Health related research is impressive; it changes lives and it saves lives. It is a collective endeavour by people committed to making a difference to patients and the public. It is also a complicated endeavour. One that involves a number of difficult decisions on the best way to design, deliver and make best use of research; yet the best way is often not known. At best this leads to missed opportunities – at worst it leads to research waste.
One way of increasing our understanding of the best ways to approach research is to do a Study within a Trial (SWAT). SWATs are embedded within a trial and generally evaluate alternative ways of doing a trial process to provide evidence about how we can improve. By repeating this for many trial processes we will start to build up evidence to support evidence-based trial process decision-making.
The UK’s National Institute for Health Research has launched a pilot scheme to allow researchers to embed studies evaluating alternative ways of undertaking a trial process (e.g. public involvement, trial recruitment, retention, data collection, etc) to provide evidence about how we can improve the way we perform that process.
This is why I think this is important.
The impact of research, what difference research actually makes for patients and the public, is quite rightly our usual focus. It’s the reason health related research maintains the support of the UK’s National Health Service and society generally. But it is also essential to consider and acknowledge how we deliver research.
When we choose to fund and deliver research we balance ethical and moral considerations, allocate money from the finite public purse, make difficult choices between comparably important opportunities, make use of excellent professionals who could focus on other priorities, and above all, rely on the involvement and participation of patients and the public. We therefore have a responsibility and necessity to consider what we do well and what could be improved.
Randomised trials play a particularly central role in improving clinical care in the UK and are a key component of many clinical practice guidelines developed by NICE and others. Despite their importance, trials can also be inefficient. Many take longer than planned, struggle to recruit and/or retain participants or go over budget, especially through extensions. Some fail to adequately answer their research question and some are abandoned altogether. Let me be clear though – this is not a criticism of those that design and deliver research. It is directly related to a lack of research on the process of research itself.
Given the importance to public health and the costs involved in randomised trials, Treweek et al 2018 posed the straw man “you might think there was plenty of research to support the choices” trialists must make to deliver high quality and efficient studies. They quickly dispel that proposition. “There is remarkably little evidence available to support the doing of trials, and trials are much less efficient than they could be as a result.”
The NIHR has supported researcher-initiated SWATs within some of its studies in the past. NIHR is now raising the importance and profile further by launching a formal call for SWATs to be embedded within Health Technology Assessment trial applications.
This initiative sits within a broader context for the NIHR and its work on Adding Value in Research (AViR). This is the NIHR’s response to the challenges highlighted by the REWARD alliance and set out in these pages. AViR raises the impact of research for a given cost by reducing avoidable waste, increasing its relevance, and improving quality and integrity of research. By defining Value as impact for a given cost, we make an explicit connection between how we deliver research and the benefits research ultimately delivers.
The people who work in health related research, what they do, and how they do it, are impressive; they change lives and they save lives. Investing in research on research, for example through SWATs, will help us all do more and do it better. To make more of a difference to more patients’ lives.
NIHR Lead for Adding Value in Research
The views and opinions expressed in this blog are those of Matt Westmore and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.