Better Knowledge. Better Health?
Making Research Relevant,
Accessible, and Prioritized to
Patient Needs.
Marie Ennis-O’Connor
@JBBC
INTRO
#CochraneAdvocate
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Equipped
Enabled
Empowered
Engaged
Shared Decision Making (SDM) is the
conversation that happens between a
patient and their health professional
to reach a healthcare choice together.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
• Clinicians have an ethical imperative to
share important decisions with patients.
• Patients should have access to accurate,
evidence-based information about
treatment options and the uncertainties,
benefits and harms of treatment.
More than a third of
people living with a
long-term condition
said they were not
given helpful
information
about their
condition
when first
diagnosed.
Patient Information Forum
“Central to the vision of patient centred care, is
the principle of providing a wide range of
appropriate, accessible and timely information
enabling people to make informed decisions”
NHS England, Liberating the NHS: No decision about me, without
me, December 2012
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
.
Patients can now gain access to citations of more than 12
million medical articles online.
online
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Filtering the information overload for better
decisions
"Where is the knowledge we have lost in
information?“ TS Eliot "The Rock
In an age of digitized health
information we still need context and
expertise to interpret the research.
Role of systematic review in making
research relevant, accessible, and
prioritized to patient needs.
25,000 biomedical journals in print.
8,000 articles published per day.
All studies not equally well designed or interpreted.
We Need A Study of Studies
• To summarize evidence from studies that
address a specific clinical question;
• To explain differences among studies on the
same question ;
• To determine implications for healthcare
policy and practice;
• To limit bias.
The usefulness to any source of
information is equal to its relevance,
multiplied by its validity, divided by
the work required to extract the
information.
Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master:
feeling good about not knowing everything. J Fam Pract 1994;38:505-513.
Relevant
Valid
Accessible
Prioritized to patient
values and needs
Effective, reliable, actionable
Timely, accessible,
understandable
Relevance
“To be relevant we must select questions
that need answering, and plan our reviews
to make sure the right information is
gathered and presented to answer those
questions”.
Cochrane Training
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
How do you know which question is
actually relevant and useful to patient
values and practice contexts?
Ask The Patient!
“When it comes to managing a health condition, how do
we know what matters most unless we ask those living
with it? Knowing what matters most is vital for good
stewardship of our finite resources to fund research,
ensuring that work goes into seeking answers to questions
that patients most want answered.”
Sarah Chapman, Evidently Cochrane
The patient perspective is paramount.
Don’t just include at peer review stage.
Include patient voice from the outset
and throughout the review process.
“If a patient/consumer group don't review your
proposal you might miss that one important outcome
measure. Many researchers are fascinated by P-values
and statistical significance. In clinical research, the
Patient is the only P we should be evaluating. “
Pete Carr, Cochrane Reviewer
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
“If patient engagement were a drug, it would be
the blockbuster drug of the century and
malpractice not to use it” ~ Leonard Kish
The Consumer's Role in
The Cochrane Collaboration
• Co-applicant on research grant applications
• Provides perspective by commenting on the "Plain Language
Summary" of the review
• Commenting on a Cochrane review of the best evidence on a
healthcare intervention, prior to publication
• Commenting on protocols to ensure that outcomes relevant to
consumers are included
• Preparing review summaries in plain language
• Searching journals
• Translation of reviews
• Co-authoring systematic reviews of best evidence
Acknowledge appropriately in the published review
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
The James Lind Alliance brings
patients, carers, and clinicians
together to prioritise research
questions.
Relevant
Valid
Accessible
Prioritized to patient
values and needs
Effective, reliable, actionable
Timely, accessible,
understandable
“To him who devotes his life
to science, nothing can give
more happiness than
increasing the number of
discoveries, but his cup of
joy is full when the results
of his studies immediately
find practical applications.”
—Louis Pasteur
2. Validity
Who is likely to use intervention?
What are their unique needs?
How they are likely to use it?
What resources, and infrastructure
exist to support intervention?
Summarise the existing evidence
Address uncertainty
Present findings in a way that
informs SDM
Knowledge Translation
Dissemination
Highlight gaps in the evidence
To help people
understand and
support decision
making
“The success of my research outcomes depends on the
success of the patient outcome. They are the key cog in
the evidence wheel. At least one of the research
proposals primary outcomes should directly impact on
patient care. “
Pete Carr, Cochrane Reviewer
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Relevant
Valid
Accessible
Prioritized to patient
values and needs
Effective, reliable, actionable
Timely, accessible,
understandable
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
“Simple can be harder than complex.
You have to work hard to get your
thinking clean to make it simple. But
it’s worth it in the end, because once
you get there, you can move
mountains”
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Timeliness
The Lancet 2009 374, 86-89DOI: (10.1016/S0140-6736(09)60329-9)
Copyright © 2009 Elsevier Ltd
As much as 85% of research
investment wasted
“Research results should be easily accessible to people who need
to make decisions about their own health…Why was I forced to
make my decision knowing that information was somewhere but
not available? Was the delay because the results were less
exciting than expected? Or because in the evolving field of
myeloma research there are now new exciting hypotheses (or
drugs) to look at? How far can we tolerate the butterfly
behaviour of researchers, moving on to the next flower well
before the previous one has been fully exploited?”
Alessandro Liberati, BMJ 2004
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Dissemination
Disseminating
Research
Active Model
Views people as active change agents
rather than passive recipients of
information.
Spreading research through social
networks
Passive Model
Providing access to information, but
relying on potential users to find the
information themselves.
The Health Foundation: Spreading Improvement Ideas accessed at www.health.org.uk
Articles
Conferences
Involving leaders
Collaboratives
Social Media
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
• Twitter forms communities
of interest
• May help you clarify your
ideas
• Easy to use
• Know your Twitter Ps & Qs!
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
• A tweet chat is a
live Twitter event.
• To filter all the chatter
on Twitter into a single
conversation a hashtag is
used.
• A set time is also established
so that the moderator, guest
or host is available to engage
in the conversation.
• Transcript of tweets available
after the chat.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Malcolm Gladwell
The Law of the Few
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Facebook can reach targeted groups
But issue of trust and credibility
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Multiple exposure to the same message can
increase the likelihood that information is shared.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Create content
Track across
multiple platforms
Engage
Measure results
Repeat
Social Media
Iterative
Process
A Challenge For You
“The patient has
been lost in
industrial scale
production of
guidelines.”
Neil Maskrey
Image: www.delta7.com
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and Prioritized to Patient Needs.

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Better Knowledge. Better Health? Making Research Relevant, Accessible, and Prioritized to Patient Needs.

  • 1. Better Knowledge. Better Health? Making Research Relevant, Accessible, and Prioritized to Patient Needs. Marie Ennis-O’Connor @JBBC
  • 7. Shared Decision Making (SDM) is the conversation that happens between a patient and their health professional to reach a healthcare choice together.
  • 9. • Clinicians have an ethical imperative to share important decisions with patients. • Patients should have access to accurate, evidence-based information about treatment options and the uncertainties, benefits and harms of treatment.
  • 10. More than a third of people living with a long-term condition said they were not given helpful information about their condition when first diagnosed. Patient Information Forum
  • 11. “Central to the vision of patient centred care, is the principle of providing a wide range of appropriate, accessible and timely information enabling people to make informed decisions” NHS England, Liberating the NHS: No decision about me, without me, December 2012
  • 14. . Patients can now gain access to citations of more than 12 million medical articles online. online
  • 19. Filtering the information overload for better decisions "Where is the knowledge we have lost in information?“ TS Eliot "The Rock
  • 20. In an age of digitized health information we still need context and expertise to interpret the research.
  • 21. Role of systematic review in making research relevant, accessible, and prioritized to patient needs.
  • 22. 25,000 biomedical journals in print. 8,000 articles published per day. All studies not equally well designed or interpreted.
  • 23. We Need A Study of Studies • To summarize evidence from studies that address a specific clinical question; • To explain differences among studies on the same question ; • To determine implications for healthcare policy and practice; • To limit bias.
  • 24. The usefulness to any source of information is equal to its relevance, multiplied by its validity, divided by the work required to extract the information. Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master: feeling good about not knowing everything. J Fam Pract 1994;38:505-513.
  • 25. Relevant Valid Accessible Prioritized to patient values and needs Effective, reliable, actionable Timely, accessible, understandable
  • 26. Relevance “To be relevant we must select questions that need answering, and plan our reviews to make sure the right information is gathered and presented to answer those questions”. Cochrane Training
  • 28. How do you know which question is actually relevant and useful to patient values and practice contexts?
  • 30. “When it comes to managing a health condition, how do we know what matters most unless we ask those living with it? Knowing what matters most is vital for good stewardship of our finite resources to fund research, ensuring that work goes into seeking answers to questions that patients most want answered.” Sarah Chapman, Evidently Cochrane
  • 31. The patient perspective is paramount. Don’t just include at peer review stage. Include patient voice from the outset and throughout the review process.
  • 32. “If a patient/consumer group don't review your proposal you might miss that one important outcome measure. Many researchers are fascinated by P-values and statistical significance. In clinical research, the Patient is the only P we should be evaluating. “ Pete Carr, Cochrane Reviewer
  • 35. “If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it” ~ Leonard Kish
  • 36. The Consumer's Role in The Cochrane Collaboration • Co-applicant on research grant applications • Provides perspective by commenting on the "Plain Language Summary" of the review • Commenting on a Cochrane review of the best evidence on a healthcare intervention, prior to publication • Commenting on protocols to ensure that outcomes relevant to consumers are included • Preparing review summaries in plain language • Searching journals • Translation of reviews • Co-authoring systematic reviews of best evidence Acknowledge appropriately in the published review
  • 38. The James Lind Alliance brings patients, carers, and clinicians together to prioritise research questions.
  • 39. Relevant Valid Accessible Prioritized to patient values and needs Effective, reliable, actionable Timely, accessible, understandable
  • 40. “To him who devotes his life to science, nothing can give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of his studies immediately find practical applications.” —Louis Pasteur 2. Validity
  • 41. Who is likely to use intervention? What are their unique needs? How they are likely to use it? What resources, and infrastructure exist to support intervention? Summarise the existing evidence Address uncertainty Present findings in a way that informs SDM Knowledge Translation Dissemination Highlight gaps in the evidence To help people understand and support decision making
  • 42. “The success of my research outcomes depends on the success of the patient outcome. They are the key cog in the evidence wheel. At least one of the research proposals primary outcomes should directly impact on patient care. “ Pete Carr, Cochrane Reviewer
  • 45. Relevant Valid Accessible Prioritized to patient values and needs Effective, reliable, actionable Timely, accessible, understandable
  • 47. “Simple can be harder than complex. You have to work hard to get your thinking clean to make it simple. But it’s worth it in the end, because once you get there, you can move mountains”
  • 52. The Lancet 2009 374, 86-89DOI: (10.1016/S0140-6736(09)60329-9) Copyright © 2009 Elsevier Ltd As much as 85% of research investment wasted
  • 53. “Research results should be easily accessible to people who need to make decisions about their own health…Why was I forced to make my decision knowing that information was somewhere but not available? Was the delay because the results were less exciting than expected? Or because in the evolving field of myeloma research there are now new exciting hypotheses (or drugs) to look at? How far can we tolerate the butterfly behaviour of researchers, moving on to the next flower well before the previous one has been fully exploited?” Alessandro Liberati, BMJ 2004
  • 56. Disseminating Research Active Model Views people as active change agents rather than passive recipients of information. Spreading research through social networks Passive Model Providing access to information, but relying on potential users to find the information themselves.
  • 57. The Health Foundation: Spreading Improvement Ideas accessed at www.health.org.uk Articles Conferences Involving leaders Collaboratives Social Media
  • 63. • Twitter forms communities of interest • May help you clarify your ideas • Easy to use • Know your Twitter Ps & Qs!
  • 66. • A tweet chat is a live Twitter event. • To filter all the chatter on Twitter into a single conversation a hashtag is used. • A set time is also established so that the moderator, guest or host is available to engage in the conversation. • Transcript of tweets available after the chat.
  • 73. Facebook can reach targeted groups But issue of trust and credibility
  • 76. Multiple exposure to the same message can increase the likelihood that information is shared.
  • 78. Create content Track across multiple platforms Engage Measure results Repeat Social Media Iterative Process
  • 80. “The patient has been lost in industrial scale production of guidelines.” Neil Maskrey