reflecting the breadth of interventions applicable in oncology.

The reviewed SW-CRTs evaluated diverse interventions, such as new models of care and training programs for healthcare professionals. Notably, 12 trials (80%) incorporated educational and training components to support implementation, and 10 trials (67%) met or exceeded their recruitment targets, demonstrating the feasibility of the SW-CRT approach in oncology. Despite the high reporting rate of implementation outcomes (93%), a significant majority (86%) did not utilize established evaluation frameworks, which are critical for guiding the selection and reporting of these outcomes effectively.

The findings underscore the utility of SW-CRTs in implementing complex interventions in oncology. However, they also highlight the necessity for more structured planning, including the integration of implementation frameworks and strategies to enhance trial design and resource allocation. By adopting a strategic approach that incorporates these elements, trialists can improve the robustness and impact of SW-CRTs, ultimately leading to better patient outcomes and significant advancements in cancer care. This review emphasizes the importance of meticulous trial planning to leverage the full potential of SW-CRTs in oncology, ensuring that interventions are both effective and sustainably integrated into healthcare practices.

Source: sciencedirect.com/science/article/pii/S1040842824002907