The CARE pilot trial has already had an impact on patients and professionals in the clinical neuroscience community, by showing that a wide-ranging collaboration can be formed across the UK and potentially Ireland, also including patient advocacy organisations and qualitative researchers. We obtained engagement from a large number and proportion of the neurosurgical sites in the UK, which engaged with the QRI, which was itself embedded in clinical consultations, where interventions about barriers and facilitators could be implemented.
In the longer term, the result of the CARE pilot RCT seems likely to reinforce reasons for uncertainty about symptomatic brain cavernoma management with intervention. In time, the RCT will be incorporated into updated clinical guidelines.14–16 The pilot RCT justifies the conduct of a definitive RCT, informs its feasibility and provides suggestions for how multidisciplinary decision-making, conventions of usual care, willingness to offer intervention and the design of participant materials may increase the recruitment rate. The financial and logistical feasibility of a definitive RCT will be determined by clinical communities’ reactions to the result, equipoise, willingness of sites to engage with a definitive RCT across the world, willingness of clinical researchers to apply for funding to support the RCT in their own country and funding agencies’ decisions.