elke sennewald berlin, 19 february 2009

Elke SennewaldBerlin, 19 February 2009

CDASH Tutorial

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Learning Objectives

• Learn more about CDASH V1.0

• Identify the domains addressed

• Understand the content of domains

• Get insight into design decisions

• Understand CDASH team recommendations

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General Remarks

• CDASH: A set of ‘content standards’• Initial scope: 16 core safety domains• The term “CRF” used throughout this document refers to both paper

and electronic formats, unless otherwise specified• Not CRF layouts• “Fields” refers to fields that are commonly seen on the CRF.• “Variables” refers to what is seen in a clinical database.• “Study treatment” has been used in order to include all types of

study designs and products.• Different data collection mechanisms can be used to control how

data are collected, e.g., tick boxes, check boxes, radio buttons, drop-down lists, etc. These terms will be used interchangeably.

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Contents Sections 1 to 4

• Section 1: Orientation – purpose and goals of the CDASH project as well as – organization of CDASH Standard Version 1.0.

• Section 2: CDASH Alignment with Other Standards – relationship of CDASH Standard Version 1.0 to the Study Data Tabulation Model

Implementation Guide (SDTMIG), controlled terminology and other non-CDISC standards.

• Section 3: Best Practice Recommendations – for creating data collection instruments – Frequently Asked Questions (FAQs) section

• Section 4: Overview of CDASH Domain Tables – new ideas and approaches recommended by the CDASH Domain Teams– data collection fields noted not necessary to collect– core designations used throughout CDASH Standard Version 1.0 – explains the table headers used in the domain tables.

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Contents Section 5: CDASH Domain Tables

• Approach taken regarding common identifier and timing variables • Metadata tables and/or recommendations for the following domains:

- Adverse Events (AE) - Inclusion and Exclusion Criteria (IE)

- Comments (CO) - Laboratory Test Results (LB)

- Prior and Conc. Med. (CM) - Medical History (MH)

- Demographics (DM) - Physical Examination (PE)

- Disposition (DS) - Protocol Deviations (DV)

- Drug Accountability (DA) - Subject Characteristics (SC)

- ECG Test Results (EG) - Substance Use (SU)

- Exposure (EX) - Vital Signs (VS)

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Contents Sections 6 and 7

• Section 6: Change Control and the Process for Creating New CDASH Domains– describes the procedure for change control and maintenance of CDASH

Standard Version 1.0 as well as the

– procedure for creating new CDASH domains.

• Section 7: Appendices– provides additional background material regarding the CDASH project

as well as

– references and supplemental information relevant to implementation of CDASH Standard Version 1.0

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Core Designations for Basic Data Collection Fields

• Highly Recommended: A data collection field that should be on the CRF (e.g., a regulatory requirement).

• Recommended/Conditional: A data collection field that should be collected on the CRF for specific cases or to address TA requirements (may be recorded elsewhere in the CRF or from other data collection sources).

• Optional: A data collection field that is available for use if needed.

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Explanation of Table Headers

1. Data Collection Field: Basic data to be collected.

2. Variable Name: Lists the SDTM-based variable name defined in the SDTMIG. (CDASH variable name shaded)

3. Definition: Describes the purpose of the data collection field. Reference to the code list will be provided, in the format {code list name}

4. Case Report Form Completion Instructions: how to enter collected information on the CRF.

5. Additional Information for Sponsors: Contains further information

6. CDASH Core: Contains the CDASH core designations

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Example

Question or data being collected

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Example

EDC or database variable name

Unshaded = SDTM name

Shaded = CDASH specific

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Example

Purpose of the field

May or may not mirror the text in the SDTMIG

CRF text examples are presented in italics

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Example

Reference to the code list:{code list name}

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Example

Suggested instructions to give to the sites for completing the CRF

These will vary depending upon the protocol

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Example

More information that explains the field, helps with implementation or clarifies intent

Not only for sponsors but for anyone who is using the standard

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Example

Degree of ‘required-ness’

- Highly recommended

- Recommended / Conditional

- Optional

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Core Domains

• Common Identifier Variables

• Common Timing Variables

• Adverse Events (AE)

• Comments (CO)

• Prior and Conc. Med. (CM)

• Demographics (DM)

• Disposition (DS)

• Drug Accountability (DA)

• ECG Test Results (EG)

• Exposure (EX)

• Inclusion and Exclusion Criteria (IE)

• Laboratory Test Results (LB)

• Medical History (MH)

• Physical Examination (PE)

• Protocol Deviations (DV)

• Vital signs (VS)

• Subject Characteristics (SC)

• Substance Use (SU)

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Domain Review: AE

• Where any AEs experienced?

• Line #

• Adverse Events Text

• Start Date / Start Time

• End Date / End Time

• Ongoing

• Severity

• Serious Event

• Serious Event Type

• Relationship to Study Treatment

• Action Taken with Study Treatment

• Other Action Taken

• Outcome

• Adverse Event that Caused Study Discontinuation

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Domain Review: AE


• Line #




• Ongoing


• Severity

• Serious Event





• Outcome


The intent/purpose is to help withdata cleaning and monitoring. It provides verification that all other fields on the CRF were deliberately left blank.Note: AEYN will not be included as part of the SDTMIG AE Domain for submission.

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Domain Review: AE


• Line #




• Ongoing


• Severity

• Serious Event





• Outcome


Sponsor-defined reference number. Perhaps pre-printed on the CRF as an explicit line identifier or defined in the sponsor’soperational database (derived)

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Domain Review: AE


• Line #




• Ongoing


• Severity

• Serious Event





• Outcome


The date of data collection in conjunction with End Date and the Ongoing CDASH fields would determine how the SDTMIG variable AEENRF will be populated.

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Domain Review: AE


• Line #




• Ongoing


• Severity

• Serious Event





• Outcome


If the details regarding a Serious AE need to be collected in the clinical database, then it is recommended that a separate Yes/No variable be defined for each Serious AE type, e.g.:Congenital Anomaly or Birth DefectInitial or Prolonged Hospitalization Life Threatening Death

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Domain Review: AE


• Line #




• Ongoing


• Severity

• Serious Event





• Outcome


CDISC controlled terminology should be used to indicate the action taken with the study treatment in response to the AE.Other Action: Free text field. Example: Treatment Unblinded, Primary Care Physician Notified.

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Domain Review: Comment

Just say no

ICH E3 & E6: no requirement that indicate unsolicited comments should be included in a submission dataset.

Recommendation: only the parameters captured in appropriate CRF data collection fields are considered clinical study data that is submitted to regulatory parties in datasets; all other comments are considered unsolicited comments.

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Domain Review: Prior & Conc. Med.

• Where any medications taken?

• Line #

• Medication Name

• Active Ingredient(s)

• Indication

• AE Line #

• MH Line #

• Dose

• Total Daily Dose

• Unit

• Dose Form

• Frequency

• Route


• Mark if taken prior to study

• End Date

• Mark if Ongoing

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• Line #

• Medication Name

• Active Ingredient(s)

• Indication

• AE Line #

• MH Line #

• Dose


• Unit

• Dose Form

• Frequency

• Route



• End Date

• Mark if Ongoing

Intent is to establish a link between the adverse event / medical history condition and the medication taken for the adverse event.May result in unnecessary data cleaning work.

Note: will not be included in the SDTMIG CM domain in submissions.

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• Line #Line #

• Medication Name

• Active Ingredient(s) Active Ingredient(s)

• IndicationIndication

• AE Line #AE Line #

• MH Line #MH Line #

• DoseDose

• Total Daily Dose Total Daily Dose

• Unit Unit

• Dose FormDose Form

• FrequencyFrequency

• RouteRoute

• Start Date / Start TimeStart Date / Start Time


• End DateEnd Date

• Mark if Ongoing

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• Line #

• Medication Name


• IndicationIndication

• AE Line #

• MH Line #

• DoseDose

• Total Daily Dose Total Daily Dose

• Unit Unit

• Dose FormDose Form

• FrequencyFrequency

• RouteRoute


• Mark if taken prior to studyMark if taken prior to study

• End Date

• Mark if Ongoing

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• Line #Line #

• Medication Name


• Indication

• AE Line #AE Line #

• MH Line #MH Line #

• DoseDose


• Unit

• Dose Form

• Frequency

• Route


• Mark if taken prior to studyMark if taken prior to study

• End Date

• Mark if Ongoing

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Domain Review: Demographics

• Date of Birth (and time)

– Year of Birth

– Month of Birth

– Day of Birth

– Time of Birth

• Age

• Age Units

• Today’s date

• Sex

• Ethnicity

• Race

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Domain Review: Demographics

• Date of Birth (and time)

– Year of Birth

– Month of Birth

– Day of Birth

– Time of Birth

• Age

• Age Units

• Today’s date

• Sex

• Ethnicity

• Race

Subjects in countries where privacy rules preclude the collection of personal data containing more detail than the year of birth might only provide date of birth data to the year level. Note: It is recommended that the CRF should be modified for sites in these counties to prevent the clinician from entering the data that would violate the privacy rule (i.e., gray out the month and day fields on paper or make them inaccessible for entry in an EDC system).

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Domain Review: Disposition

• Trial Epoch

• Subject Status

• Date of Completion or Discontinuation

• Time of Completion or Discontinuation

• Was treatment unblinded by the site

• Will the subject continue?

• Next trial epoch or new trial subject will be entering

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Domain Review: Disposition

• Trial Epoch

• Subject Status

• Date of Completion or Discontinuation

• Time of Completion or Discontinuation

• Was treatment unblinded by the site

• Will the subject continue?

• Next trial epoch or new trial subject will be entering

. Subject Status data collection field should be presented on the CRF as a check box linked to an item from the approved controlled terminology list (DSDECOD). Only collect the date of completion or discontinuation on the disposition CRF module if the same information is not being collected on another CRF module.

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Domain Review: Drug Accountability

• Date Study Treatment Dispensed

• Study Treatment Dispensed or Returned

• Results of Study Treatment Dispensed or Returned

• Units of Study Treatment Dispensed or Returned

• Date Study Treatment Returned

• Study Treatment Category

• Study Treatment Subcategory

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Domain Review: ECG

• Scenario 1: Central reading

• Scenario 2: Local reading

• Scenario 3: Central reading with Clinical Significance Assessment and/or Overall Interpretation

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Domain Review: ECG (Central Reading)

• Indicate if ECG was performed

• ECG Reference ID

• Method of ECG

• Position of the Subject

• Date of ECG

• Planned Time Point

• Time of ECG

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Domain Review: ECG (Local Reading)


• Method of ECG


• Date of ECG


• Time of ECG

• Test Name

• Test Result

• Units

• Clinical Significance

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Domain Review: ECGCentral processing but CRF includes site assessment of clinical significance and/or overall interpretation


• ECG Reference ID

• Method of ECG


• Date of ECG


• Time of ECG

• Test Name

• Test Result

• Units


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Domain Review: Exposure

• Start Date / Start Time• End Date / End Time• Dose Amount• Dose Unit• Study Treatment Identification

Number• Study Treatment Name• Dose Adjusted?• Reason for Dose Adjustment• Frequency• Route• Formulation

• Duration of Optional Interruption (including units)• Body Location• Total Volume Administered• Total Volume Administered Unit• Flow Rate• Flow Rate Unit• Planned Time Point• Did subject complete full course of study med• Planned Dose• Planned Dose Units

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Domain Review: Inclusion/Exclusion

• Met All Eligibility Criteria?

• Criterion Identifier *

• Criterion

• Inclusion or Exclusion?

* This variable is only populated in SDTM for those criteria that are not met, and it will only be recorded on the CRF for those criteria that are not met.

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Domain Review: Lab Test Results

• Scenario 1: Central processing

• Scenario 2: Local processing

• Scenario 3: Central processing with Clinical Significance Assessment for abnormal values

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Domain Review: LB – Central

• Lab Status

• Date of Collection

• Time of Collection

• Panel Name


• Protocol-defined testing conditions met

• Accession Number

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Domain Review: LB – Local Processing

• Lab Status



• Panel Name



• Sample Status

• Test Name

• Test Result

• Units

• Reference Range Lower Limit Numeric Value

• Reference Range Upper Limit Numeric Value

• Reference Range for Character Results in Standard Units

• Abnormal Flag


• Lab Name


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Domain Review: LB – Central Processing & CRF with Site Assessment

• Lab Status



• Panel Name



• Sample Status

• Test Name

• Test Result



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Domain Review: Medical History

• Has the subject experienced any past and / or concomitant diseases or past surgeries?

• Pre-printed row number (e.g., 1, 2, 3)

• Type of Medical History being collected

• Category of Medical History being collected

• Reported Term

• Ongoing?

• Disease controlled?

• Pre-printed prompt for a specific condition/surgery (e.g., Does the subject have high blood pressure?)

• Onset Date

• End Date

• Completion Date

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Domain Review: Physical Examination

• Traditional:Use PE form at baseline and post-baseline visits. Record abnormalities for each listed body system.

• Intermediate:Use PE form at baseline but not post-baseline visits. Record any post-baseline abnormalities or conditions that worsened post baseline on the AE page.

• Best Practice:Use PE CRF only to record whether PE was performed, and if so, the date of the examination. Record any baseline abnormalities on Medical History CRF and any post-baseline abnormalities or conditions that worsened post baseline on the AE page.

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Domain Review: Physical ExaminationTraditional Approach

• Was the Physical Examination Performed?

• Date of Examination

• Time of Examination

• Sponsor-Defined Identifier

• Body System Examined

• Examination Result

• Abnormal Findings


• Evaluator

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Domain Review: Physical ExaminationBest Practice Approach

• Was the Physical Examination Performed?

• Date of Examination

• Time of Examination

• Sponsor-Defined IdentifierSponsor-Defined Identifier

• Body System ExaminedBody System Examined

• Examination ResultExamination Result

• Abnormal FindingsAbnormal Findings

• Clinical SignificanceClinical Significance

• EvaluatorEvaluator

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Domain Review: Protocol Deviations

Generally form is discouraged

• Were there any protocol deviations?• Protocol Deviation Term (text) and or Protocol Deviation Coded

Term

• Start Date

• Start Time

• End Date

• End Time

• Sponsor-Defined Identifier

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Domain Review: Subject Characteristics

• Subject Characteristic Question• Subject Characteristic Answer/Result

• Examples of Subject Characteristics Questions– Gestational Age at Birth

– Childbearing Potential

– Education

– Sub-study Participation

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Domain Review: Substance Use

• Type of substance used?• Substance use?• Category of substance used

• Amount

• Unit

• Frequency

• Start Date

• End Date

• Duration

• Unit for Duration

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Domain Review: Vital Signs

• Date of Measurements• Time of Vital Sign

Measurements• Sponsor-Defined Identifier


• Vital Sign Test Name

• Vitals Status

• Vital Sign Test Result or Finding

• Original Units


• Location of Vital Signs Measurement

• Position of Subject

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Recommendations for CDASH Domains

• Comments: Avoid the creation of a General Comments CRF to collect unsolicited comments. Solicited comments linked to specific data collection fields is the recommended approach.

• Inclusion/Exclusion Criteria: Use the IE form to collect only the criterion or criteria NOT MET.

• Physical Examination: Record only whether or not an exam was done on the PE form. Clinical sites are asked to record baseline abnormalities on a Medical History, Targeted Medical History or Baseline Conditions CRF. Post baseline abnormalities or baseline conditions that worsened during the clinical study are to be recorded on the Adverse Event CRF.

• Protocol Deviations: Avoid creating a Protocol Deviations CRF if this information can be derived from other domains or system functionalities

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Answers to FAQs on Best Practices

• “Yes/No” questions should be preferred over “Check all that apply” questions

• Standard order for “Yes/No” response• unambiguous date format DD-MMM-YYYY• 24-hour clock using the HH:MM:SS format• Manually-calculated fields should not typically be recorded• Data that are collected on CRFs should usually be databased• “Yes/No” exam completed is preferred over “Check if not done”• Data should not be pre-populated in the CRF• CDASH recommends not providing actual coding dictionaries to the

site for adverse events, concomitant medications or medical history reported terms, as this may bias responses.

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Best Practice Recommendations

• Necessary data only• Control• Adequate review• Site workflow• Employ standards• Clarity• Translations• CRF completion guidelines

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Challenges

• There are many ways to implement CDASH domains

• There are still some unresolved issues

• There are pieces missing

• It requires giving up favorite practice

• Change is hard, especially across departments

• Requires learning about parts of clinical studies that are “not our job”

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Practical Implementation in an EDC System

• CDASH domain specs need to be transferred to EDC eCRF specs• CDASH is not necessarily conducive to a database design

– For example:• VS domain has one variable for “test Result” – this needs to cover all tests,

e.g. height, weight, etc – where different database variables are needed• Necessitates creation of (non-CDASH) database variables which can be

mapped to SDTM

• Some CDASH domains can be collected once or many times/study– This means more than one eCRF standard may be needed for each

CDASH domain

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CDASH and SDTM Terminology

• Answers to CDASH questions need to comply with SDTM terminology– Need to define which code lists will be applied to which questions

– Some SDTM terminology code lists are huge, e.g. “units” which covers all potential units for all potential tests

– An efficient data entry system requires a concise list of potential terms per variable

– Necessitates some customisation of the SDTM terminology list to divide into question specific lists

– In turn, this means a stringent cross check of further SDTM terminology developments is required to ensure updates are implemented

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Questions?

elke sennewald berlin, 19 february 2009

Documents

cdash variable

cdash project

cdash v1

cdash alignment

cdash domain tablesapproach

new cdash domainsdescribes

data collection instruments

data collection sources