Reflections from @becsta94

Last month saw the culmination of the PenCLAHRC prioritisation process – known to those involved as ‘the stakeholder meeting’. The meeting was held in the beautiful surroundings of Dartington Hall.

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Twenty-seven representatives from the PenCLAHRC stakeholder organisations got together in the Great Hall to discuss ten of the top ranked uncertainties that had been gathered from the region over the preceding six months. The evidence synthesis team manages the prioritisation process, with the whole team involved at different stages.

Using prioritisation to determine which research is undertaken is a cornerstone of PenCLAHRC (Whear et al, 2015). It’s a process that resonates well with the increasing recognition of the need to reduce research waste across the world. In 2009, Iain Chalmers and Paul Glasziou, suggested that up to 85% of research is being wasted.  Waste occurs because research is poorly designed or conducted, unable to answer its intended question, is looking at an issue that we already know the answer to, or is not published or reported well. Ben Goldacre in his ‘closing plenary’ at the Cochrane UK and Ireland 21st Anniversary Symposium also referred to the issue of waste, and stated that if he was in charge, he would cancel all primary research for a year….’we need to get better at synthesising and disseminating the evidence we already have’ he said!  In 2014, the Lancet published a series of five articles on research waste. The series brings to the fore issues around making research more relevant to users, improving research design and analysis, research regulation, making research information more accessible and the importance of unbiased and usable research reports.  Cochrane also recently published key findings from their survey on approaches to minimising research waste advocating for systematic reviews and supporting priority setting processes.

So, sitting round the table at the stakeholder meeting, was a timely reminder of how we at PenCLAHRC are making our own contribution to reducing research waste. We tick many of the boxes that Iain Chalmers and colleagues recommend in their ‘how to increase value and reduce waste when research priorities are set’. We involve local users of research, both lay people and clinicians, from the very start by asking for their research or clinical practice uncertainties.  Those involved in the ranking of the uncertainties are asked to base their decisions on the relevance of the topic (research) to the region, the perceived clinical importance and whether the uncertainty is feasible and cost-effective to investigate. We search for the evidence that is already out there, but unlike these detective canines, we don’t then bury it again!

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with the kind permission of Mike Gruhn

We systematically check for what has already been done and what is in the process of being researched and synthesise these in one page summaries and 4-6 page rapid evidence briefs that are used to inform different stages of the prioritisation process.  We seek comments from the representatives of the stakeholder organisations, including representatives of patients and the public, on the uncertainties as they pass through the process. This iterative step helps ensure that the uncertainties are considered alongside research user-led concerns of relevance, importance, and perhaps practicality.

Fifty-eight uncertainties entered the process in September. After two stages of ranking (a progressive  sieving of those seen as more important) the top ranked ten were discussed at the stakeholder meeting. Rich discussions from everyone around the table teased out whether the topics were of concern to the populations of Cornwall, Devon and Somerset and whether there was expertise in the region for the issue being addressed. ‘Not that old cabbage’  was the response from one expert clinician who informed the group that one uncertainty under consideration was indeed a known issue, but the research needed to answer the intricacies of dosing timing and adjuvant treatment  would be large scale and well beyond resources available.

cabbage

Our evidence briefs helped inform the discussion. The votes were then cast. Three uncertainties stood out from the rest, and the two that received the most votes are now being scoped by PenCLAHRC for their feasibility as research projects.

The stakeholder meeting is always a rewarding day. Within our academic evidence synthesis world, we read, write and talk evidence, but to hear the clinicians and administrators place the evidence in a real world context is an eye-opener, and can often be a wake-up call. Hearing about the pragmatic and practical issues faced in every day healthcare reminds us that there is another virtual evidence base of which we have no ‘peer-reviewed’ evidence. Are we doing our best at minimising research waste? It’s hard to know, but I think we are at least giving it a go…

For a quick and easy summary of the PenCLAHRC Prioritisation Model take a look at our short video.

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