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Getting research findings into practice
Getting Research Findings into Practice HainesA, Donald A (eds) BMJ 1998 ISBN 0-7279-1257-7, Price: s 19.95 Given that the NHS spends millions of pounds on research funding, getting some of the fruits of that activity into practice seems like a good idea. So this book is welcome and has been published at a time when all the health-care professions are gearing up their activities in preparation for the clinical governance agendas. The book is edited by Haines and Donald, both public health specialists, and purports to address the problem of why there is such a gap between research findings and what actually happens in clinical practice. The focus is very much on the medical practitioner and the treatment of individual patients. The reader is offered a wide range of relevant topics such as: sources of information, criteria for selecting best evidence, using research in clinical practice, decision analysis, health economics and changing practice in the light of evidence. The contributor list reads like a 'who's who' from the good and the great in the evidence-based practice movement, with chapters by J. E. Muir Gray, D. L. Sackett, Ruairidh Milne, Trevor Sheldon and Jeremy Grimshaw amongst others The book is undoubtedly an excellent and welcome contribution to the literature. Getting research findings into practice is not an easy task but the book successfully unpicks the various stages in the process and also adds some nice little enhancing touches. The book follows a logical structure loosely based on that outlined by Haines and Donald in their introduction, namely: keeping abreast of new knowledge, implementing knowledge, linking research with practice, interaction between purchaser and provider, and making implementation an integral part of research training. All the chapters are well written, concise and well referenced. Because of the high quality of all the chapters it is difficult to single out one or two for special mention. However, once I had finished the book some chapters remained prominent in my memory. One of these was an early chapter by Sheldon, Guyatt and Haines entitled 'Criteria for the implementation of research evidence in policy and practice'. This chapter, as one would expect, reinforces the well-known message that practice and policy should not necessarily be changed in the basis of o n e particular piece of research, but that research findings need to be pulled together in a systematic review to ascertain what the message actually is. But the authors go on to stress that even if the findings are definitive, implementation is not Clinical Effectiveness in Nursing (I 999) 3, 142 147 9 1999 Harcourt Publishers Ltd
necessarily advocated. There are a number of risk and other factors to be considered before the evidence can be applied to individual patients - one of which is 'what do the patient and their family want?' The next two chapters which remained in my memory were those on 'Decision support' by Taylor and Wyatt; and 'Decision analysis and the implementation of research findings' by Lilford, Pauker, Braunholtz and Chard. These chapters demonstrated how computers, decision-support systems and decision-analysis techniques, could be used routinely by clinicians in implementing evidencebased practice. It was a fascinating read, but one which left me with an image of house officers walking round with mini computers rather than their dog-eared copy of MIMS bulging out of their pocket, and no longer able to think of consultants in the same terms as Oliver Goldsmith's parson in the Deserted Village: And still they gaz'd and still the wonder grew, That one small head could carry all he knew The final chapter that remained with me was the last one, in which Vivienne Van Someren described two contrasting stories from perinatology about the implementation of two interventions which had been shown to reduce perinatal mortality. In one scenario, an evidence-based guideline was quickly taken up by the paediatricians, in the other, the obstetricians were reluctant to use the new guideline even though the evidence for its efficacy was strong. In her chapter, Van Someren highlights the complex interplay between the mindset of the individual clinician and the nature of the intervention. She described two case studies, in one, the disease was central to the everyday practice of the clinicians (the paediatricians) and they were attuned to seeking out new information about it; in the other, the disease would only affect a small number of the patients of an the clinician (the obstetricians) and, therefore, it was not at the top of the priority list for evidence gathering. It was this last chapter that highlighted what I considered was the main weakness of the book - its failure to set the implementation of research findings in context. While not wishing to diminish the content of the book, it seemed at times just a little too slick and recipe like - the real world, as Van Someren showed, is rather more complex. It would have been useful if some of the issues which were raised in the final chapter had been discussed more fully.
Professor Claire Hale
necessarily advocated. There are a number of risk and other factors to be considered before the evidence can be applied to individual patients - one of which is 'what do the patient and their family want?' The next two chapters which remained in my memory were those on 'Decision support' by Taylor and Wyatt; and 'Decision analysis and the implementation of research findings' by Lilford, Pauker, Braunholtz and Chard. These chapters demonstrated how computers, decision-support systems and decision-analysis techniques, could be used routinely by clinicians in implementing evidencebased practice. It was a fascinating read, but one which left me with an image of house officers walking round with mini computers rather than their dog-eared copy of MIMS bulging out of their pocket, and no longer able to think of consultants in the same terms as Oliver Goldsmith's parson in the Deserted Village: And still they gaz'd and still the wonder grew, That one small head could carry all he knew The final chapter that remained with me was the last one, in which Vivienne Van Someren described two contrasting stories from perinatology about the implementation of two interventions which had been shown to reduce perinatal mortality. In one scenario, an evidence-based guideline was quickly taken up by the paediatricians, in the other, the obstetricians were reluctant to use the new guideline even though the evidence for its efficacy was strong. In her chapter, Van Someren highlights the complex interplay between the mindset of the individual clinician and the nature of the intervention. She described two case studies, in one, the disease was central to the everyday practice of the clinicians (the paediatricians) and they were attuned to seeking out new information about it; in the other, the disease would only affect a small number of the patients of an the clinician (the obstetricians) and, therefore, it was not at the top of the priority list for evidence gathering. It was this last chapter that highlighted what I considered was the main weakness of the book - its failure to set the implementation of research findings in context. While not wishing to diminish the content of the book, it seemed at times just a little too slick and recipe like - the real world, as Van Someren showed, is rather more complex. It would have been useful if some of the issues which were raised in the final chapter had been discussed more fully.
Professor Claire Hale