It is the reality that many more people are interested in clinical research than participate in clinical research. This is not surprising, given the conflicting demands which healthcare professionals perceive in their everyday working life. Yet there are many advantages in integrating some aspects and disciplines of clinical research into everyday clinical activity, not least the translation of the disciplines of clinical research into opportunities to improve the care of patients.
There is a view that clinical research should only be done by those with a full-time or largely full-time commitment to that field, also that there is no time to develop clinical research expertise. And yet we do not approach many other aspects of our lives with the same thoughts. Many, if not most of us will participate in a sporting, intellectual or other pursuit, with no intention of attempting to progress to an elite level or of doing that activity full time. Nonetheless, we feel that such participation brings us new skills, amongst which might be the ability to focus when required and manage distractions when they appear, both skills which are useful in our working lives.
The same can be said about participation in clinical research. Reading is part and parcel of how we develop expertise as our careers progress. Perhaps the simplest or most basic level of participation in clinical research is to focus reading on what research projects are being carried out locally or regionally or on a topic which might, not infrequently, have developed from a clinical conundrum or hard-to manage case. At worst, this allows clinicians to knowledgeably discuss “the latest” in the area with patients, and engage in discussion with experts in the field. This can help improve the recruitment of your patients into clinical research while keeping up with their progress clinically. Additionally the knowledge gained can be helpful in advising less experienced members of your team, some of whom may grasp the carrot and develop into early career researchers.
Some might rebut this argument by saying that this is not really clinical research. Yet even large projects commence with a detailed examination of relevant literature. Indeed, examining the literature may well answer some questions, but will almost certainly generate more. Such generation is the key to developing hypotheses which can be tested. On the other hand, there is limited amount to be gained by diving into a research project without appropriate literature review, since it is often the case that the research question has been developed and addressed in some form already, the realisation of which in the middle of someone’s research endeavours leads to disillusionment. The knowledge gained from literature review and the integration of discussion with clinical academics provides a good model for self-evaluation of how one is delivering clinical care to patients.
Beyond this most basic level, the question of balancing time spent in clinical research and in other aspects of a healthcare professional’s job come more to the fore. Yes, it can be nice to think that you have “your own project,” but inevitably you are going to have to involve other people if you want that project to be completed successfully. But the level of participation in clinical research need not begin and end with the view that only by having your own project can you be seen as doing “real” clinical research. Even those doing a PhD will be working with many interfaces with other people involved in research.
You do have to decide at what level you wish to participate.
For example, even in large multicentre, intensive clinical trials, there can be scope to be involved in identifying patients from your caseload, discussing an outline of projects which are being done locally, regionally or nationally, and referring people based on the type of assessments that one is already doing in clinical practice, or mentioning research before during or after the disclosure of diagnosis so that patients are prepared for the opportunity of being involved in some form of clinical study. If one has time and enthusiasm to be involved as a blind rater in clinical trials, this can be done as a discreet commitment involving a fixed amount of time, but the discipline involved in detailed interviewing can bring increased benefits into interviews in a clinical setting.
If I can give an example from my own career, I was in clinical practice at the time cholinesterase inhibitors were introduced. Enthusiasm for their prescription had to be balanced against concerns about their efficacy in a typical clinical population. Reading the literature suggested the possibility that high levels of homocysteine might be disadvantageous to the outcome of people with Alzheimer’s disease. These levels could be reduced by folic acid, a common compound which is well tolerated by the general population. Setting up a double-blind trial of the effect of adding folic acid or placebo to the prescribed cholinesterase inhibitor involved inviting (willing) colleagues to participate, including agreement that biochemical measurements could be undertaken in return for agreement about authorship and did involve some extra work on blood collection, transportation, and so on. However, the patients were being seen anyway, the drugs were prescribed according to the protocol in use at that time, follow up of the those prescribed the drugs was done at intervals which fitted nicely with further blood sampling, and no assessments were done other than those which were being done as part of normal clinical practice in our area. So by choosing a population who were going to be treated anyway and integrating a compound into their care which might improve outcome, there was a reasonable balance between clinical care and clinical research.
Questioning what is done with your own patients can very much be a way forward. Yes, there are many balances to be made with commitments to management, teaching, training, audit, and so on, but clinical research is no less important and like all those other topics, it is not necessary to do them full time to feel that you are participating, nor is clinical research any less important than these other areas.
It has been said that the first person to have their disease arrested or to recover from it will have been part of clinical research.
Would it not be a good feeling if you felt part of that person’s stability or improvement?
Dr Peter Connelly
Author
Dr Peter Connelly [1] is a retired Old Age Psychiatrist who spent much of his career in Tayside, helping to establish clinical trials for dementia and neuroprogressive disorders in Scotland. Now working with the Scottish Neuroprogressive and Dementia Network, he combines professional insight with personal experience as a former carer. In retirement, he enjoys music, golf, and time with his grandchildren.