research in practice: how to survive and thrive

Research in practice: how to survive and thrive

Jenny Freeman, Plymouth University

Jenny Thain, Walton Centre

Freeman&Thain/MSTrust/2015

Session Plan

• Aimed at novice researchers

• Based around a real-life case scenario in which many lessons were learnt

• Key learning points at each stage

• Ask questions and raise issues along the way

• Sign-posts to practical resources

• Our aim – to prevent you making the same mistakes!


Jenny T’s research story: A well planned journey?

Or a series of unknown

barriers eventually

overcome?


The Beginning “I’d done research projects previously including an MPhil, but this was in a much more supported situation ie registered with University and was working in a research post therefore had time.” “Subsequent research projects were within my clinical practice and proved more challenging….”

How difficult could it be?

As a clinical specialist research was written into my job description and job plan……..


The journey starts…… • Trust’s RD & I committee keen on influencing

changing perceptions of AHP RD & I capability and on promoting a ‘World Class Service’”

• Non –medic research award – 1 page application

• 3 shortlisted

• 10 page application form…….


Writing the application

• Consultant Lead supportive

• Therapy Manager – staff costs

• Trust’s RD & I team support in writing application and design

• Literature search – Library services

• Critical analysis and concluding what evidence tells us

• Design – how to access a statistician – links to University

• Patient and Public Involvement

• Not funded /resourced for this time


Key Learning Points

• A good research idea is essential

• Be confident there is an evidence gap

• Clinical experience and enthusiasm needs to be

accompanied by support from a research team • If you don’t have appropriate skills “go and get it!”

• Don’t go it alone - seek advice early on

• Research requires money and time

• Grant funding is very competitive ……..so you need a good research question


Why are “good” research questions important?

“Well-crafted questions guide the systematic

planning of research. Formulating your

question precisely enables you to design a

study with a good chance of answering

them.”

Light, Singer, Willett, By Design (1990)


What are the characteristics of a

“good” research question?

• Feasible - it can be answered

• Interesting – to you and others

• Novel - it breaks new ground

• Ethical - no harm to subjects

• Relevant - the “So What” test (F-I-N-E-R)

Hulley, Newman & Cummings, 1988


Formulating an answerable research question

opulation or participants

ntervention

omparator or Control

utcome


PICO • What are your questions?

• Can you fit them into the PICO frame?

• Please discuss with your neighbour (5 min)…


Developing a grant is like climbing a mountain

Grant Submission

HS&DR RfPB

HTA

Charities

EME i4i

HS & DR PGAR

Grant application


From the outset you need to consider…

• The team (clinical and research)

• A convincing project plan

• Feasibility: supporting audit or pilot data

• Access to participants & agreement of other sites

• Involvement of other key organisations

• Clear management arrangements

• Properly costed


Collaborate with a range of people

• Research Design Service

• Clinical Research Network

• R&D departments of trust (e.g. research nurse manager)

• Universities

• Statisticians

• Clinical Trials Unit

• Finance Departments


Involve people with MS from the start

• The research topic

• The research question

• Study design

• Outcomes to measure

• Methods of recruitment

• Methods of retention

• Dissemination


MS Trust

– http://www.mstrust.org.uk/research/gettinginvolved

MS Society Research Network:

– http://www.mssociety.org.uk/research/research_network

INVOLVE

http://www.invo.org.uk

Involving people with MS


http://www.mstrust.org.uk/research/gettinginvolved



http://www.mssociety.org.uk/research/research_network



http://www.invo.org.uk/

Cost your project effectively

Find someone who knows what they are doing and who:

• understands the forms

• can help you to cost your project

• can help you to complete the forms

• start by listing all research activities

• don’t underestimate the time this will take

• start early by involving your finance departments


Make a clear project plan

• Identify key milestones

• Link with objectives

• Be realistic – things always take longer than you think

• Timetable / Gantt chart linked to milestones / objectives


Bright idea

Incorporate comments from team

Costs to finances

Draft revised for 10th time!

Public and patient

involvement

Circulate draft for meeting

Feedback

Submit to

funder

Develop a Timeline


Produce a Gantt Chart Development of a falls management intervention for people with multiple sclerosis: Building stakeholder consensus

Project Gannt Chart

Month -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12

Ethics Approval

Comprehensive Lit Review

Recruitment

Service User Training

Nominal Group (NG) Meetings

Feedback, Analysis and writing up

Dissemination

Milestones

Recruitment ends month 5

NG Meetings completed month 9

Project written up month 12

12 month funding period requested from the MS Society

and use it to check your progress throughout the project


Seek research advice early

Research Design Services Universities

http://www.ccf.nihr.ac.uk/Pages/RDSMap.aspx

Service covering England ; local access Universities are keen to collaborate


Useful Websites: Research Process

For information re: • developing research question • deciding on research design and methods • writing your research proposal • collecting the data • disseminating the findings http://www.rddirect.org.uk http://www.rdinfo.org.uk http://www.csp.org.uk


http://www.rddirect.org.uk/

http://www.rddirect.org.uk/

http://www.rdinfo.org.uk/flowchart/flowchart.html

http://www.rdinfo.org.uk/flowchart/flowchart.html

http://www.csp.org.uk/

Award successful: The next stage of the journey

• Ethics

• R & D approval

• Venues

• Staff / training / log / costs

• Availability of staff and Departments ie R & D and Neurophysiology

• Recruitment procedures

• Site File

• Storage of data


Useful Websites: Ethics application

NRES: http://www.nres.npsa.nhs.uk/applications/guidance Finding your local REC and R & D Organisation Detailed Guidance sheets Procedure Flowcharts IRAS: https://www.myresearchproject.org.uk Tutorials on application Detailed Guidance sheets www.swpctresearch.nhs.uk: Up-to-date information on latest changes involved with NHS ethics application process - click on the 'ethical information' link


http://www.nres.npsa.nhs.uk/applications/guidance

http://www.swpctresearch.nhs.uk/

http://www.swpctresearch.nhs.uk/

What am I doing???

• General feeling of loss of interest, even me.

• R & D link person left – felt “starting from scratch again”

• Updates required by Trust but…

“I was really embarrassed as little was going on!!

I couldn’t face them sometimes”


Key Learning Points

• Use the resources IRAS provides

• Talk to people

• Seek advice and help

• Be realistic re timeframe

• “Buy-in” from partners

• Leadership is essential

• And most importantly

…………………


Be prepared for the rollercoaster ride


The high’s…

……and lows Freeman&Thain/MSTrust/2015

Finally……doing the research!

• Slow to identify participants

• Recruitment procedure seemed complex for one control group

• Room availability change as R& D moved

• Changes of staff

• Declines

• DNA’s

• Time to chase up above…..


Key learning points

• Be realistic about the numbers of potential participants / centres

• If you involve other centres, there is a need for regular communication to ensure everyone is doing what is required!


Undertaking a “virtual investigation”

To help ensure the

research process

runs smoothly,

carry out the study in

your mind….undertake a

“virtual investigation”


Participant / Centre numbers

• How many patients of this group enter the Trust / are seen in your practice?

• How many of these fulfil the inclusion criteria?

• What is your predicted recruitment rate

(be pessimistic)?

• What is your predicted attrition?

• What are these estimates based on?


I’m almost there…… but what do I do with the data?

• All information collected

• Ensure it is recorded in right place from start

• Do ‘adding up’ as you go along

• Statistician

• SPSS

• What to do with the data?

• Then the write up!!


Key learning points

• Don’t put “your head in the sand”

• Decide how you analyse data from the outset

• Seek advice from statistician at the beginning

• Sample size calculations

• Cost in statistical support

• Allow enough time for analyses and write-up

…….and dissemination


Reflection

Positives

• Study now complete and written up (2 .5 years for a ‘pilot’)

• Results not what we expected but still able to suggest future study from what we did find

• Have been able to use this as an example ‘in-house’ whilst working on increasing AHP Research interest & activity in Trust as ‘live’ so validates


Reflection

Negatives

• Monkey on my back - has been a long haul

• Frustrating with slow recruitment

• Had to change protocol as other clinicians not fully supporting recruitment

• Participants agreeing to attend then DNA

• Difficulties re access to stats / SPSS – tenacity

• Need to disseminate results


Use guidance available to

report results


(Lots of) Guidance Available


“From idea to fundable proposal”

A nice simple linear process??


Moving forwards in the real world: START SIMPLE

Perhaps….. • Be involved as an assessor in someone else’s study • A Masters project is a great starter • Supported schemes can help (e.g. CATP) • Case reports / Single case studies / Routine Data

collection / Audit are manageable • Incorporate research with your own appraisal

process • Be a collaborator in another research project • Recognise your own strengths – a great idea ? A

good head for design? A data collector? A proof reader? A disseminator?


Training pathway with four levels of award (Masters, Doctoral, Clinical Lectureship (post-doc) and Senior Clinical Lectureship


Any questions?

Most importantly………….. don’t struggle on alone


research in practice: how to survive and thrive

Healthcare