Research in practice: How to survive and thrive

Research in practice:
how to survive and thrive
Jenny Freeman, Plymouth University
Jenny Thain, Walton Centre
Freeman&Thain/MSTrust/2015

Session Plan
• Aimed at novice researchers
• Based around a real-life case scenario in which
many lessons were learnt
• Key learning points at each stage
• Ask questions and raise issues along the way
• Sign-posts to practical resources
• Our aim – to prevent you making the same
mistakes!

Jenny T’s research story:
A well planned journey?
Or a series of unknown
barriers eventually
overcome?

The Beginning
“I’d done research projects previously including an
MPhil, but this was in a much more supported
situation ie registered with University and was
working in a research post therefore had time.”
“Subsequent research projects were within my
clinical practice and proved more challenging….”
How difficult could it be?
As a clinical specialist research was written
into my job description and job plan……..

The journey starts……
• Trust’s RD & I committee keen on influencing
changing perceptions of AHP RD & I capability and on
promoting a ‘World Class Service’”
• Non –medic research award – 1 page application
• 3 shortlisted
• 10 page application form…….

Writing the application
• Consultant Lead supportive
• Therapy Manager – staff costs
• Trust’s RD & I team support in writing application and
design
• Literature search – Library services
• Critical analysis and concluding what evidence tells us
• Design – how to access a statistician – links to University
• Patient and Public Involvement
• Not funded /resourced for this time

Key Learning Points
• A good research idea is essential
• Be confident there is an evidence gap
• Clinical experience and enthusiasm needs to be
accompanied by support from a research team
• If you don’t have appropriate skills “go and get it!”
• Don’t go it alone - seek advice early on
• Research requires money and time
• Grant funding is very competitive ……..so you need
a good research question

Why are “good” research
questions important?
“Well-crafted questions guide the systematic
planning of research. Formulating your
question precisely enables you to design a
study with a good chance of answering
them.”
Light, Singer, Willett, By Design (1990)

What are the characteristics of a
“good” research question?
• Feasible - it can be answered
• Interesting – to you and others
• Novel - it breaks new ground
• Ethical - no harm to subjects
• Relevant - the “So What” test
(F-I-N-E-R)
Hulley, Newman & Cummings, 1988

Formulating an answerable
research question
opulation or participants
ntervention
omparator or Control
utcome

PICO
• What are your questions?
• Can you fit them into the PICO frame?
• Please discuss with your neighbour (5 min)…

Developing a grant is like
climbing a mountain
Grant
Submission
HS&DRRfPB
HTA
Charities
EME
i4i
HS & DR PGAR
Grant application

From the outset you need to consider…
• The team (clinical and research)
• A convincing project plan
• Feasibility: supporting audit or pilot data
• Access to participants & agreement of other sites
• Involvement of other key organisations
• Clear management arrangements
• Properly costed

Collaborate with a range of people
• Research Design Service
• Clinical Research Network
• R&D departments of trust (e.g. research nurse manager)
• Universities
• Statisticians
• Clinical Trials Unit
• Finance Departments

Involve people with MS from the start
• The research topic
• The research question
• Study design
• Outcomes to measure
• Methods of recruitment
• Methods of retention
• Dissemination

MS Trust
– http://www.mstrust.or
g.uk/research/gettingi
nvolved
MS Society Research
Network:
– http://www.mssociety.
org.uk/research/resear
ch_network
INVOLVE
http://www.invo.org.uk
Involving people with MS

Cost your project effectively
Find someone who knows what they are doing and who:
• understands the forms
• can help you to cost your project
• can help you to complete the forms
• start by listing all research activities
• don’t underestimate the time this will take
• start early by involving your finance departments

Make a clear project plan
• Identify key milestones
• Link with objectives
• Be realistic – things
always take longer than
you think
• Timetable / Gantt chart
linked to milestones /
objectives

Bright
idea
Incorporate
comments
from team
Costs to
finances
Draft revised
for 10th time!
Public and
patient
involvement
Circulate
draft for
meeting
Feedback
Submit
to
funder
Develop a Timeline

Produce a Gantt Chart
Development of a falls management intervention for people with multiple sclerosis: Building stakeholder consensus
Project Gannt Chart
Month -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12
Ethics Approval
Comprehensive Lit Review
Recruitment
Service User Training
Nominal Group (NG) Meetings
Feedback, Analysis and writing up
Dissemination
Milestones
Recruitment ends month 5
NG Meetings completed month 9
Project written up month 12
12 month funding period requested from the MS Society
and use it to check your progress throughout the project

Seek research advice early
Research Design Services Universities
http://www.ccf.nihr.ac.uk/Pages/RDSMap.aspx
Service covering England ; local access Universities are keen to
collaborate

Useful Websites: Research Process
For information re:
• developing research question
• deciding on research design and methods
• writing your research proposal
• collecting the data
• disseminating the findings
http://www.rddirect.org.uk
http://www.rdinfo.org.uk
http://www.csp.org.uk

Award successful:
The next stage of the journey
• Ethics
• R & D approval
• Venues
• Staff / training / log / costs
• Availability of staff and Departments ie R & D and
Neurophysiology
• Recruitment procedures
• Site File
• Storage of data

Useful Websites: Ethics application
NRES:
http://www.nres.npsa.nhs.uk/applications/guidance
Finding your local REC and R & D Organisation
Detailed Guidance sheets
Procedure Flowcharts
IRAS:
https://www.myresearchproject.org.uk
Tutorials on application
Detailed Guidance sheets
www.swpctresearch.nhs.uk:
Up-to-date information on latest changes involved with NHS
ethics application process - click on the 'ethical information'
link

What am I doing???
• General feeling of loss of interest, even me.
• R & D link person left – felt “starting from scratch
again”
• Updates required by Trust but…
“I was really embarrassed as little was going on!!
I couldn’t face them sometimes”

Key Learning Points
• Use the resources IRAS
provides
• Talk to people
• Seek advice and help
• Be realistic re timeframe
• “Buy-in” from partners
• Leadership is essential
• And most importantly
…………………

Be prepared for the rollercoaster ride

The high’s…
……and lowsFreeman&Thain/MSTrust/2015

Finally……doing the research!
• Slow to identify participants
• Recruitment procedure seemed complex for one
control group
• Room availability change as R& D moved
• Changes of staff
• Declines
• DNA’s
• Time to chase up above…..

Key learning points
• Be realistic about the numbers of potential
participants / centres
• If you involve other centres, there is a need for
regular communication to ensure everyone is
doing what is required!

Undertaking a “virtual investigation”
To help ensure the
research process
runs smoothly,
carry out the study in
your mind….undertake a
“virtual investigation”

Participant / Centre numbers
• How many patients of this group enter the
Trust / are seen in your practice?
• How many of these fulfil the inclusion criteria?
• What is your predicted recruitment rate
(be pessimistic)?
• What is your predicted attrition?
• What are these estimates based on?

I’m almost there……
but what do I do with the data?
• All information collected
• Ensure it is recorded in
right place from start
• Do ‘adding up’ as you go
along
• Statistician
• SPSS
• What to do with the
data?
• Then the write up!!

Key learning points
• Don’t put “your head in the
sand”
• Decide how you analyse
data from the outset
• Seek advice from
statistician at the beginning
• Sample size calculations
• Cost in statistical support
• Allow enough time for
analyses and write-up
…….and dissemination

Reflection
Positives
• Study now complete and written up (2 .5
years for a ‘pilot’)
• Results not what we expected but still able to
suggest future study from what we did find
• Have been able to use this as an example ‘in-
house’ whilst working on increasing AHP
Research interest & activity in Trust as ‘live’ so
validates

Reflection
Negatives
• Monkey on my back - has been a long haul
• Frustrating with slow recruitment
• Had to change protocol as other clinicians not
fully supporting recruitment
• Participants agreeing to attend then DNA
• Difficulties re access to stats / SPSS – tenacity
• Need to disseminate results

Use guidance
available to
report results

(Lots of) Guidance Available

“From idea to fundable proposal”
A nice simple linear process??

Moving forwards in the real world:
START SIMPLE
Perhaps…..
• Be involved as an assessor in someone else’s study
• A Masters project is a great starter
• Supported schemes can help (e.g. CATP)
• Case reports / Single case studies / Routine Data
collection / Audit are manageable
• Incorporate research with your own appraisal
process
• Be a collaborator in another research project
• Recognise your own strengths – a great idea ? A
good head for design? A data collector? A proof
reader? A disseminator?Freeman&Thain/MSTrust/2015

Training pathway with four levels of award
(Masters, Doctoral, Clinical Lectureship (post-
doc) and Senior Clinical LectureshipFreeman&Thain/MSTrust/2015

Any questions?
Most importantly…………..
don’t struggle on alone

Research in practice: How to survive and thrive

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