Do remote clinical trials offer carbon savings while maintaining research quality? Experiences from the Eczema Bathing Study

Abstract Background Traditional clinical trials contribute significantly to the carbon footprint of healthcare. They are also expensive and take a long time to complete. Remote trials could offer part of the solution. They are a type of decentralized trial that use digital innovations to move all activities to participants’ homes or online. This gives them the potential to speed up recruitment, reduce overall trial duration, improve geographical inclusion and reduce the trial’s carbon footprint. Objectives To assess whether a remote trial could reduce a trial’s carbon footprint, while maintaining the research quality needed to answer the scientific questions. The primary objective was to calculate the carbon footprint of a remote eczema trial and compare it with traditional and hybrid trials; the secondary objective was to assess quality indicators of remote, hybrid and traditional eczema trials in terms of speed of recruitment, retention and adherence to interventions. Methods Carbon footprinting of the remote Eczema Bathing Study (n = 438, 4 weeks’ duration) was completed using the National Institute for Health and Care Research (NIHR)-funded detailed guidance and method to calculate the carbon footprint of a clinical trial. This footprint was compared with footprints of previously published publicly funded trials. Recruitment, retention and adherence metrics were compared between the Eczema Bathing Study and eight other NIHR-funded eczema treatment trials. Results The carbon footprint of the Eczema Bathing Study was 14 tonnes CO2e. The most carbon-intensive activity was staff commuting. The mean speed of recruitment for remote, hybrid and traditional trials was 52, 27 and 13 participants per month, respectively. Mean retention for remote, hybrid and traditional trials was 90%, 95% and 95%, respectively. Adherence was defined individually for each study, making comparison difficult. Conclusions The Eczema Bathing Study’s lower carbon footprint in comparison with the other clinical trials mentioned in this study was largely due to online recruitment methods, reduced need for patient and staff travel, and reduced overall trial duration. Adherence and retention were slightly lower than for traditional trials but remained within predefined limits for the study’s size calculations. In situations where remote assessment of diagnosis and outcomes is possible, and where advertising direct to participants is appropriate, running trials completely online has the potential to improve speed of recruitment, reduce overall trial duration and reduce carbon emissions.