BULLETIN

Recommendations

Info

Page 14 | Bulletin 93 | September 2015 niaa@rcoa.ac.uk www.niaa.org.uk Anaesthesia and perioperative care research priorities setting partnership: Final results Oliver Boney, PSP Steering Group coordinator/NIAA HSRC research fellow, on behalf of the PSP Steering Group The NIAA’s Anaesthesia and Perioperative Care Priority Setting Partnership (PSP) has recently published its final ‘Top Ten Research Priorities’ for the specialty. This initiative, which was funded by the NIAA’s funding partners, had two objectives: to identify unanswered questions (‘what we still don’t know’) in anaesthesia and perioperative medicine, and to prioritise those questions for future research. Defining the research agenda: then and now The research agenda for most specialties has, until recently, been dictated largely by those already involved in research. This arrangement clearly served the interests of the research community; it was also accepted dogma that research should be designed and conducted by ‘experts’, since only those with expertise in a subject could properly identify gaps in our current knowledge. Those experts were also considered best placed to design research studies to probe those knowledge gaps and thus progress our understanding. This notion, though perhaps still true for highly abstract disciplines, is now widely challenged. The underlying aim of all medical research is to improve healthcare for patients. The medical research community increasingly recognises that patients should therefore have a say in all aspects of medical research, from study design and implementation to setting research agendas. Involving patients in decisions about their care is enshrined in the fundamental ethical principle of patient autonomy; a recent government white paper stated that ‘[shared decisionmaking] is equally fundamental to the partnership between patients and clinician in research.’ 1 The Anaesthesia and Perioperative Care PSP directly addressed the need to involve patients and carers in deciding what research topics are important and how research funding should be directed. Importantly, it also involved everyday clinicians. Anecdotally, many practising anaesthetists feel that current research bears little relevance to their everyday practice, and this PSP represented a novel opportunity for anaesthetists and other clinicians not actively engaged in research to participate in setting the future research agenda. The priority setting process The PSP was overseen by the James Lind Alliance (JLA), an arm of NIHR whose remit is ‘bringing patients, carers and clinicians together to identify and prioritise unanswered questions’. 2 The JLA has experience of conducting over 30 PSPs ranging from dementia to joint replacement surgery, and a JLA adviser (Leanne Metcalfe) provided expert guidance throughout the Anaesthesia and Perioperative Care PSP to ensure adherence to JLA guidelines. The PSP’s methods are described in detail elsewhere (www.niaa.org.uk/psp, other publications in press); however, a brief overview of the steps involved is provided here. Identifying and engaging stakeholders: The PSP set out to engage a wide range of ‘stakeholders’ – i.e. anyone with an interest in anaesthesia and perioperative care, whether as a ‘provider’ or a ‘service user’. Providers were defined as anaesthetic or perioperative healthcare professionals; service users constituted anyone who has had, or may have in the future, surgery requiring anaesthesia, and their carers and relatives. Twenty five professional organisations (anaesthetic subspecialist societies, trainee networks, organisations representing surgeons, ODPs, recovery nurses etc.) and 20 service user groups joined the PSP as partner organisations. A steering group comprising 12 volunteers from the partner organisations was chosen to manage and oversee the PSP’s progress. Identifying research questions: We conducted an online survey during June – July 2014 (publicised mainly via our partner organisations), in which stakeholders were asked to propose up to three ideas for future research. Partner organisations were also consulted for their suggestions. 623 respondents (approximately 60% clinicians, 40% patients and/or carers)
Page 15 | Bulletin 93 | September 2015 niaa@rcoa.ac.uk www.niaa.org.uk submitted 1,420 questions, plus a further 56 questions from partner organisations. Shortlisting: These 1,476 questions were classified by theme, and similar questions amalgamated. A subgroup of the steering group met in December 2014 to compile a shortlist of ‘summary’ questions encapsulating all the suggestions received in the ideas-gathering survey. A literature review was conducted in early 2015 to check whether any of the 92 shortlist questions had in fact already been answered by existing research. None of the summary questions was found to have been fully answered as judged by JLA criteria, so none was excluded. Prioritisation: A second online survey was conducted between February and early April 2015, asking respondents to choose their ten most important research questions from the shortlist. We received 1,718 responses, with approximately twice as many clinicians as service users; we therefore doubled the service user votes (as per JLA guidelines) in order to even up the balance of clinician / lay representation. We then ranked the shortlist questions in order of popularity (i.e. by number of votes received). The 25 highest ranked questions then went through to the Final PSP workshop. Choosing the ‘Top Ten’: All partner organisations were invited to send a representative to the Final workshop, which took place at the AAGBI on 12 th May 2015. The workshop was attended by 23 partner representatives (13 clinicians, 10 lay representatives) and a modified Delphi process involving repeated rounds of group discussion and ranking – all coordinated with consummate efficiency by our JLA chair and two of her JLA colleagues – was successfully employed to reach unanimous agreement on a final ‘Top Ten Research Priorities’ for Anaesthesia and Perioperative Care. The future What happens with these Top Ten Research Priorities now? The purpose of the PSP is to inform the research agenda, and its ultimate success will be judged by its impact on research funding and the tangible research outcomes it yields. The next stages will therefore involve publicising the Top Ten as widely as possible within the Anaesthetic and Perioperative medicine research communities. Several academic publications are either pending or planned; the results have been presented at various academic conferences and meetings (both UK and international), as well as to the NIAA funding partners, Research Council and Board. The methods and all results (i.e. not just the top ten, but the full ranking of the 92 shortlist questions featured in the prioritisation survey) are accessible on the NIAA website, and all research suggestions will be entered in the UK Database of Uncertainties of Effects of Treatments (UK DUETs) maintained by NICE, 3 where they will be visible to researchers and research funding bodies. Summary documents have also been sent to all partners, highlighting research questions of particular relevance to each organisation. How do these research priorities affect me? Regardless of whether you consider yourself ‘research experienced’, ‘research aware’ or merely ‘research agnostic’, these research questions all have obvious implications for the clinical practice of every anaesthetist. Moreover, some of the more general Table 1: The Top Ten research priorities for Anaesthesia and Perioperative Care What can we do to stop patients developing chronic pain after surgery? How can patient care around the time of emergency surgery be improved? What long-term harm may result from anaesthesia, particularly following repeated anaesthetics? What outcomes should we use to measure the ‘success’ of anaesthesia and perioperative care? How can we improve recovery from surgery for elderly patients? For which patients does regional (local) anaesthesia give better outcomes than general anaesthesia? What are the effects of anaesthesia on the developing brain? Do enhanced recovery programmes (fast-track surgery to speed up patient recovery) improve short and long-term outcomes? How can pre-operative exercise or fitness training, including physiotherapy, improve outcomes after surgery? How can we improve communication between the teams looking after patients throughout their surgical journey?
Page 1 and 2: ROYAL COLLEGE OF ANAESTHETISTS ACCR
Page 3 and 4: Page 3 | Bulletin 93 | September 20
Page 13: Page 13 | Bulletin 93 | September 2
Page 19 and 20: ROYAL COLLEGE OF ANAESTHETISTS Page
Page 65 and 66:
Page 65 | Bulletin 93 | September 2
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
show all

BULLETIN

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?