Research Engagement with SLPs

I still have days when I miss my former job as a research coordinator in a hospital speech-language department. As a faculty researcher, I try to embed my research in clinical settings as often as I can but it is not easy. Administrators, in particular, and speech-language pathologists on occasion may be leery of the time requirement and often worry that the project might shine too bright a light on every day clinical practices that may not be up to the highest evidence based standard. I always try to design projects that are mutually beneficial to the research team and the clinical setting. As a potential support to the promise of mutual benefit, I was pleased to read a recent paper in the British Medical Journal “Does the engagement of clinicians and organizations in research improve healthcare performance: a three-stage review”. On the basis of an hour-glass shaped review, using an interpretive sythesis of the literature on the topic, Boaz, Hanney, Jones, and Saper drew the following conclusions:

Some papers reported an association between hospital participation in research and improved patient outcomes. Some of these findings were quite striking as for example significantly worse survival from ovarian cancer in “non study hospitals” versus hospitals involved in research trials (my sister-in-law died from this terrible disease this month so I couldn’t help but notice this).

A majority of papers reported an association between hospital participation in research and improved processes of healthcare. This includes the adoption of innovative treatments as well as better compliance with best practice guidelines.

Different causal mechanisms may account for these findings when examining impacts at the clinician versus organization level. For example, involvement in a clinical trial may include staff training and other experiences that change clinician attitudes and behaviors. Higher up, participation in the trial may require the organization to acquire new infrastructure or adopt new policies.

The direction of cause and effect may be difficult to discern. Specifically, a hospital that is open to involvement in research may have a higher proportion of research-active staff who have unique skills, specialization or personal characteristics. These characteristics may jointly improve healthcare outcomes in that setting and that make those staff more amenable to engagement with research.

This last point resonates well with my experience at the Alberta Children’s Hospital in the 80’s and 90’s. The hospital had a very large SLP department, up to 30 SLPs, permitting considerable specialization among us. Furthermore, as a teaching hospital we a had a good network of linkages to the two universities in the province and to a broad array of referral sources. Our working model, that was based on multidisciplinary teams, also supported involvement in research. Currently, in Montreal I am able to set up research clinics in healthcare and educational settings from time to time, but none of them have the resources that we enjoyed in Alberta three decades ago.

Of course, direct involvement in research is not the only way for SLPs to engage with research evidence. Another paper, published in Research in Developmental Disabilities used a survey to explore “Knowledge acquisition and research evidence in autism.” Carrington et al found that researchers and practitioners had somewhat different perspectives. The researcher group (n=256) and the practitioner group (n=422) identified sources of information that they used to stay up to date with current information on autism. Researchers were more likely to identify scientific journals and their colleagues whereas practitioners were more likely to identify conferences/PD workshops and non-academic journals. Respondents also identified sources of information that they thought would help practitioners translate research to practice. Researchers thought that nontechnical summaries and interactions with researchers would be most helpful. Practitioners identified academic journals as the best source of information (but the paper doesn’t explain why they were not using these journals as their primary source).

Finally, the most interesting finding for me was that both groups did not use or suggest social media as a helpful source of information. I thought this was odd because social media is a potential access point to academic journal articles or summaries of those articles as well as a way of interacting directly with scientists.

The authors concluded that knowledge translation requires that practitioners be engaged with research and researchers. For that to happen they suggest that “research should focus on priority areas that meet the needs of the research-user community” and that “attempts to bridge the research-practice gap need to involve greater collaboration between autism researchers and research-users.”

Given that the research shows that the involvement of practitioners in research actually improves care and outcomes for our  clients and patients, I would say that it is past time to bring down barriers to researcher-SLP collaboration and bring research right into the clinical setting.