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Simon Denegri's Lay review

The public, health research and democracy @SDenegri
July 25, 2013

Clinician resistance to research may require an arm around the shoulder not a red card

….despite the temptation.

Summer means many things for me.  One of them is keeping track of the football transfers.  Here’s hoping that the Eagles do manage to persuade Ronaldo to South London!

The comments that managers make about players never cease to amuse me.  One of the most common goes something along the lines of:  ‘He’s a good lad that Denegri, he just needs an occasional arm around the shoulder.’  During the playing season this is usually before or after they have been sent off for some professional foul.

I have not decided whether it is a professional foul worthy of a yellow or red card. But the perennial resistance of clinicians to take part in the matching of patients to clinical research seems worthy of a caution at least don’t you think?  It is disappointing to see it feature yet again in the feedback we have had to the ‘OK to Ask’ campaign that NIHR ran for International Clinical Trials Day (ICTD) in May. You will recall that the aim of the campaign was to highlight to patients that they can and should be asking doctors about opportunities to take part in research.

A summary report on the campaign can be found here.  As proof of principle that we can run a co-ordinated campaign about research across both NIHR and the NHS, and in support of a simple message aimed primarily at patients, I am delighted with the outcome.  The degree of involvement among NHS Trusts in getting the message across to the public  – with over 150 events listed – was very positive indeed.  It has also helped promote research awareness among staff within hospitals as the results from our follow-up survey show:

  • 77% of people rated the overall campaign as “good” or “excellent” 
  • 67% of people said that campaign engagement within their Trust was either “good” or “excellent”
  •  71% rated how well the campaign was received by patients as either “good” or “excellent” 
  • 80% said that the OK to ask campaign helped them to deliver some momentum for research awareness within their Trust, Network or organisation
  • 98% said they would continue to promote the OK to ask message

But it’s clear from the extensive comments fed back to us (not published as part of the summary by the way) that there was some resistance to the campaign among clinicians.  Some were concerned about raising false expectations.  Others found it was difficult to signpost people appropriately when some of the tools we have such as the UK Clinical Trials Gateway (UKCTG) don’t yet support local interaction.  A few thought the message was demeaning.  They probably have not been to Pizza Express either.

It wasn’t a show-stopper – 7 out of 10 people said the campaign was good or excellent from a patient perspective versus 5-6 out of 10 saying the same for clinicians.  However, it is something we need to consider as we develop ‘Ok to ask’ over few years; your views and thoughts will be welcome as ever.  We will also have a greater opportunity to get it right from a clinician standpoint from this point onwards because we will have a longer lead-in time for the campaign itself.  This year we turned it round in about 3 months from beginning to end which makes everything a whole lot more difficult.  There will also be opportunities to build on the message at both local and national level in the meantime.

It would also be remiss of us not to recognise the wider context here, the difficulties for staff in the current environment when it comes to research.  This was astutely identified by the Association of Medical Research Charities (AMRC) in its recently published vision for the NHS.  It’s an excellent document. Part of its vision is that: ‘All NHS staff see the importance of research.’  And it lays out a good plan for ensuring that NHS staff are given the tools, support and opportunities to support the research agenda. Getting behind this call and making it happen is what I mean by putting ‘an arm around the shoulder’ I suppose.

That’s not to say that I do not share the frustration and anger people feel over the stubbornness of our professions in general:  when it comes to them engaging with research but also in engaging their patients in research.  It featured strongly in the Arthritis Research UK strategy meeting on stratified medicine I attended yesterday for instance.  And in that arena it could be a real show-stopper.

But we should take hope from, and use,  the fact that many clinicians quite clearly did get on board with the campaign as did the Boards and senior staff of many Trusts. This leadership is essential to changing behaviours.

As is the leadership you and many other patient, public, research and other health professional colleagues showed in making ‘Ok to ask’ a success.  For that, I thank you most sincerely.

PS: By the way, it is actually true that I need an arm around the shoulder on occasion! 🙂

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NIHR Ok to ask patient and public involvement

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