5th International Cancer Control Congress
Opportunities for integrating pragmatic research approaches to support practice and policy priorities
Dr Jon Kerner - Canadian Partnership against Cancer (CPAC), Canada
I’ve been asked to talk about the role of what’s called pragmatic research in terms of how it helps inform practice and policy. I spent twenty years as a researcher and much of the research that I did and my colleagues did would get published in peer reviewed journals but was not necessarily read or understood by those who could benefit from learning the lessons from science. So one of the things that has happened in research is that if research is to influence practice and policy the question then comes up, how does practice and policy influence research? How do we make sure that the research questions academics are looking at are actually the questions that are plaguing the public policy or the public health or the clinical practice communities? The pragmatic research approach says, well, if you’re going to design a research question or address a research question that actually helps people in the field, in the practice and policy fields, you need to rethink how your research is done. So in the kind of research I was trained in everything is controlled very tightly so the exact people who are going to be invited to participate in the research are very specific, they can have some risk factors but not others, they can be exposed to certain interventions but only a certain way and only delivered by people who are well trained. That’s good when you’re trying to understand whether or not what you’re doing is making a difference in an experimental setting but it’s not so useful when you’re actually trying to translate that experiment into the real world. So the pragmatic research approach is arguing that you should involve practice and policy people in the design of the research, you should try and make the people who are participating in the study more heterogeneous so that they reflect the real world, not the tightly controlled world of an experiment, and that the way it’s delivered should reflect how it would be delivered if it works in the real world. So it’s very much trying to understand how to make our research more relevant to the practice and policy people who will be looking to improve what they do but need to know that the research that was done is relevant to the context in which they work.
Could you talk to us about the differences in peer review requirements among different regions of the world and specially Latin America?
There are two pieces, or two answers, to your question. First, as part of my presentation I was trying to learn what are the research resources in Latin America, so what kind of research gets done in Latin America. It was very hard to find that information. So in Canada, for example, we have something called the Canadian Cancer Research Alliance which actually documents all the funding of most of the major research funding agencies in Canada. So we know whether, for example, how much money we’re spending on basic science, how much money we’re spending in clinical research, how much money we’re spending in population science in the different areas. So when you’re trying to compare Latin American research with research in Europe or in North America, if you don’t know where the money is being spent and what kind of scientists are working in Latin America it’s very difficult to make the comparison.
The second answer to your question is should the criteria for peer review be the same? The dilemma there is this gets back to the pragmatic research design. The protocols for peer review tend to be defined by the very tightly controlled experimental models. So when people working, for example, in Latin America, may start to do what I would call pragmatic research where they’re not being as tightly controlled but they’re engaging more of the audience that’s being studied in the design of the research, you need a peer review system that values that. If you don’t have that then all of that research is going to be knocked out in peer review. So it’s important for your journal to look at the kinds of research that’s being done in Latin America and decide what’s the right peer review model for this so that you’re mixing both. Both types of research are valuable but the peer review process has to be different.
