Prospective clinical trials as a model for patient-centred care.

An authoritative and well researched report from two of the UK's most influential national bodies, the Commission for Health Improvement (CHI) and the Audit Commission, has already been influential in setting the agenda for cancer care in England and Wales [1]. This service review, entitled NHS Cancer Care in England and Wales, is aimed at the general public as well as those with a specialist interest. It seeks not only to analyse the present state of cancer services—warts and all—but also to provide formal benchmarks and address national levels of progress following recommendations from the 1995 Calman–Hine Report, itself widely recognised as an important watershed in the development of oncology services in the UK [2]. The document regards the concept of patient-centred care as critical to the pursuit of quality. Though a somewhat nebulous concept, patient-centred care is usually defined in terms of the need for professionals working directly with patients to give careful attention to their individual needs and concerns, offering choice where appropriate, together with full information on the implications of making certain decisions. The CHI document makes clear that patients should be given full attention by a doctor (and all other health professionals), be treated with humanity and honesty, and wherever possible, by a specialist or team able to offer good continuity of care. As the authors of the report pointed out, all of these points lie at the heart of the principles of the Calman–Hine Report. These points relating to patient-centred care might at first sight appear to sit uncomfortably with the many demands relating to participation in a prospectively controlled clinical trial for cancer—especially where the treatment choices are randomised, and the patient required to understand and agree to a highly unfamiliar concept. Although there is now universal agreement that prospectively controlled clinical trials offer the best opportunity for assessing new treatments [3], patients remain wary so our rate of recruitment remains relatively low [4]. Some clinical trials are remarkably (even unexpectedly) successful where others fail completely—even though, when first put forward, the initial research proposal always seems such a terrific idea at the time! [5]. Furthermore, leading clini-cians remain both unconvinced and anxious about the future of academically (rather then industrially) sponsored clinical research [6, 7]. Despite these and other difficulties, particularly the thorny issue of informed consent [8]—the message seems clear enough: the benefits of clinical trials are now becoming more apparent to …