BACKGROUND: Growing numbers of randomized controlled trials (RCTs) are showing the effectiveness of interventions to improve medication adherence in transplantation recipients. However, real-world implementation is still a major challenge. This systematic review assesses the range of information available in RCTs supporting these interventions' clinical adoption in adult transplant populations. METHODS: We included RCTs of interventions that a) targeted any phase of medication adherence in solid organ or allogeneic stem cell transplantation recipients and b) were published between January 2015 and November 2020. We excluded study protocols, conference abstracts and studies focusing only on pediatric populations. We identified relevant database and trial registries as well as traced references backward and citations forward. Implementation-relevant information was evaluated using adapted versions of Peters' ten criteria: 1. healthcare/organizational context; 2. social/economic/policy context; 3. patient involvement; 4. other stakeholder involvement; 5. sample representativeness; 6. trial conducted in a real-world-setting; 7. presence of feasibility study; 8. implementation strategy; 9. process evaluation; 10. implementation outcomes, using a stoplight color-rating system. RESULTS: Screening 17'004 titles/abstracts resulted in 23 eligible RCTs, including 2'339 patients (n = 19-209/study). All included studies focused on the implementation phase of medication adherence. The best-reported criteria were feasibility study (43%), representative sample (17%) and conducted in a real-world-setting (17%). Least reported were context (9%), implementation strategies (4%), process evaluation (4%). CONCLUSIONS: RCTs testing medication adherence interventions tend to report limited implementation-relevant information. This hinders their translation to real-world transplant settings. Integrating implementation science principles early in the conceptualization of RCTs would fuel real-world-translation, reducing research waste.

Department of Population Health Science Duke University 215 Morris St Durham NC 27701 USA; Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Health Care System 508 Fulton St Durham NC 27705 USA

Department of Social and Clinical Pharmacy Faculty of Pharmacy in Hradec Kralove Charles University Akademika Heyrovskeho 1203 500 05 Hradec Kralove Czech Republic

Department of Theragnostic Hematology University Hospital of Basel Petersgraben 4 4031 Basel Switzerland; Department of Hematology Cantonal Hospital of Aarau Tellstrasse 25 5001 Aarau Switzerland

Institute of Nursing Science Department of Public Health University of Basel Bernoullistrasse 28 4056 Basel Switzerland; Academic Center for Nursing and Midwifery Department of Public Health and Primary Care KU Leuven Kapucijnenvoer 35 blok d box 7001 3000 Leuven Belgium

Institute of Nursing Science Department of Public Health University of Basel Bernoullistrasse 28 4056 Basel Switzerland; Department of Theragnostic Hematology University Hospital of Basel Petersgraben 4 4031 Basel Switzerland

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