Workshops - Dublin 2016
Workshop 1 Wednesday 6th July during parallel session 1 - 1F
The good, the bad and the ugly: improving the reporting of implementation studies
Dr Hilary Pinnock, University of Edinburgh
Prof Stephanie Taylor, Barts and The London School of Medicine and Dentisry
Studies reporting the implementation of interventions in routine practice are often poorly reported. This makes them challenging for systematic reviewers to find; difficult for readers to understand exactly what was done; and impossible for clinicians /managers to determine if the initiative will work in their healthcare context. The Standards for Reporting Implementation Studies (StaRI) project is using recognised methodology, to develop a checklist of reporting standards for implementation studies.[Moher D et al. PLoS Med 2010; 7: e1000217] Following a literature review, an e-Delphi [Pinnock H et al. Implementation Science 2015; 10:42] and an international consensus workshop we have developed a draft checklist.
This workshop aims to encourage delegates to consider their approach to reporting implementation studies, to discuss the applicability and importance of some of the key items and provide us with feedback that we will use to refine the StaRI checklist.
Format: Highly interactive, 15 min presentation on StaRI followed by delegate discussion and feedback. We will summarise the StaRI work and explain the rationale and theory underpinning the standards. We will then request feedback from the delegates on the relevance, applicability, and usability of the draft checklist. Feedback and discussion will be the core of this workshop. The StaRI checklist is designed to apply to a broad range of implementation science methodologies – so we will be encouraging discussion about how the standards apply to clinical and public heath interventions, small scale and national initiatives, using qualitative and quantitative evaluations.
All those interested in implementation and impregnation research. This workshop should appeal to a wide range of delegates. We are currently writing the Explanation and Elaboration document and are looking out for exemplar projects to cite in the document (so do bring along any of your ‘implementation’ papers that might be useful!) Please note: The StaRI checklist is not yet published: we will be asking delegates to respect confidentiality at this stage. We will also request permission to audio record the workshop so that we can capture the feedback.
Workshop 2 Thursday 7th July during parallel session 2 - 2F
Making the most of UK primary care databases through multidisciplinary collaborations
Facilitators: Helen Strongman, Clinical Practice Research Datalink (CPRD)
Arlene Gallagher, CPRD
Mark Wright, CPRD
Willie Hamilton, University of Exeter Medical School
Aim and intended outcome:
Primary care data collected from NHS General Practices and collated in pseudonymised databases are a major UK resource for health research. Research using Electronic Healthcare Records (EHR) requires multidisciplinary expertise including knowledge of the clinical setting and the ability to process and analyse big data. In this session, we will discuss how primary healthcare scientists and academic clinicians can collaborate to optimise use of primary care data for public health research.
Introductory presentation (15 minutes) Forming multidisciplinary groups (15 minutes) Three table discussions (3 x 15 minutes) Collective group discussion after final table discussion (15 minutes)
The Clinical Practice Research Datalink (CPRD) has experience of using primary care EHR data for observational and interventional research and is a primary provider of UK EHR data. Facilitators will give a brief overview of the CPRD, form multidisciplinary groups with similar special interests, and introduce the three key discussion objectives of the workshop:
(1) Identify research questions that could be answered with the CPRD data;
(2) Build awareness of how clinical practice expertise and experience with using GP software systems can enhance research;
(3) Develop collaborative networks to answer key public health questions and optimise research.
Academic clinicians and healthcare scientists at all career stages with an interest in how primary care EHR databases can be used to address research questions. It would be helpful if participants could bring research questions that may be suitable for a primary care EHR database study or any questions about the EHR data that clinicians may be able to answer.
Workshop 3 Thursday 7th July during parallel session 3 - 3F
Getting qualitative research into print: an interactive workshop
Roger Jones, BJGP/KCL
Fiona Stevenson, UCL
Kalwant Sidhu, KCL
Aims and Intended outcome
Qualitative research is widely used in primary care but publication in high impact, peer review journals remains problematic. A recent comment to the editor on a paper submitted to the British Journal of General Practice encapsulated some relevant issues: "There's a certain sadness about some qualitative papers - they seem full of good intentions, but often seem to be written by people who don't fully understand or engage with the issues confronting practitioners (a bit like the charitable gift of a mandolin to someone who can't afford eggs). Nevertheless, they often harness some interesting views, which I find quite comforting as a reader. GPs work in comparative isolation still, and it's good to know that others experience the same clinical, organisational, and personal quandaries. Is that enough to warrant publishing them? I suppose it depends how replete you are and how good the competition is." (Dr Stuart Handysides, with permission) Research questions, regardless of methodology, need to be clearly framed, grounded within an analysis of the existing evidence, and the methods chosen must be appropriate to address the problem posed. Guidelines for the conduct and reporting of qualitative studies may be based on those more suitable for quantitative studies and may therefore prove unhelpful when writing an article that flows well and engages the reader. Constraints on space and word length in high impact medical journals, and the preferred formats for articles, can cause further difficulties. This workshop aims to enable attendees to have a much better appreciation of the kinds of research questions that qualitative research is best able to answer, the need for methodological rigour, and the most effective approaches to reporting and writing up qualitative studies.
Format and content
In this highly interactive workshop we will concentrate on three aspects of qualitative research – (i) effective framing of the research question, (ii) the steps needed for a rigorous, timely and effective contribution to practice and (iii) getting into print. The format will be small-group discussion based around these questions, each introduced by a five-minute bullet pointed presentation, using published qualitative research papers to provide examples and discussion points. Attendees will be encouraged to bring their own real-life qualitative questions and quandaries to the workshop. The workshop leaders include experts in qualitative methods,postgraduate education, and journal editing in primary care
This workshop will be suitable for anyone who is interested in research questions best answered using qualitative methods, and wants to explore and develop their own questions and designs, and get the findings into print.It will also be of interest to those who wish to become more discerning consumers of published research
Workshop 4 Friday 8th July during parallel session 4 - 4F
The self in primary care
Facilitators: Christopher Dowrick, University of Liverpool
Joanne Reeve, University of Warwick
Deborah Swinglehurst, Queen Mary University of London
Aim and intended outcome.
Our aim is to establish a body of work in an area that we propose as a key basic science of person-centred primary care. Our intended outcome is to generate dangerous ideas within both the academic and clinical communities, to be supported by establishing a SAPC special interest group.
1. Opening presentation: Why we need a new theory of the self.
2. Facilitated small group discussions using case vignettes to generate dangerous ideas e.g. Are doctors’ and patients’ selves different? Is the self agentic or distributed? How do we achieve a sense of coherence? What sort of a self does someone with dementia have?
3. Final plenar . Dangerous idea pitches (2 minutes per small group). Agenda setting for future work.
Medicine does not formally espouse a theory of the self, nor does it explicitly consider what it means to be a person. This absence causes some problems. We are encouraged to work collaboratively with our patients, to foster shared-decision-making and promote self-management. We ask our patients to choose and book, control their diabetes, make lifestyle choices. These orientations assume elements of patient agency, capacity and self-determination. We may also have a more ‘distributed’ notion of the self: a social, collective version performed and constructed through relationship with other human beings and (increasingly) through interaction with material artefacts and technologies. However, the (scant) research into our behaviour in primary care consultations indicates that we adopt a highly skewed view in practice. We tend to see patients as mechanical systems and diseases as puzzles, placing ourselves in the position of problem solvers and controllers of disease. We are actors: patients are passive, acted upon. An explicit theory of the active patient self could address these tensions. Promising concepts include: patients as coherent persons engaged in leading their lives in relation to depressive experiences; creative capacity in the context of palliative care and multi-morbidity; creativity, resistance and agency extending beyond the GP; virtue ethics and the notion of flourishing; embodied selfhood and the social self as applied to people with dementia; flexible understandings of the self and the extent to which it becomes distributed so as to enable life to be lived. These concepts need to be explored and tested: separately for their rigour; jointly for their synthetic potential; and – most importantly – for their catalytic utility, their potential to change our understanding of and interactions with our patients for the better.
Primary care academics interested in wrestling with these complex, knotty questions in order to enhance the professional practice of clinicians and academics alike.