{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T08:23:36Z","timestamp":1787387016832,"version":"build-2736575974"},"reference-count":8,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100018063","name":"Bowel Research UK","doi-asserted-by":"publisher","award":["SG\u201024030"],"award-info":[{"award-number":["SG\u201024030"]}],"id":[{"id":"10.13039\/100018063","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Patients and health professionals face difficult decisions every day when choosing between standard\u2010of\u2010care treatments for the same disease. In bowel disease, some treatments are used interchangeably, but a lack of evidence may exist as to whether one is more effective than another. Randomised controlled trials provide robust evidence in these settings, but they are expensive, time\u2010consuming and disruptive to usual care. The introduction of electronic health records (EHR) has created unique opportunities to develop efficient trial designs, such as Decision Architecture Randomised Trials (DART). These implement unobtrusive and sometimes indiscernible EHR \u2018nudges\u2019, prompting clinicians towards one treatment or another. There is no obligation for clinicians to use the assigned intervention or for the patient to accept it. However, the association between the assignment and the actual treatment received can be used to estimate unbiased treatment effects. We discuss the key features of DART studies and outline the persisting uncertainties to operationalising this study design in clinical practice.<\/jats:p>","DOI":"10.1111\/codi.70589","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T05:00:13Z","timestamp":1786683613000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Addressing \u2018hard\u2010to\u2010fund\u2019 research questions in bowel research: Exploring the role of decision architecture randomised trials"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2413-5690","authenticated-orcid":false,"given":"Stephen J.","family":"Chapman","sequence":"first","affiliation":[{"name":"Leeds Institute of Medical Research University of Leeds  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3331-4420","authenticated-orcid":false,"given":"Carly","family":"Bisset","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Glasgow Royal Infirmary  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2247-4349","authenticated-orcid":false,"given":"Hayley","family":"Fowler","sequence":"additional","affiliation":[{"name":"Health Education England, North West  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Murray","sequence":"additional","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Banks","sequence":"additional","affiliation":[{"name":"MRC Unit, The Gambia London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judit","family":"Kovacs","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health Queen Mary University  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5582-7748","authenticated-orcid":false,"given":"Jim","family":"Tiernan","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Cornish","sequence":"additional","affiliation":[{"name":"Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9969-9760","authenticated-orcid":false,"given":"Susan","family":"Moug","sequence":"additional","affiliation":[{"name":"Department of General Surgery Golden Jubilee University National Hospital  Clydebank UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5817-8969","authenticated-orcid":false,"given":"Dale","family":"Vimalachandran","sequence":"additional","affiliation":[{"name":"Institute of Systems, Molecular and Integrative Biology University of Liverpool  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0259-969X","authenticated-orcid":false,"given":"James H.","family":"Flory","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Centre  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1525-6503","authenticated-orcid":false,"given":"Andrew","family":"Vickers","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Centre  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8530-5011","authenticated-orcid":false,"given":"Clare","family":"Relton","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health Queen Mary University  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"The Kings Fund.Tackling Variations in Clinical Care.2017. Available from:https:\/\/assets.kingsfund.org.uk\/f\/256914\/x\/2cdd9d686e\/tackling_variations_in_clinical_care_2017.pdf. Accessed 6th Dec 2025"},{"key":"e_1_2_13_3_1","unstructured":"National Bowel Cancer Audit.National Bowel Cancer Audit State of the Nation Report 2025: Summary of findings for the public and patients. Available from:https:\/\/www.natcan.org.uk\/wp\u2010content\/uploads\/2025\/10\/NBOCA\u2010State\u2010of\u2010the\u2010Nation\u2010Patient\u2010and\u2010Public\u2010Report\u20102025.pdf. Accessed 1st Dec 2025"},{"key":"e_1_2_13_4_1","unstructured":"Bowel Cancer UK.Bowel Cancer. Available from:https:\/\/www.bowelcanceruk.org.uk\/about\u2010bowel\u2010cancer\/bowel\u2010cancerAccessed 1st Dec 2025"},{"key":"e_1_2_13_5_1","unstructured":"Crohn's & Colitis UK.New research shows over 1 in 123 people in UK living with Crohn's or Colitis. Available from:https:\/\/crohnsandcolitis.org.uk\/news\u2010stories\/news\u2010items\/new\u2010research\u2010shows\u2010over\u20101\u2010in\u2010123\u2010people\u2010in\u2010uk\u2010living\u2010with\u2010crohn\u2010s\u2010or\u2010colitis. Accessed 13th June 2025."},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjebm-2023-112386"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2025.112428"},{"key":"e_1_2_13_8_1","unstructured":"Gabapentin And Breast Surgery Decision Architecture Randomization Trial (GABS\u2010DART) Protocol. Available from:https:\/\/clinicaltrials.gov\/study\/NCT07308717. Accessed 12th May 2026"},{"key":"e_1_2_13_9_1","unstructured":"NHS England.Digitising the frontline. Available from:https:\/\/www.england.nhs.uk\/digitaltechnology\/digitising\u2010the\u2010frontline\/. Accessed 13th June 2026"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.70589","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/codi.70589","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.70589","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T07:45:48Z","timestamp":1787384748000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.70589"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":8,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/codi.70589"],"URL":"https:\/\/doi.org\/10.1111\/codi.70589","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-05-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70589"}}