Implementation of an evidence-based management algorithm for patients with chronic pancreatitis (COMBO trial): study protocol for a stepped-wedge cluster-randomized controlled trial

Florence E.M. de Rijk*, Charlotte L. van Veldhuisen, for the Dutch Pancreatitis Study Group, Marc G. Besselink, Jeanin E. van Hooft, Hjalmar C. van Santvoort, Erwin J.M. van Geenen, Cornelis H. van Werkhoven, Pieter Jan F. de Jonge, Marco J. Bruno, Robert C. Verdonk

*Corresponding author for this work

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Background: Chronic pancreatitis (CP) is an inflammatory disease that may be complicated by abdominal pain, pancreatic dysfunction, nutritional deficiencies, and diminished bone density. Importantly, it is also associated with a substantially impaired quality of life and reduced life expectancy. This may partly be explained by suboptimal treatment, in particular the long-term management of this chronic condition, despite several national and international guidelines. Standardization of care through a structured implementation of guideline recommendations may improve the level of care and lower the complication rate of these patients. Therefore, the aim of the present study is to evaluate to what extent patient education and standardization of care, through the implementation of an evidence-based integrated management algorithm, improve quality of life and reduce pain severity in patients with CP. Methods: The COMBO trial is a nationwide stepped-wedge cluster-randomized controlled trial. In a stepwise manner, 26 centers, clustered in 6 health regions, cross-over from current practice to care according to an evidence-based integrated management algorithm. During the current practice phase, study participants are recruited and followed longitudinally through questionnaires. Individual patients contribute data to both study periods. Co-primary study endpoints consist of quality of life (assessed by the PANQOLI score) and level of pain (assessed by the Izbicki questionnaire). Secondary outcomes include process measure outcomes, clinical outcomes (e.g., pancreatic function, nutritional status, bone health, interventions, medication use), utilization of healthcare resources, (in) direct costs, and the level of social participation. Standard follow-up is 35 months from the start of the trial. Discussion: This is the first stepped-wedge cluster-randomized controlled trial to investigate whether an evidence-based integrated therapeutic approach improves quality of life and pain severity in patients with CP as compared with current practice. Trial registration: ISRCTN, ISRCTN13042622. Registered on 5 September 2020.

Original languageEnglish
Article number18
Issue number1
Publication statusPublished - 7 Jan 2023

Bibliographical note

The COMBO trial is an investigator-initiated study. Financial support is provided by Viatris Global Healthcare Company. The subsidizing party had no influence on the design of this study, content of our evidence-based management algorithm, statistical analysis plan, and publication policy of this trial.

Publisher Copyright: © 2023, The Author(s).


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