Elsevier

The Lancet

Volume 355, Issue 9220, 10 June 2000, Pages 2037-2040
The Lancet

Articles
Relation between agendas of the research community and the research consumer

https://doi.org/10.1016/S0140-6736(00)02351-5Get rights and content

Summary

Background

Previous studies have suggested that research agendas can be biased. To determine whether there is a mismatch between available research evidence and the research preferences of consumers we examined research on interventions for the treatment of osteoarthritis of the knee joint.

Methods

We searched published and unpublished studies on interventions in this condition to assess the structure of the evidence base. Focus groups and a postal survey of research consumers were then undertaken to examine their views and research priorities.

Findings

Review of published and unpublished reports showed that the evidence base was dominated by studies of pharmaceutical (550, 59%) and surgical (238, 26%) interventions. 24 (36%) of 67 survey respondents ranked knee replacement as the highest priority for research, whereas 14 (21%) chose education and advice as their first choice.

Interpretation

There is a mismatch between the amount of published work on different interventions, and the degree of interest of consumers. We suggest that broadening of the research agenda would be more in line with current treatment patterns and consumer views. If this mismatch is not addressed, then evidence-based medicine will not be representative of consumer needs.

Introduction

The move towards evidence-based medicine has been a valid response to the variations in practice and behaviour in healthcare. The amount of evidence published has risen steadily over the past 50 years in response to calls for reliable information on efficacy and effectiveness of treatments. As a result, there is too much information for any individual clinician to assimilate. The response to this difficulty has been the publication of systematic reviews, meta-analyses, and guidelines, which have been used to summarise the evidence base for health professionals.

With establishment of the Cochrane Collaboration and publication of their guidelines,1 the methodology used for collating evidence has become more standardised. However, there could be biases that affect research-eg, Gross and colleagues2 have shown how US National Institutes of Health research funding does not reflect the burden of disease on the population. Factors such as funding sources,3 vested researcher interests, publication bias,4 and consumer pressure could all be influencing the research agenda away from the needs of the population it is meant to serve. A biased research agenda could have several consequences. First, treatments that are ineffective might continue to be widely used because of lack of evidence. Second, treatments that are effective might not be used because of lack of evidence. Third, treatments could be restricted only to those interventions for which (potentially biased) evidence does exist. Fourth, treatments that patients find unacceptable may be promoted, resulting in problems with adherence.

As evidence-based medicine has developed there has been a concurrent move towards increasing the role of patients in health-care decision making and policy. More consumer involvement could be creating friction with existing research interests (commercial interest, research groups, government policymakers); the areas and interventions that consumers feel warrant more research attention may not match priorities of those who currently control the research agenda. As a result, there will be an increasing need to find better ways of matching research to consumer needs to provide high quality evidence in areas of importance to consumers. The potential impact of this problem has already been noted.5, 6

We aimed to examine the possible mismatch between the current research base and the agenda of current consumers of that research, using interventions for osteoarthritis of the knee as an example. By mismatch we mean a discrepancy between the treatments investigated by researchers, and those preferred and prioritised by consumers. Osteoarthritis was selected since we have experience of this disease, and it is a good example of a chronic disease with a spectrum of available treatment options. This was a pilot study to explore the views and priorities of groups of research consumers.

Section snippets

Review of published and unpublished studies

Any study of an intervention for treatment of osteoarthritis of the knee in humans published in the English language was included in our analysis. The inclusion criteria were deliberately open to capture the entire research base on interventions, and not specific areas. The selection was undertaken by JAC. A second investigator (PAD) independently checked a random 10% sample of selected studies. Three methods were used to identify articles for review. First, searches were done on electronic

Review of published and unpublished studies

A search of published and unpublished reports identified 51 34 studies. After selection criteria had been applied, English language constraints imposed, and multiple publication addressed, 930 articles remained for review (there was 87% agreement between PAD and JAC on study inclusion, based on a 10% sample of studies).Table 1 summarises the overview results by intervention type. Alternative and complementary treatment included homoeopathy, folk medicine, transcutaneous electrical nerve

Discussion

We have noted a clear mismatch between the interventions that are researched, and those regularly used and prioritised by consumers. The results of our focus groups and survey show that people use various treatment options and want information on all these, and that professional groups want high-quality evidence for all interventions. However, the review of published and unpublished studies shows a massive concentration of research in drug and surgical treatments. This finding suggests a need

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