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Hanrahan V, Biesty L, Lawrie L, Duncan E, Gillies K. Theory-guided interviews identified behavioral barriers and enablers to healthcare professionals recruiting participants to maternity trials. J Clin Epidemiol 2022; 145:81-91. [PMID: 35081447 DOI: 10.1016/j.jclinepi.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/24/2021] [Accepted: 01/18/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To conduct a behavioral investigation, using the Theoretical Domains Framework (TDF), to identify barriers and enablers to maternity healthcare professionals (HCP) inviting all eligible women to participate in a maternity care trial. STUDY DESIGN AND SETTING We invited HCP recruiters from maternity care trials in high priority research areas including, diabetes, preeclampsia and breastfeeding, from across Ireland and the UK, to take part in a semi-structured interview. Data collection was informed by the TDF, followed by inductive thematic analysis and deductive mapping to the TDF. RESULTS Twenty-two recruiters including midwives, nurses, allied health professionals and doctors were interviewed online or by telephone phone. Thematic analysis generated four global themes; Availability and accessibility of resources, Navigating the recruitment pathway, Prioritising clinical responsibilities over research responsibilities and The influence of colleagues and peers. Themes were mapped to the TDF, identifying 13 domains relevant to the behaviour. CONCLUSION This paper identifies the factors enabling or inhibiting maternity HCP recruiters to invite all eligible women to participate in a maternity care trial. The findings provide guidance for researchers designing trials for this population and the essential first step in developing a recruiter-focused behaviour change intervention to support recruitment to trials in maternity care.
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Affiliation(s)
- Vivienne Hanrahan
- School of Nursing and Midwifery, National University of Ireland, Galway, Áras Moyola, Upper Newcastle, Galway, Ireland; Health Research Board - Trial Methodology Research Network, Áras Moyola, NUI Galway, University Road, Galway, Ireland.
| | - Linda Biesty
- School of Nursing and Midwifery, National University of Ireland, Galway, Áras Moyola, Upper Newcastle, Galway, Ireland
| | - Louisa Lawrie
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen, UK
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2
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Nemeh F, Buchbinder R, Hawley CM, Nelson MR, Waterkeyn JG, Reid CM. Activities supporting the growth of Clinical Trial Networks in Australia. Trials 2022; 23:81. [PMID: 35090533 PMCID: PMC8795956 DOI: 10.1186/s13063-021-05974-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/21/2021] [Indexed: 01/20/2023] Open
Abstract
Clinical Trial Networks in which trialists work collaboratively enable multi-site, large-scale, high-quality clinical trials to be efficiently run. Although the benefits of Clinical Trial Networks are largely known, establishing a Clinical Trial Network can be complex. There are many factors for clinicians and researchers to consider, and there is currently a paucity of information on how to form a Clinical Trial Network. This article provides a suggested roadmap on how to establish a Clinical Trial Network. The Australian Clinical Trials Alliance (ACTA) is the peak body for Clinical Trial Networks, Coordinating Centres and Registries in Australia, and has produced several resources to support the effective and efficient running of clinical trials. This guide has come about through discussions with members of the ACTA Clinical Trial Network Sector Expansion Reference Group consisting of clinical trialists, clinicians, researchers, and consumers.
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Affiliation(s)
- Fiona Nemeh
- Australian Clinical Trials Alliance, Melbourne, Victoria, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Mark R Nelson
- Australian Clinical Trials Alliance, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Christopher M Reid
- Australian Clinical Trials Alliance, Melbourne, Victoria, Australia. .,School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia. .,School of Public Health, Curtin University, Bentley, Western Australia, Australia.
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Attar SG, Poustie VJ, Smye SW, Beety JM, Hawcutt DB, Littlewood S, Oni L, Pirmohamed M, Beresford MW. Working together to deliver stratified medicine research effectively. Br Med Bull 2019; 129:107-116. [PMID: 30753334 DOI: 10.1093/bmb/ldz003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION OR BACKGROUND Stratified medicine is an important area of research across all clinical specialties, with far reaching impact in many spheres. Despite recently formulated global policy and research programmes, major challenges for delivering stratified medicine studies persist. Across the globe, clinical research infrastructures have been setup to facilitate high quality clinical research. SOURCES OF DATA This article reviews the literature and summarizes views collated from a workshop held by the UK Pharmacogenetics and Stratified Medicine Network and the NIHR Clinical Research Network in November 2016. AREAS OF AGREEMENT Stratified medicine is an important area of clinical research and health policy, benefitting from substantial international, cross-sector investment and has the potential to transform patient care. However there are significant challenges to the delivery of stratified medicine studies. AREAS OF CONTROVERSY Complex methodology and lack of consistency of definition and agreement on key approaches to the design, regulation and delivery of research contribute to these challenges and would benefit from greater focus. GROWING POINTS Effective partnership and development of consistent approaches to the key factors relating to stratified medicine research is required to help overcome these challenges. AREAS TIMELY FOR DEVELOPING RESEARCH This paper examines the critical contribution clinical research networks can make to the delivery of national (and international) initiatives in the field of stratified medicine. Importantly, it examines the position of clinical research in stratified medicine at a time when pressures on the clinical and social services are mounting.
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Affiliation(s)
- S G Attar
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - V J Poustie
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,NIHR Clinical Research Network (CRN) Coordinating Centre, 21 Queen's Street, Leeds, UK
| | - S W Smye
- NIHR Clinical Research Network (CRN) Coordinating Centre, 21 Queen's Street, Leeds, UK
| | - J M Beety
- NIHR Clinical Research Network (CRN) Coordinating Centre, 21 Queen's Street, Leeds, UK
| | - D B Hawcutt
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - S Littlewood
- NIHR Clinical Research Network (CRN) Coordinating Centre, 21 Queen's Street, Leeds, UK
| | - L Oni
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M Pirmohamed
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M W Beresford
- Departments of Women's and Children's Health, and Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,NIHR Clinical Research Network (CRN) Coordinating Centre, 21 Queen's Street, Leeds, UK
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Berge E, Salman RAS, van der Worp HB, Stapf C, Sandercock P, Sprigg N, Macleod MR, Kelly PJ, Nederkoorn PJ, Ford GA, Arnold M, Berge E, Diez-Tejedor E, Jatuzis D, Kelly PJ, Krieger DW, Nederkoorn PJ, Sandercock P, Stapf C, Weimar C, Ford GA, Salman RAS. Increasing value and reducing waste in stroke research. Lancet Neurol 2017; 16:399-408. [DOI: 10.1016/s1474-4422(17)30078-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/06/2017] [Accepted: 03/07/2017] [Indexed: 12/21/2022]
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Preston NJ, Farquhar MC, Walshe CE, Stevinson C, Ewing G, Calman LA, Burden S, Brown Wilson C, Hopkinson JB, Todd C. Strategies designed to help healthcare professionals to recruit participants to research studies. Cochrane Database Syst Rev 2016; 2:MR000036. [PMID: 35658160 PMCID: PMC8190980 DOI: 10.1002/14651858.mr000036.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Identifying and approaching eligible participants for recruitment to research studies usually relies on healthcare professionals. This process is sometimes hampered by deliberate or inadvertent gatekeeping that can introduce bias into patient selection. OBJECTIVES Our primary objective was to identify and assess the effect of strategies designed to help healthcare professionals to recruit participants to research studies. SEARCH METHODS We performed searches on 5 January 2015 in the following electronic databases: Cochrane Methodology Register, CENTRAL, MEDLINE, EMBASE, CINAHL, British Nursing Index, PsycINFO, ASSIA and Web of Science (SSCI, SCI-EXPANDED) from 1985 onwards. We checked the reference lists of all included studies and relevant review articles and did citation tracking through Web of Science for all included studies. SELECTION CRITERIA We selected all studies that evaluated a strategy to identify and recruit participants for research via healthcare professionals and provided pre-post comparison data on recruitment rates. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results for potential eligibility, read full papers, applied the selection criteria and extracted data. We calculated risk ratios for each study to indicate the effect of each strategy. MAIN RESULTS Eleven studies met our eligibility criteria and all were at medium or high risk of bias. Only five studies gave the total number of participants (totalling 7372 participants). Three studies used a randomised design, with the others using pre-post comparisons. Several different strategies were investigated. Four studies examined the impact of additional visits or information for the study site, with no increases in recruitment demonstrated. Increased recruitment rates were reported in two studies that used a dedicated clinical recruiter, and five studies that introduced an automated alert system for identifying eligible participants. The studies were embedded into trials evaluating care in oncology mainly but also in emergency departments, diabetes and lower back pain. AUTHORS' CONCLUSIONS There is no strong evidence for any single strategy to help healthcare professionals to recruit participants in research studies. Additional visits or information did not appear to increase recruitment by healthcare professionals. The most promising strategies appear to be those with a dedicated resource (e.g. a clinical recruiter or automated alert system) for identifying suitable participants that reduced the demand on healthcare professionals, but these were assessed in studies at high risk of bias.
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Affiliation(s)
- Nancy J Preston
- Lancaster UniversityInternational Observatory on End of Life CareFurness CollegeLancasterUKLA1 4YG
| | - Morag C Farquhar
- University of CambridgePublic Health & Primary CareInstitute of Public HealthForvie Site, Robinson WayCambridgeCambridgeshireUKCB2 0SR
| | - Catherine E Walshe
- Faculty of Health and Medicine, Lancaster UniversityInternational Observatory on End of Life CareBailriggLancasterLancashireUKLA1 4YG
| | - Clare Stevinson
- Loughborough UniversitySchool of Sport, Exercise and Health SciencesLoughboroughLeicesterUKLE11 3TU
| | - Gail Ewing
- University of CambridgeCentre for Family ResearchFree School LaneCambridgeCambridgeshireUKCB2 3RF
| | - Lynn A Calman
- University of SouthamptonMacmillan Survivorship Research GroupHeath Sciences Building 67Highfield Campus, University RoadSouthamptonUKSO17 1BJ
| | - Sorrel Burden
- University of ManchesterSchool of Nursing, Midwifery and Social WorkRoom 6.32, Jean McFarlane Building, Oxford RoadManchesterUKM13 9PL
| | - Christine Brown Wilson
- The University of QueenslandSchool of Nursing, Midwifery and Social WorkChamberlain BuildingSt. LuciaBrisbane St LuciaAustralia4067
| | - Jane B Hopkinson
- Cardiff UniversitySchool of Healthcare Sciences, College of Bio‐medical and Life SciencesEastgate House35‐43 Newport RoadCardiffWalesUKCF24 0AB
| | - Chris Todd
- University of ManchesterSchool of Nursing, Midwifery and Social WorkRoom 6.32, Jean McFarlane Building, Oxford RoadManchesterUKM13 9PL
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Abstract
BACKGROUND Study feasibility and deliverability can benefit from involving patients and carers in the research process, known as patient and public involvement (PPI). There is less evidence on the experiences of patients and carers themselves and we require more information across a range of studies, health conditions and research stages. AIMS This study explored how patients and carers in eight diagnostic research specialties have been involved in research, their motivations and the impact involvement had on them. METHOD 143 patients and carers across the Clinical Research Network (CRN) responded to an online semi-structured questionnaire (developed using participatory methodology). Quantitative and qualitative data were analysed. RESULTS A range of benefits were reported, including providing a life focus and an improved relationship with illness. Less positive experiences regarding time and money and lack of acknowledgement were also reported, along with suggestions for improvement. CONCLUSIONS PPI confers many benefits on patients and carers which could increase PPI recruitment if made explicit. More involvement in study recruitment and dissemination would increase the effectiveness of PPI input. Involving a more varied socioeconomic demographic and at an earlier stage is vital. Financial support for lower earners and greater feedback following involvement should also be explored.
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Affiliation(s)
- Joanne Ashcroft
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK
| | - Til Wykes
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK
| | - Joseph Taylor
- b Department of Psychological Medicine , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK , and
| | - Adam Crowther
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK
| | - George Szmukler
- c King's College London, Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience , London , UK
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7
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Abstract
OBJECTIVE There is a widely held assumption that engagement by clinicians and healthcare organisations in research improves healthcare performance at various levels, but little direct empirical evidence has previously been collated. The objective of this study was to address the question: Does research engagement (by clinicians and organisations) improve healthcare performance? METHODS An hourglass-shaped review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves healthcare performance; and (3) a wider (but less systematic) review of papers identified during the two earlier stages, focusing on mechanisms. RESULTS Of the 33 papers included in the focused review, 28 identified improvements in health services performance. Seven out of these papers reported some improvement in health outcomes, with others reporting improved processes of care. The wider review demonstrated that mechanisms such as collaborative and action research can encourage some progress along the pathway from research engagement towards improved healthcare performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved healthcare performance. CONCLUSIONS Current evidence suggests that there is an association between the engagement of individuals and healthcare organisations in research and improvements in healthcare performance. The mechanisms through which research engagement might improve healthcare performance overlap and rarely act in isolation, and their effectiveness often depends on the context in which they operate.
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Affiliation(s)
- Annette Boaz
- Faculty of Health, Social Care and Education, St George's, University of London and Kingston University, Grosvenor Wing, Cranmer Terrace, London, UK
| | - Stephen Hanney
- Health Economics Research Group, Brunel University London, London, UK
| | - Teresa Jones
- Health Economics Research Group, Brunel University London, London, UK
| | - Bryony Soper
- Health Economics Research Group, Brunel University London, London, UK
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8
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Abstract
As event rates fall, if mortality and disability are to improve further there is increasing need for large, well-designed trials. These should enroll more patients, more rapidly and at lower cost, with better representation of infants at highest risk and greater integration with routine care. This may require simpler datasets, linkage with routinely collected data, and international collaboration. It may be helpful to draw attention to recent evidence that participation in Phase III randomized controlled trials (RCTs) is at least as safe as receiving established care. Nationally coordinated clinical research networks employing local research staff may be the single most effective strategy to integrate clinical trials into routine practice. Other goals are: international standardization of outcomes; consensus on composite endpoints, biomarkers, surrogates and measures of disability; greater efficiency through randomized factorial designs and cluster or cross-over cluster RCTs; and equipping parents as partners in all aspects of the conduct of RCTs and in implementing their results.
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Affiliation(s)
- William Tarnow-Mordi
- WINNER Centre for Newborn Research, NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
| | - Melinda Cruz
- Miracle Babies Foundation, Chipping Norton, Sydney, NSW 2170, Australia
| | - Jonathan Morris
- Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, Sydney, NSW 2065, Australia
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McFadden E, Bashir S, Canham S, Darbyshire J, Davidson P, Day S, Emery S, Pater J, Rudkin S, Stead M, Brown J. The impact of registration of clinical trials units: the UK experience. Clin Trials 2014; 12:166-73. [PMID: 25475881 DOI: 10.1177/1740774514561242] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Over the last decade, the United Kingdom has invested significant resources in its clinical trial infrastructure. Clinical research networks have been formed, and some general oversight functions for clinical research have been centralised. One of the initiatives is a registration programme for Clinical Trials Units involved in the coordination of clinical trials. An international review panel of experts in clinical trials has been convened for three reviews over time, reviewing applications from Clinical Trials Units in the United Kingdom. The process benefited from earlier work by the National Cancer Research Institute that developed accreditation procedures for trials units involved in cancer trials. This article describes the experience with the three reviews of UK Clinical Trials Units which submitted applications. PURPOSE This article describes the evolution and impact of this registration process from the perspective of the current international review panel members, some of whom have served on all reviews, including two done by the National Cancer Research Institute. PROCESS Applications for registration were invited from all active, non-commercial Clinical Trials Units in the United Kingdom. The invitations were issued in 2007, 2009 and 2012, and applicants were asked to describe their expertise and staffing levels in specific areas. To ensure that the reviews were as objective as possible, a description of expected core competencies was developed and applicants were asked to document their compliance with meeting these. The review panel assessed each Clinical Trials Unit against the competencies. The Clinical Trials Unit registration process has evolved over time with each successive review benefiting from what was learned in earlier ones. RESULTS The review panel has seen positive changes over time, including an increase in the number of units applying, a greater awareness on the part of host institutions about the trials activity within their organisations, more widespread development of Standard Operating Procedures in key areas and improvements in information technology systems used to host clinical trials databases. Key funders are awarding funds only to registered units, and host institutions are implementing procedures and structures to ensure improved communication between all parties involved in trials within their organisation. CONCLUSION The registration process developed in the United Kingdom has helped to ensure that trials units in the United Kingdom are compliant with regulatory standards and can meet acceptable standards of quality in their conduct of clinical trials. There is an increased awareness among funders, host institutions and Clinical Trials Units themselves of the required competencies, and communication between all those involved in trials has increased. The registration process is an effective and financially viable way of ensuring that objective standards are met at a national level.
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Affiliation(s)
| | - Saeeda Bashir
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | | | - Peter Davidson
- NIHR Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Southampton, UK
| | - Simon Day
- Clinical Trials Consulting & Training Limited, Buckinghamshire, UK
| | - Sean Emery
- Kirby Institute, University of New South Wales Australia, Sydney, NSW, Australia
| | | | | | | | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
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McCowan C, Ford I. Commentary on Vickers. Clin Trials 2014; 11:624-5. [PMID: 25389226 DOI: 10.1177/1740774514553483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Colin McCowan
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Hanney S, Boaz A, Jones T, Soper B. Engagement in research: an innovative three-stage review of the benefits for health-care performance. Health Services and Delivery Research 2013. [DOI: 10.3310/hsdr01080] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThere is a widely held assumption that research engagement improves health-care performance at various levels, but little direct empirical evidence.ObjectivesTo conduct a theoretically and empirically grounded synthesis to map and explore plausible mechanisms through which research engagement might improve health services performance. A review of the effects on patients of their health-care practitioner's or institution's participation in clinical trials was published after submission of the proposal for this review. It identified only 13 relevant papers and, overall, suggested that the evidence that research engagement improves health-care performance was less strong than some thought. We aimed to meet the need for a wider review.MethodsAn hourglass review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves health care; and (3) a wider (but less systematic) review of papers identified during the two earlier stages. Studies were included inthe focused review if the concept of ‘engagementinresearch’ was an input and some measure of ‘performance’ an output. The search strategy covered the period 1990 to March 2012. MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and other relevant databases were searched. A total of 10,239 papers were identified through the database searches, and 159 from other sources. A further relevance and quality check on 473 papers was undertaken, and identified 33 papers for inclusion in the review. A standard meta-analysis was not possible on the heterogeneous mix of papers in the focused review. Therefore an explanatory matrix was developed to help characterise the circumstances in which research engagement might improve health-care performance and the mechanisms that might be at work, identifying two main dimensions along which to categorise the studies:the degree of intentionalityandthe scope of the impact.ResultsOf the 33 papers in the focused review, 28 were positive (of which six were positive/mixed) in relation to the question of whether or not research engagement improves health-care performance. Five papers were negative (of which two were negative/mixed). Seven out of 28 positive papers reported some improvement in health outcomes. For the rest, the improved care took the form of improved processes of care. Nine positive papers were at a clinician level and 19 at an institutional level. The wider review demonstrated, for example, how collaborative and action research can encourage some progress along the pathway from research engagement towards improved health-care performance. There is also evidence that organisations in which the research function is fully integrated into the organisational structure out-perform other organisations that pay less formal heed to research and its outputs. The focused and wider reviews identified the diversity in the mechanisms through which research engagement might improve health care: there are many circumstances and mechanisms at work, more than one mechanism is often operative, and the evidence available for each one is limited.LimitationsTo address the complexities of this evidence synthesis of research we needed to spend significant time mapping the literature, and narrowed the research question to make it feasible. We excluded many potentially relevant papers (though we partially addressed this by conducting a wider additional synthesis). Studies assessing the impact made on clinician behaviour by small, locally conducted pieces of research could be difficult to interpret without full knowledge of the context.ConclusionsDrawing on the focused and wider reviews, it is suggested that when clinicians and health-care organisations engage in research there is the likelihood of a positive impact on health-care performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved health-care performance. Further explorations are required of research networks and schemes to promote the engagement of clinicians and managers in research. Detailed observational research focusing on research engagement within organisations would build up an understanding of mechanisms.Study registrationPROSPERO: CRD42012001990.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- S Hanney
- Health Economics Research Group, Brunel University, Uxbridge, UK
| | - A Boaz
- Faculty of Health, Social Care and Education, St George's, University of London and Kingston University, London, UK
| | - T Jones
- Health Economics Research Group, Brunel University, Uxbridge, UK
| | - B Soper
- Health Economics Research Group, Brunel University, Uxbridge, UK
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12
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Affiliation(s)
- Walter N Kernan
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
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13
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Gilleard O, Dheansa B. New developments for the delivery of burns care research in the UK. Burns 2013; 39:195-9. [DOI: 10.1016/j.burns.2012.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 08/06/2012] [Indexed: 11/16/2022]
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Affiliation(s)
- William Tarnow-Mordi
- WINNER Centre for Newborn Research; University of Sydney; Camperdown New South Wales Australia
| | - John Simes
- NHMRC Clinical Trials Centre; University of Sydney; Camperdown New South Wales Australia
| | - Melinda Cruz
- Chief Executive Officer, Miracle Babies Foundation; Chipping Norton New South Wales Australia
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Selby P, Kaplan R, Cameron D, Cooper M, Seymour M. The Royal College of Physicians Simms Lecture, 6 December 2011: clinical research networks and the benefits of intensive healthcare systems. Clin Med (Lond) 2012; 12:446-52. [PMID: 23101146 PMCID: PMC4953768 DOI: 10.7861/clinmedicine.12-5-446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Clinical research contributes to the evidence base for the planning of improved healthcare services and creates an excellent environment for the delivery of healthcare and the recruitment and retention of excellent and well-motivated staff. In this paper, we consider the evidence that a research-intensive healthcare system might yield improved outcomes as a result of the impact of the process of research on the provision of care. We review progress in establishing clinical research networks for cancer and the evidence of the impact of the conduct of clinical cancer research in the National Health Service.
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Callaghan P, David A, Lewis S, Marshall M, Szmukler G, Wykes T, Ashcroft J, Burns S. Developing support for mental health clinical research: the Mental Health Research Network experience. ACTA ACUST UNITED AC 2012; 2:459-63. [DOI: 10.4155/cli.12.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cameron D, Stead M, Lester N, Parmar M, Haward R, Maughan T, Wilson R, Spaull A, Campbell H, Hamilton R, Stewart D, O'Toole L, Kerr D, Potts V, Moser R, Cooper M, Poole K, Darbyshire J, Kaplan R, Seymour M, Selby P. Research-intensive cancer care in the NHS in the UK. Ann Oncol 2012; 22 Suppl 7:vii29-vii35. [PMID: 22039142 DOI: 10.1093/annonc/mdr423] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the late 1990 s, in response to poor national cancer survival figures, government monies were invested to enhance recruitment to clinical cancer research. Commencing with England in 2001 and then rolling out across all four countries, a network of clinical cancer research infrastructure was created, the new staff being linked to existing clinical care structures including multi-disciplinary teams. In parallel, a UK-wide co-ordination of cancer research funders driven by the 'virtual' National Cancer Research Institute, combined to create a 'whole-system approach' linking research funders, researchers and NHS clinicians all working to the same ends. Over the next 10 years, recruitment to clinical trials and other well-designed studies, increased 4-fold, reaching 17% of the incident cancer population, the highest national rate world-wide. The additional resources led to more studies opened, and more patients recruited across the country, for all types of cancers and irrespective of additional clinical research staff in some hospitals. In 2006, a co-ordinated decision was made to increasingly focus on randomized trials, leading to increased recruitment, without any fall-off in accrual to non-randomized and observational studies. The National Cancer Research Network has supported large successful trials which are changing clinical practice in many cancers.
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Affiliation(s)
- D Cameron
- National Cancer Research Network, Leeds, UK
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