![Diagram][1] For this, participants were asked to share and reflect on their individual experiences during the COVID-19 crisis, as well as the long term impacts it would have on both the patient population and the people working in the field. They were then asked to identify the challenges and opportunities brought by the crisis and the adaptations that had to be made. **Resilience** - #### COVID-19 has shown the resilience and adaptability of trialists and their network. *"There has been some positivity, I think I think it taught us all (...) how resilient we actually are."* *"If you look at the practice of oncology, it's constantly changing, we're always bringing in new therapies, new drugs, improvements in care. And one of things really impressed me about the pandemic is actually that progress has continued despite the pandemic. We've introduced new drugs, we've introduced new ways of treating people."* **Patient Experience** - #### There is a worry that the delayed diagnosis of patients will have serious long-term consequences that will be felt after COVID. *"So there will be patients that have had delayed diagnoses, and they will never get the treatments that they should have gotten. There will be delays, or there'll be reduced numbers of trial options for a cohort of patients. They'll be companies that don't come to where they perceive high incidence of COVID to be, which obviously includes the UK, so they'll be missing out on trial opportunities. I'm worried that some centres will lose most of their trial activity, because they weren't able to get funding from things like the cancer charities. And I don't think patients will want to travel in the same way that they used to. And, you know, then the patients may not want to be treated in the same way. So they might not want to have as many appointments and as many scans and maybe clinicians won't want to do that either."* **Networking remotely and the value of face to face contact** - #### COVID-19 has disrupted networking and communication, forcing rapid adaptation in switching to remote meetings and conferences. Whilst some opportunities have been missed, such as serendipitous chats in hallways and in conferences, trialists recognise the need to adapt to the circumstances and create new modalities of networking remotely. *"It's all about collaboration. It's all about talking to people, it's all about networking. And, yes, there is a definite need and role for face to face meetings. But of course, you can never get everybody you want at a face to face meeting if they have to travel for days to get there. Now, there's no excuse if you can get much better attendance when the whole meeting is on zoom. I think the really valuable lesson everybody has finally learned is that virtual meetings don't work if half the people are real, and half the people are virtual, everybody has to be on an equal footing at the meeting. So I think we will have a clearer understanding of this meeting would be better run virtually, this is the meeting that needs to be face to face. And therefore will be able to be more inclusive, you be able to get the right people at the meeting. And it enabled us to have to and to interact differently, and hopefully to interact better. You know that the meeting behaviors and interactions are different when you're on a zoom call. We mustn't assume that they're all better."* *"One of the things that really worries me actually is virtual meetings, and working from home, are they fine as a sticking plaster? We thought this was done and dusted in three or four weeks, everybody went home with a laptop, sitting in their office at home, works fine for a few weeks. But if it's permanent, then you do lose stuff. And these things will be permanent. And what really concerns me is, it works fine for me, because I've spent years building a network of people who do the work I do, I know who to talk to, I know how to how to deal with individuals. And then in 10 or 15 years time, they'll be nobody who was here before. So how do we bring in new people, how do the new starters, the young, the new talent, build those networks? How do they know who to talk to? I'm not saying they have to do it the way I did it. But what we've put in place is sticking plasters. We've not put in place systems to build networks. And so we have to really think about that, and how we bring in new people. And it's not just about training, it's about it's about those less tangible things around networking, and that's really, really important in clinical trials research."* *"(Networking has suffered during COVID) because you're not having those opportunistic meetings with people in the corridor of a conference, or we're looking at the same post or whatever. But it hasn't completely eliminated the opportunities to network, you still form them by knowing people through projects you're working on, and being proactive in terms of engaging with sites where you already have involvement and getting to know the people who work there, but also they introduce you to other people. We're going to go to fewer face to face conferences in the future. No matter what happens in the next six months or a year, people are going to go to more online conferences, because it's cheaper, it's more efficient with your time, it's better for the environment, etc. We all have to think about our strategies for how we're going to network in a new world where we're leaving our house a bit less."* **Accelerating change** - #### Remote consultations have reduced travel time for patients seeking to take part in trials. Other measures, such as local blood tests and drug delivery, have been put in place for the benefit of patients. #### Digital meetings have bridged silos by enabling people who would not usually be part of panels/meeting/talks, such as international collaborators or people from different disciplines, thus lowering the barrier of entry. Finally COVID-19 has highlighted the value of networks, as trialists leveraged international connections to get quick and accurate information about the virus and safety for patients. *"We've had, in an effort to kind of keep everyone updated and connected, a lot more meetings, and virtual meetings, not necessarily just within the group, but within the institute. And people can understand what other groups are doing. And so there has been a lot more kind of drive to kind of stay away from these silos, where you don't know what's going on within your own Institute."* *"And I think we really used our paediatric networks right at the beginning. So you know, we didn't know whether children with cancer were going to be affected by COVID or not. So we literally just picked up the phone and emailed our colleagues in Italy, and in China, and just said, “Have you seen lots of cases?”. we didn't have to wait for it to come out. And so actually, we had reassurance really quite early on in the pandemic, that there wasn't going to be a major problem, because we literally had the paediatric oncologists from EU saying, “we haven't seen a big problem”. So there's, I think our paediatric networks really, really helped us at the beginning, although obviously, we still had to take all of the precautions."* **Visibility of Trials in the public eye** - #### The COVID-19 vaccine trials and the quick development of the vaccines has highlighted the value of trials in the public eye, and given a clear example of impact that trialists can refer to. *"I think if we can build on that, it will be great. Because we now have very concrete examples of how trials helped care in a very short time. I think it's different, more difficult with cancer, where we found this target 20 years ago, and we found the drug 10 years ago, and then we did these trials, whereas it's very condensed, the examples that you can give for COVID research."* *"I suppose the general public will better understand better what we do and then support their families to make those choices."* *"We've had examples of vaccine developed through clinical trial. If you want to think about trial impact, you've got basically an amazingly impactful number of trials, showing you how it can be done."* You can view the full enhanced report here: https://osf.io/azg8e/ You can download the full enhanced report here: https://osf.io/azg8e/download [1]: https://mfr.de-1.osf.io/export?url=https://osf.io/k96wm/?direct%26mode=render%26action=download%26public_file=False&initialWidth=560&childId=mfrIframe&parentTitle=OSF+%7C+COVID19.jpg&parentUrl=https://osf.io/k96wm/&format=2400x2400.jpeg