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Lindsay CR, Shaw EC, Blackhall F, Blyth KG, Brenton JD, Chaturvedi A, Clarke N, Dick C, Evans TRJ, Hall G, Hanby AM, Harrison DJ, Johnston SRD, Mason MD, Morton D, Newton-Bishop J, Nicholson AG, Oien KA, Popat S, Rassl D, Sharpe R, Taniere P, Walker I, Wallace WA, West NP, Butler R, Gonzalez de Castro D, Griffiths M, Johnson PWM. Somatic cancer genetics in the UK: real-world data from phase I of the Cancer Research UK Stratified Medicine Programme. ESMO Open 2018; 3:e000408. [PMID: 30233821 PMCID: PMC6135448 DOI: 10.1136/esmoopen-2018-000408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Phase I of the Cancer Research UK Stratified Medicine Programme (SMP1) was designed to roll out molecular pathology testing nationwide at the point of cancer diagnosis, as well as facilitate an infrastructure where surplus cancer tissue could be used for research. It offered a non-trial setting to examine common UK cancer genetics in a real-world context. METHODS A total of 26 sites in England, Wales and Scotland, recruited samples from 7814 patients for genetic examination between 2011 and 2013. Tumour types involved were breast, colorectal, lung, prostate, ovarian cancer and malignant melanoma. Centralised molecular testing of surplus material from resections or biopsies of primary/metastatic tissue was performed, with samples examined for 3-5 genetic alterations deemed to be of key interest in site-specific cancers by the National Cancer Research Institute Clinical Study groups. RESULTS 10 754 patients (98% of those approached) consented to participate, from which 7814 tumour samples were genetically analysed. In total, 53% had at least one genetic aberration detected. From 1885 patients with lung cancer, KRAS mutation was noted to be highly prevalent in adenocarcinoma (37%). In breast cancer (1873 patients), there was a striking contrast in TP53 mutation incidence between patients with ductal cancer (27.3%) and lobular cancer (3.4%). Vast inter-tumour heterogeneity of colorectal cancer (1550 patients) was observed, including myriad double and triple combinations of genetic aberrations. Significant losses of important clinical information included smoking status in lung cancer and loss of distinction between low-grade and high-grade serous ovarian cancers. CONCLUSION Nationwide molecular pathology testing in a non-trial setting is feasible. The experience with SMP1 has been used to inform ongoing CRUK flagship programmes such as the CRUK National Lung MATRIX trial and TRACERx.
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Affiliation(s)
- Colin R Lindsay
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Manchester Experimental Cancer Medicine Centre, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
| | - Emily C Shaw
- Cancer Research UK, London, UK
- Southampton Experimental Cancer Medicine Centre, Southampton, UK
| | - Fiona Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Manchester Experimental Cancer Medicine Centre, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester, UK
| | - Kevin G Blyth
- Glasgow Experimental Cancer Medicine Centre, Glasgow, UK
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Institute ofInfection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - James D Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre and Cambridge Experimental Cancer Medicine Centre, Cambridge, UK
- Addenbrooke'sHospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Anshuman Chaturvedi
- Department of Histopathology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Noel Clarke
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Craig Dick
- Glasgow Experimental Cancer Medicine Centre, Glasgow, UK
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Thomas R J Evans
- Glasgow Experimental Cancer Medicine Centre, Glasgow, UK
- Cancer Research UK Beatson Institute, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Geoff Hall
- Leeds Experimental Cancer Medicine Centre, Leeds, UK
- St James's University Hospital, Cancer Research UK Clinical Cancer Centre, Leeds, UK
| | - Andrew M Hanby
- Leeds Experimental Cancer Medicine Centre, Leeds, UK
- Department of Cellular Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - David J Harrison
- School of Medicine, University of St Andrews, St Andrews, UK
- Edinburgh Experimental Cancer Medicine Centre, Edinburgh, UK
| | - Stephen R D Johnston
- Department of Medical Oncology, Royal Marsden Hospital, London, UK
- Institute of Cancer Research Experimental Cancer Medicine Centre, London, UK
| | - Malcolm D Mason
- Velindre Hospital, Cardiff University, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
- Cardiff Experimental Cancer Medicine Centre, Cardiff, UK
| | - Dion Morton
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
- Birmingham Experimental Cancer Medicine Centre, Birmingham, UK
| | - Julia Newton-Bishop
- Leeds Experimental Cancer Medicine Centre, Leeds, UK
- Section of Biostatistics and Epidemiology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Andrew G Nicholson
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Karin A Oien
- Glasgow Experimental Cancer Medicine Centre, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Sanjay Popat
- Institute of Cancer Research Experimental Cancer Medicine Centre, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Lung Unit, Royal Marsden Hospital, London, UK
| | - Doris Rassl
- Cancer Research UK Cambridge Centre and Cambridge Experimental Cancer Medicine Centre, Cambridge, UK
- Department of Histopathology, Papworth Hospital, Cambridge, UK
| | | | - Phillipe Taniere
- Birmingham Experimental Cancer Medicine Centre, Birmingham, UK
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - William A Wallace
- Edinburgh Experimental Cancer Medicine Centre, Edinburgh, UK
- Department of Pathology, Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicholas P West
- Leeds Experimental Cancer Medicine Centre, Leeds, UK
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - David Gonzalez de Castro
- Genomic Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Mike Griffiths
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Peter W M Johnson
- Cancer Research UK, London, UK
- Southampton Experimental Cancer Medicine Centre, Southampton, UK
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A population-level investigation of cancer clinical trials participation in a UK region. Eur J Cancer Prev 2018; 26 Joining forces for better cancer registration in Europe:S229-S235. [PMID: 28542078 DOI: 10.1097/cej.0000000000000373] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to document cancer trial participation since establishment of the Northern Ireland Cancer Trials Network and investigate population and disease factors associated with trial participation. An independent cohort of over 51 000 cancer patients from the Northern Ireland Cancer Registry covering the same population (2007-2012) was linked to a database of 1316 interventional cancer trial participants in a UK region. The primary outcome measure was participation in an intervention clinical trial. Patients were followed up until 31 March 2013. Kaplan-Meier tests and Cox proportional hazard models using person days at risk to allow for death were used to investigate factors associated with trial participation. Multivariate analysis assessed the impact of age, cancer type and stage, distance from the cancer centre (radiotherapy), marital status, deprivation quintile and rurality. Participation was analysed separately for children (<15 years) and young individuals (15-24 years). Trial recruitment increased three-fold with establishment of a network. Participation was the highest for children at 21%, but relatively low at 2.05% for adults, although higher for haematological malignancies (4.5%). Lower likelihood of trial participation in adults was associated with female sex, older age, distance from regional Cancer Centre and stage 1 disease. The introduction of a regional Cancer Trials Network was associated with increased participation; however, trial participation remains relatively low at the population level especially among elderly patients. Linkage of clinical trials and cancer registry database provide an easy mechanism to monitor trial representativeness at the population level.
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Downing A, Morris EJA, Corrigan N, Sebag-Montefiore D, Finan PJ, Thomas JD, Chapman M, Hamilton R, Campbell H, Cameron D, Kaplan R, Parmar M, Stephens R, Seymour M, Gregory W, Selby P. High hospital research participation and improved colorectal cancer survival outcomes: a population-based study. Gut 2017; 66:89-96. [PMID: 27797935 PMCID: PMC5256392 DOI: 10.1136/gutjnl-2015-311308] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 08/18/2016] [Accepted: 08/25/2016] [Indexed: 12/08/2022]
Abstract
OBJECTIVE In 2001, the National Institute for Health Research Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all patients with CRC managed in those research-intensive hospitals. DESIGN Data for patients diagnosed with CRC in England in 2001-2008 (n=209 968) were linked with data on accrual to NCRN CRC studies (n=30 998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day postoperative mortality and 5-year survival and the level and duration of study participation. RESULTS Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer 'centres of excellence', although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower postoperative mortality (p<0.001) and improved survival (p<0.001) after adjustment for casemix and hospital-level variables. The effects increased with sustained research participation, with a reduction in postoperative mortality of 1.5% (6.5%-5%, p<2.2×10-6) and an improvement in survival (p<10-19; 5-year difference: 3.8% (41.0%-44.8%)) comparing high participation for ≥4 years with 0 years. CONCLUSIONS There is a strong independent association between survival and participation in interventional clinical studies for all patients with CRC treated in the hospital study participants. Improvement precedes and increases with the level and years of sustained participation.
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Affiliation(s)
- Amy Downing
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK
- Cancer Research UK Centre, University of Leeds, St James's University Hospital, Leeds, UK
| | - Eva JA Morris
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK
- Cancer Research UK Centre, University of Leeds, St James's University Hospital, Leeds, UK
- MRC Bioinformatics Centre, Leeds, UK
| | - Neil Corrigan
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David Sebag-Montefiore
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK
- Cancer Research UK Centre, University of Leeds, St James's University Hospital, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul J Finan
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- National Cancer Intelligence Network, London, UK
| | | | | | | | - Helen Campbell
- Department of Health, Research and Development, London, UK
- Clinical Research Facilities, and Cancer Research, University of Exeter Medical School, Exeter, UK
| | - David Cameron
- NIHR Cancer Research Network, Leeds, UK
- Edinburgh Cancer Research Centre, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Richard Kaplan
- NIHR Cancer Research Network, Leeds, UK
- MRC Clinical Trials Unit at University College London, London, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit at University College London, London, UK
| | - Richard Stephens
- NCRI Consumer Liaison Group, NIHR Cancer Research Network, Leeds, UK
| | - Matt Seymour
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK
- Cancer Research UK Centre, University of Leeds, St James's University Hospital, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- NIHR Cancer Research Network, Leeds, UK
| | - Walter Gregory
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Peter Selby
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK
- Cancer Research UK Centre, University of Leeds, St James's University Hospital, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Shaw RJ, Holsinger FC, Paleri V, Evans M, Tudur-Smith C, Ferris RL. Surgical trials in head and neck oncology: Renaissance and revolution? Head Neck 2015; 37:927-30. [DOI: 10.1002/hed.23846] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Richard J. Shaw
- Department of Molecular and Clinical Cancer Medicine; The University of Liverpool Cancer Research Centre; Liverpool United Kingdom
| | - F. Christopher Holsinger
- Department of Otolaryngology / Head and Neck Surgery; Stanford University School of Medicine; Stanford California
| | - Vinidh Paleri
- Department of Head and Neck and Thyroid Surgery; Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne United Kingdom
| | - Mererid Evans
- Department of Clinical Oncology; Velindre Cancer Centre; Whitchurch Cardiff United Kingdom
| | - Catrin Tudur-Smith
- Department of Biostatistics; Institute of Translational Medicine; University of Liverpool; Liverpool United Kingdom
| | - Robert L. Ferris
- Department of Clinical Operations Chief; Division of Head and Neck Surgery Departments of Otolaryngology; Radiation Oncology; and Immunology; Cancer Immunology Program University of Pittsburgh Cancer Institute, Eye and Ear Institute; Pittsburgh Pennsylvania
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Adams M, Caffrey L, McKevitt C. Barriers and opportunities for enhancing patient recruitment and retention in clinical research: findings from an interview study in an NHS academic health science centre. Health Res Policy Syst 2015; 13:8. [PMID: 25971302 PMCID: PMC4429658 DOI: 10.1186/1478-4505-13-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 12/07/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In the UK, the recruitment of patients into clinical research is a national health research and development policy priority. There has been limited investigation of how national level factors operate as barriers or facilitators to recruitment work, particularly from the perspective of staff undertaking patient recruitment work. The aim of this study is to identify and examine staff views of the key organisational barriers and facilitators to patient recruitment work in one clinical research group located in an NHS Academic Health Science Centre. METHODS A qualitative study utilizing in-depth, one-to-one semi-structured interviews with 11 purposively selected staff with particular responsibilities to recruit and retain patients as clinical research subjects. Thematic analysis classified interview data by recurring themes, concepts, and emergent categories for the purposes of establishing explanatory accounts. RESULTS The findings highlight four key factors that staff perceived to be most significant for the successful recruitment and retention of patients in research and identify how staff located these factors within patients, studies, the research centre, the trust, and beyond the trust. Firstly, competition for research participants at an organisational and national level was perceived to undermine recruitment success. Secondly, the tension between clinical and clinical research workloads was seen to interrupt patient recruitment into studies, despite national funding arrangements to manage excess treatment costs. Thirdly, staff perceived an imbalance between personal patient burden and benefit. Ethical committee regulation, designed to protect patients, was perceived by some staff to detract from clarification and systematisation of incentivisation strategies. Finally, the structure and relationships within clinical research teams, in particular the low tacit status of recruitment skills, was seen as influential. CONCLUSIONS The results of this case-study, conducted in an exemplary NHS academic research centre, highlight current systematic challenges to patient recruitment and retention in clinical studies more generally as seen from the perspective of staff at the 'sharp end' of recruiting. Staff experience is that, beyond individual clinical research design and protocol factors, wider organisational and extra-organisational norms, structures, and processes operate as significant facilitators or hindrances in the recruitment of patients as research subjects.
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Affiliation(s)
- Mary Adams
- King's College London, Division of Health and Social Care Research, and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Faculty of Life Sciences and Medicine, Capital House, 42 Weston Street, London, SE1 3QD, UK.
| | - Louise Caffrey
- King's College London, Division of Health and Social Care Research, and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Faculty of Life Sciences and Medicine, Capital House, 42 Weston Street, London, SE1 3QD, UK.
| | - Christopher McKevitt
- King's College London, Division of Health and Social Care Research, and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Faculty of Life Sciences and Medicine, Capital House, 42 Weston Street, London, SE1 3QD, UK.
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Wright P, Fenlon D, Jones H, Foster C, Ashley L, Seymour KC, Velikova G, Okamoto I, Brown J. Using the Clinical Research Network for psychosocial cancer research: lessons learned from two observational studies. BMJ Support Palliat Care 2014; 4:202-211. [PMID: 24644175 DOI: 10.1136/bmjspcare-2012-000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 06/11/2013] [Accepted: 07/24/2013] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patient recruitment to psychosocial oncology research has increased but the many studies have been single-site or small-scale. The National Institute for Health Research Clinical Research Network, supports National Institute for Health Research portfolio studies through provision of research staff for recruitment and follow-up. These studies are usually clinical trials of an investigational medicinal product. Psychosocial researchers have little used this resource. PROCESS We report the processes followed and experiences of two psychosocial research teams who recently used the Clinical Research Network, to undertake patient recruitment to two prospective observational studies: electronic Patient-reported Outcomes from Cancer Survivors study (ePOCS) and the ColoREctal Wellbeing study (CREW). Both research groups employed different approaches to using Clinical Research Network support. OUTCOMES ePOCS secured Comprehensive Local Research Networks funding to appoint ePOCS-specific study research nurses. CREW obtained research support through the National Institute for Health Research Cancer Research Network. Recruitment targets were met (ePOCS n=636; CREW n=1055) despite logistical, administrative and bureaucratic challenges in setting up the studies. Research nurses feedback was mainly positive (ePOCS study only). Top tips for establishing and running psychosocial studies with Clinical Research Network staff are provided and suggestions given for advancing multicentre complex psychosocial studies. CONCLUSIONS Some challenges were similar to those in delivery of clinical trials of an investigational medicinal product. The pros and cons of being involved in ePOCS from the research nurse perspective are also described. Overall the approaches used were successful with both studies reaching their recruitment targets.
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Affiliation(s)
- Penny Wright
- Psychosocial Oncology and Clinical Practice Research Group, Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, West Yorkshire, UK
| | - Deborah Fenlon
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Helen Jones
- Psychosocial Oncology and Clinical Practice Research Group, Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, West Yorkshire, UK
| | - Claire Foster
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Laura Ashley
- School of Social, Psychological & Communication Sciences, Faculty of Health and Social Sciences, Leeds Metropolitan University, Leeds, UK
| | - Kim Chivers Seymour
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Galina Velikova
- Psychosocial Oncology and Clinical Practice Research Group, Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, West Yorkshire, UK
| | - Ikumi Okamoto
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, 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] [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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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] [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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9
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Darbyshire J, Sitzia J, Cameron D, Ford G, Littlewood S, Kaplan R, Johnston D, Matthews D, Holloway J, Chaturvedi N, Morgan C, Riley A, Rossor M, Kotting P, McKeith I, Smye S, Gower J, Brown V, Smyth R, Poustie V, van't Hoff W, Wallace P, Ellis T, Wykes T, Burns S, Rosenberg W, Lester N, Stead M, Potts V, Johns C, Campbell H, Hamilton R, Sheffield J, Selby P. Extending the clinical research network approach to all of healthcare. Ann Oncol 2012; 22 Suppl 7:vii36-vii43. [PMID: 22039143 DOI: 10.1093/annonc/mdr424] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The development of Clinical Research Networks (CRN) has been central to the work conducted by Health Departments and research funders to promote and support clinical research within the NHS in the UK. In England, the National Institute for Health Research has supported the delivery of clinical research within the NHS primarily through CRN. CRN provide the essential infrastructure within the NHS for the set up and delivery of clinical research within a high-quality peer-reviewed portfolio of studies. The success of the National Cancer Research Network is summarized in Chapter 5. In this chapter progress in five other topics, and more recently in primary care and comprehensively across the NHS, is summarized. In each of the 'topic-specific' networks (Dementias and Neurodegenerative Diseases, Diabetes, Medicines for Children, Mental Health, Stroke) there has been a rapid and substantial increase in portfolios and in the recruitment of patients into studies in these portfolios. The processes and the key success factors are described. The CRN have worked to support research supported by pharmaceutical, biotechnology and medical device companies and there has been substantial progress in improving the speed, cost and delivery of these 'industry' studies. In particular, work to support the increased speed of set up and delivery of industry studies, and to embed this firmly in the NHS, was explored in the North West of England in an Exemplar Programme which showed substantial reductions in study set-up times and improved recruitment into studies and showed how healthcare (NHS) organizations can overcome delays in set up times when they actively manage the process. Seven out of 20 international studies reported that the first patient to be entered anywhere in the world was from the UK. In addition, the CRN have supported research management and governance, workforce development and clinical trials unit collaboration and coordination. International peer reviews of all of the CRN have been positive and resulted in the continuation of the system for a further 5 years in all cases.
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10
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Pater J, Rochon J, Parmar M, Selby P. Future research and methodological approaches. Ann Oncol 2012; 22 Suppl 7:vii57-vii61. [PMID: 22039148 DOI: 10.1093/annonc/mdr428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This supplement has explored the evidence for benefits from the participation of healthcare institutions and their patients in clinical research. The questions have been clarified. There is some encouragement that research active healthcare institutions may deliver improved outcomes compared to less research-active or research-inactive institutions but there is a pressing need for further research. In this chapter we explore the methodological challenges to evaluating the impact of the process of clinical research on hospitals and other healthcare organizations. The postulated mechanisms by which benefits may be accrued are important drivers of the types of research needed and these are emphasized. Study designs are explored including formal randomized trials, the stepped wedge randomized design, approaches to the design and analysis of observational studies particularly to examine whether a temporal or spatial relationship exists between changes in research activity and patients' outcomes. It is acknowledged that in most future studies the data available will be cross-sectional and observational, and such studies are susceptible to many types of bias. The importance of identifying and addressing such biases in multivariate analysis is discussed and examples of successful studies are given.
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Affiliation(s)
- J Pater
- Queen's University, Kingston, Canada
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