Stimulating research development: the effect of a patient-clinician partnership that identified and prioritized research needs in urinary incontinence

Article type
Authors
Buckley B1, Grant A2, Tincello D3, Wagg A4, Firkins L5
1General Practice, National University of Ireland, Galway, Ireland
2University of Aberdeen, Aberdeen, UK
3University of Leicester, Leicester, UK
4University of Alberta, Edmonton, Canada
5James Lind Alliance, Oxford, UK
Abstract
Background: Research often neglects important gaps in existing evidence. As a result clinicians and patients must make decisions about treatments without reliable evidence about their effectiveness. Gaps in the evidence range from specific unanswered questions about treatments to broad areas of uncertainty requiring larger programmes of research to generate the evidence needed to inform clinical decisions. Objectives: A UK partnership of 8 patient and 13 clinician organisations, reported at the 2009 Singapore Colloquium, identified and prioritized gaps in the evidence that affect everyday clinical decisions relating to the treatment of urinary incontinence. This presentation will assess the effect of the research prioritization exercise. Methods: UK organisations consulted memberships to identify ‘‘evidence gaps’’ affecting treatment decisions. Gaps were also identified in systematic reviews’ research recommendations. Initial shortlisting of 226 evidence gaps by organisations was followed by use of established consensus methods at a prioritzation workshop. A ‘‘top ten’’ was produced and published in research and clinical journals. Subsequently, reviews of research databases and peer consultation are being used to identify new research or funding applications relating to the prioritized topics. Results: Since publication, at least four funding applications relating to prioritized topics have been made and a fifth is in preparation. One large application has been awarded. Two new systematic reviews are under way. All have referenced the prioritization work. These new research activities consider optimal pelvic floor muscle training regimens, effectiveness of urodynamic investigations and aspects of tension-free vaginal tape surgery, intermittent self-catheterization and neurogenic bladder management. Conclusions: The partnership successfully developed and employed a methodology for identification and prioritization of research needs by patient-clinician consensus. Since publication of the partnership’s work, new research activity has been identified relating to five of the ten prioritized topics. Prioritization through patient-clinician consensus is effective in informing the development of clinically useful research.