TCRN Conference Grants series: Dr Maarit Laaksonen, Adult Cancer Program, UNSW

TCRN Member; Maarit Laaksonen; Conference Grant recipient TCRN Member; Maarit Laaksonen; Conference Grant recipient

Obstacles in translating research into practice: why don’t we do what we know works?

Translational research has recently become a focus for many research environments and funding agencies, and accordingly a topical theme for public health congresses. ‘Translational research and knowledge transfer’ was among the main themes of the 2012 Population Health Congress held in Adelaide in September, which I attended with the support of a TCRN Conference Grant. This congress is held every four years as a joint initiative of the four leading population health organisations in Australasia. Having worked now for 12 months in the Australian population health research environment following my previous experience in Finland, the Congress seemed an optimal opportunity to gain a broad overview of the population health research being undertaken in the region.

The process of translating research into practice seems, in principle, clear and simple: we do research to test new hypotheses or to confirm novel findings; once there is enough high-quality, evidence-based information we use it to make decisions and draft guidelines for the implementation of individualised patient care; implementation ideally results in the improvement of real-world patient outcomes. However there are many research areas, including cancer, where evidence is constantly being gathered and not all answers are clear. However as Professor Adrian Bauman, Director of the Prevention Research Collaboration, stated during the Congress: ‘the challenge in many areas is not that we don’t know what works, but rather that we don’t do what we know works’.

There are many potential obstacles in the transfer and practice of evidence-based medicine. Sub-optimal communication, and thus knowledge transfer, between researchers, decision makers and clinicians is one likely barrier. A simple example was given at the Congress by Prof Alan Shiell, Executive Director of the Centre of Excellence in Intervention and Prevention Science, Victoria. Prof Shiell described a research study demonstrating that when people were encouraged, e.g. by a simple sign, to regularly take stairs instead of the escalator or lift, this leads to improved fitness and health benefits when implemented as part of a daily routine. The same study has been repeated several times in a research context, well beyond the necessary replication to confirm any finding. However, in terms of real-life implementation, nothing has been done to promote change.

Professor Shiell suggested that a researcher’s emphasis on producing publications rather than seeing their results communicated and put in practice may be one potential reason for the lack of real-world evidence transfer. Researchers do commonly communicate their results, but too often in scientific seminars and congresses for peers rather than for policy makers and practitioners. Although many funding agencies now emphasize the importance of translational research, this is often not reflected within application criteria, which continue to focus on the quality and quantity of an applicant’s publications rather than their prior successes in adapting and communicating their research findings for policy makers, clinicians and the general public.

An additional obstacle in the translation of research in a health setting may arise from clinicians’ understanding of the research process. When a data-based research finding suggests that a modified or new treatment practice holds benefits for patient care, it should be replicated in a clinical setting to confirm its validity and generalisability prior to being permanently instituted. The validation process requires not only a well-designed study comparing outcomes with and without the intervention, but also the understanding and collaboration of a health service and its clinicians in implementing the intervention during its testing phase. While understandably there is a push to expedite broad implementation of interventions that may improve patient outcomes, carrying out a carefully designed, targeted evaluation of the intervention first will ensure that the new practice does result in the predicted patient benefits, that appropriate modifications can be made prior to widespread implementation, and that resources are not wasted in the process.

We must also remember that translational research is not one-directional. Much can be learned through clinical evidence gathered in everyday practice. New hypotheses may emerge, be formulated and further tested through more research. Only then can the knowledge transfer be considered truly translational.

But even when there is good intention for knowledge exchange, obstacles may arise, for example due to researchers’ lack of understanding of a clinician’s reality. A good example came the other day from my mother, a nurse working in elderly care. The Finnish National Institute for Health and Welfare, a previous workplace of mine with an increasing interest in translational research, had designed a new program for nurses to document relevant information from their daily tasks in order for the Institute to learn and study details of current clinical nursing practices. The intention was good, however there had been no prior communication with the nurses to explain the purpose of the program, gather their feedback or prepare them for the tasks that the program required of them. While my mother and other nurses already struggled to manage their workload in a physically demanding job, they were also expected to learn labour-intensive programs using unfamiliar technology and maintain ongoing documentation of their daily work, without change to their regular work load. The likely result of such a poorly planned, designed and communicated intervention is resistance and lack of motivation.

The involvement of researchers in translating their findings into practice is certainly important, and the understanding and cooperation of clinicians is necessary. However the greatest challenge in knowledge transfer in health research comes in achieving clear dialogue between researchers, stakeholders, clinicians and policy makers. By doing so, we can create awareness and understanding of novel findings, agreement and acceptance of the necessary infrastructure and practices required to implement change, and enable final well-informed decisions to be made that will ultimately lead to improved patient care and clinical outcomes.

Dr Maarit Laaksonen was recipient of a TCRN National Conference Grant for attendance at the 2012 Population Health Congress, held in Adelaide in September 2012, where she presented her research on A new method and program for calculation of Population Attributable Fraction in a cohort study design and Total costs of prescription medicines and medical services in patients undergoing chemotherapy in NSW hospitals.

Maarit is a biostatistician and epidemiologist with the Lowy Cancer Research Centre’s Adult Cancer Program, UNSW. After 7 years with the National Institute for Health and Welfare, Finland, Maarit took up a postdoctoral Fellowship and Lecturer position with UNSW in 2011 and lends her expertise to Australian public health research. She has extensive research experience with the analysis and interpretation of population health sets for the purposes of shaping and implementing evidence-based health care policy.

Maarit was recently awarded a 2013 NHMRC Early Career Fellowship. Her current research focus incorporates:

  • Interrelation of genetic and lifestyle factors in the development and treatment of cancer, and their significance at a population level.
  • Clarifying the importance of patient-and-treatment-related factors in cancer treatment and redressing the potential misconceptions prevailing in clinical practice.
  • Making realistic estimations of disease prevalence and the health care resources needed to address disease in future, and providing recommendations for resources optimization.
  • Understanding the cumulative disease burden and connection between different diseases, both physical and mental, as a step forward from a single disease state focus.