June 2013: Uncertainties, knowledge gaps and research priorities
“Imagine a world in which the scientists who were pioneering new understanding of earth system processes were also those who were most active in embedding that new knowledge in the delivery of social or economic value” Dr Tim Daley (i)
In the recent years, researchers are increasingly challenged not only participate in creating knowledge but to take a more active role in translating this knowledge into policy and practice. Researchers along with research organisations, funding agencies and charities make decisions every day what topics would be conducted as a research project. These research projects shape the available knowledge that policy makers, practitioners, managers and the public use to inform their decision making. However, there are few studies done evaluating systematically how decisions on selecting certain research questions affect the scope of the knowledge that is available to policy makers and the public (ii). For example a study engaging with patients with osteoarthritis of knee demonstrated a mismatch between the uncertainties that patients and clinicians face (effectiveness of physiotherapy and surgery, and assessment of educational and coping strategies) and the research that was conducted (research predominately evaluated drugs) (iii). Consequently, we need to ask ourselves (a) “are we, as researchers, doing enough to fill the knowledge gaps that policy makers and the public face in every day decision making” (b) can an earlier dialogue between the researchers and the public, practitioners and policy makers on shaping identifying, shaping and prioritisation of research questions increases the relevance and acceptability of our research”. As part of an international community called Cochrane Agenda and Priority Setting Methods Group (http://capsmg.cochrane.org), we attempt to answer these and other methodological questions to develop an evidence base for methods to prioritise research and set a research agenda. (Photograph by Roland Gehrels from the Climate Science Group with Plymouth University).
Our ongoing quest to identify and prioritise key uncertainties for dental research has identified uncertainties on strategies to achieve and maintain environmental sustainability in the dental care. This was identified as part of a research priority setting project with the Shirley Glasstone Hughes Trust and British Dental Association (BDA). The BDA hosts an online forum called curious about (http://www.bda.org/dentists/education/sgh/). Dentists are encouraged to join the online forum and submit burning question to problems they have encountered in their day to day dental practice. Once a month, they are given the opportunity to vote for the questions. The fund would commission a rapid evidence review on the most voted question; this review will be subsequently published in the British Dental Journal. The rapid evidence review intends to demonstrate whether (a) the question is already answered with research but there is a gap in translating the research to practice or (b) there is a genuine uncertainty and the question still remains unanswered. Every year, the trustees come together and make a decision informed by the rapid evidence reviews which of the prioritised topics are in more urgent need for new research to fill the knowledge gap. The selected topic (or topics) would be part of a commissioned funding call. The fund goes a step further in ensuring the relevance of its commissioned research to its final targeted audience (general dental practitioners); it requires that each grant proposal be led by a general dental practitioner in collaboration with academic researchers.
In 2012, one of the questions that was raised and prioritised was “can plastics used in dentistry act as an environmental pollutant? Can we avoid the use of plastics in dental practice?”. The rapid evidence review identified a narrative review on environmental legislations that are relevant to dental care environment. The narrative review suggested that dentists should consider using environmental audit as part of their daily practice. However, there were no studies identified evaluating the feasibility, applicability and impact of environmental audit in dental practices (iv). Further explorative searches (as part of the rapid evidence review) identified a randomised controlled trial (RCT) comparing two impression materials in a general dental practice. Unlike most RCTs which evaluate patient and biomedical outcomes, this one evaluated an environmental outcome, the relative wastage of the materials (v). The rapid evidence review has shown that despite a number of studies discussing and exploring the issue of environmental sustainability in dental care environment, there are no studies identified directly answering the prioritised question. We are currently working together with researchers in Institute for Sustainability Solutions Research on developing research proposals and applying for research grants to make the first step in filling up this knowledge gap. Finally, I do like to encourage you to “Imagine a world in which the scientists engage in a dialogue with policy makers, practitioners, managers and the public to understand their day to day problems, questions and uncertainties and reflect on strategies that facilitates making collective decisions on what research topics are most worth answering through research”.
Note: If you are interested in research priority setting methods, we developed a collection of publications and other resources on (http://capsmg.cochrane.org). You could also join us on our next two events in the Cochrane Colloquium in Quebec City, Canada (www.colloquium.info) in Sep 2013. We are organising workshop on planning and conducting a research priority setting exercise and also a special session on responsive evidence development.
(i) Daley T. Institute for Sustainability Solutions Research JanuaryBlog. http://www1.plymouth.ac.uk/research/issr/Documents/ISSR%20Blog%20January%202012.pdf
(ii) Nasser M, Welch V, Ueffing E, Crowe S, Oliver S, Carlo R. Evidence in agenda setting: new directions for the Cochrane Collaboration. J Clin Epidemiol. 2013 May;66(5):469-71. doi: 10.1016/j.jclinepi.2012.08.006. Epub 2013 Jan 9. PubMed PMID: 23312393.
(iii) Tallon D, Chard J, Dieppe P. Exploring the priorities of patients with osteoarthritis of the knee. Arthritis Care Res. 2000 Oct;13(5):312-9. PubMed PMID: 14635301.
(iv) Nasser M. Evidence summary: can plastics used in dentistry act as an environmental pollutant? Can we avoid the use of plastics in dental practice? Br Dent J. 2012 Jan 27;212(2):89-91. doi: 10.1038/sj.bdj.2012.72. Review. PubMed PMID: 22281636.
(v) Wilson N H, Cowan A J, Crisp R J, Wilson M A. Wastage of a silicone impression material in a general practice setting: a comparison between hand and automixing methods. SADJ 2001;56: 233–236.
Dr Mona Nasser is a Clinical Lecturer in Evidence Based Dentistry