The POETIC (PrOcess Evaluation of Trials In Critical care) Framework: A Structured Approach for Designing and Conducting Process Evaluations in Critical Care Trials
Bibliographic record
Abstract
BACKGROUND: A process evaluation systematically examines how an intervention is delivered, including activities, procedures, and contextual factors influencing implementation. Existing process evaluation frameworks were primarily developed for education or public health settings, and do not reflect the complexity of critical care trials, which often involve medical technologies, high-acuity patients, and multidisciplinary care in dynamic environments. This study aimed to develop a framework (the POETIC (PrOcess Evaluation of Trials In Critical care) framework) to guide researchers in designing and conducting process evaluations that capture delivery quality and contextual understanding specific to critical care settings. METHODS: Framework development began in 2015 and followed an iterative, multi-phase process. Phase 1 included structured literature reviews to identify a) existing process evaluation frameworks and dimensions, and b) critical care trials with embedded process evaluations. Both reviews were updated in 2025 to reflect POETIC's usage and ensure continued relevance. Phase 2 involved expert consultations with trialists, clinicians, and methodologists to refine framework dimensions. RESULTS AND CONCLUSIONS: Four key process evaluation frameworks and two U.K.-based critical care trials informed initial development. The 2025 update identified five additional U.K. trials, four of which applied POETIC, supporting its relevance and applicability. Expert consensus identified five core dimensions:• Context (Unit Culture, Organizational Structure, Resources, Usual Practice, Attitudes and Perceptions)• Fidelity (extent to which the intervention is delivered as intended)• Dose (amount of the intended intervention delivered and received)• Reach (extent to which the target population is exposed to, or engages with, the intervention)• Quality of Delivery (integrative measure of Fidelity, Dose, and Reach)The framework includes recommended methods such as checklists, interviews, routine trial data, and observations. It was iteratively refined to enhance usability and adaptability and has since been applied in multiple U.K.-based perioperative and critical care trials, demonstrating its utility in U.K. ICU settings. The POETIC framework supports structured evaluation of delivery quality and context in critical care trials, improving trial interpretation and advancing intervention design, delivery, and real-world applicability. Distinctively, POETIC operationalizes ICU-specific Context sub-constructs and provides a prespecified composite Quality of Delivery index to link intervention delivery to outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.031 | 0.628 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".