Reading focus
Syllabus: How Can Couples, Families and Groups Become Settings for Change?
Examine the primary endpoint, usual-care comparison and missing secondary outcomes.
Why you’re reading it. Limit generalization from one positive family-treatment example to another clinical question.
A question to consider. If hospital attendance remains unchanged while reported distress improves, what would you need to know before calling the treatment effective?
Why this reading
A plausible intervention may fail to improve its primary outcome over available care. This large service trial makes that result informative by specifying the population, comparison and event being counted.
Before you read
A pragmatic trial examines treatment under service conditions. Hospital attendance for self-harm captures a consequential event, but differs from all self-harm or distress. Intention-to-treat analysis retains participants in their assigned conditions.
Read for
- Examine the intervention, usual care and ascertainment of the primary outcome.
- Compare the completeness of hospital records with missing participant-reported outcomes.
Consider afterwards
- How might a treatment change help-seeking without changing the underlying frequency of harm?
- What conclusion would require a different outcome or comparison?
Editorial context
The SHIFT trial enrolled 832 young people across English services. It found no advantage of the manualized family intervention on subsequent hospital attendance for self-harm. Secondary outcomes had substantial missing data. The result concerns this intervention and endpoint, not every form of family involvement or every condition.