Wednesday, 15 May 2013

Health Research with Real Impact conference

I've been at the Health Research with Real Impact conference today. With a wide ranging programme across the field of health research, I wasn't sure how much, as a mere philosopher, I would be able to understand. But the unifying theme of the morning, although called 'knowledge management', was more specific even than that. Roughly, why is it that potential innovations backed by good quality evidence are not easily adopted? Why are 45% of well researched innovations not taken up?

Here are two specific examples, both from cancer care. My colleague Kinta Beaver discussed resistance to the idea of using telephone follow-up consultations in place of hospital based face to face encounters despite both its popularity  with patients and with its clinical effectiveness. Thomas Hack, from the University of Manitoba, discussed the problem of first consultations for those diagnosed with cancer.  Typically, he reported, patients are anxious and as a result fail to take in or retain information put to them. The answer, which is hardly rocket science, is to record the consultation and give the patient a copy at the end. But the interesting thing was that despite good quality Cochrane review evidence for its effectiveness in a variety of degrees there was little initial uptake for it

Different speakers gave different examples of specific approaches to addressing the gap between good evidence and change of healthcare practices. For example, Janice Eng of British Columbia showed a website which ranked research papers relevant to spinal cord injury but also made available unpublished research (which interestingly increased subsequent journal publication rather than diminishing it).£But I was more interested in the reason for the inertia in the first place. Tom Hack reported that whilst all the clinicians he interviewed about recording consultations shared a view of its probable efficacy (there being much published evidence) they disagreed about the specifics of the perceived obstacles. It seems oddly coincidental that all agreed that there would be obstacles but they disagreed about the particular reasons. What, I want to ask, is the real reason? Is it simply a universal conservatism? Is there anything more interesting behind this?

I was also struck by an ironic reversal. At the start of the morning, a couple of speakers invoked the idea of 'mind-lines' to explain entrenched habits  of thought which might explain inertia in the face of change. This is not an idea I have heard expressed before in UCLan. But in questions later, this conceptual innovation was eagerly embraced by nearly everyone. No inertia there.£