MULTIDISCIPLINARY TO TRANSDISCIPLINARY
TEAM SCIENCE AND BEYOND
What is the new research paradigm
referred to as Team Science? Since health care problems are often complex and may
be difficult to understand and improve via a one investigator or single discipline
approach, a team science approach is advantageous and necessary for advancing
science. Different disciplines can integrate their expert knowledge in
designing a research study in order to address a complex health problem so that
a positive comprehensive outcome is achieved. The degree of the complexity of a
given problem, the desired outcome and level of analysis drive the depth and complexity
of team science. The prototypes for team science have progressed from a
multidisciplinary approach to an interdisciplinary approach to the emerging paradigms
that include transdisciplinary and patient-engaged teams.
TYPES OF RESEARCH APPROACHES
In order to illustrate
how team science can be conducted, the class was given a group assignment to develop a study using each one of the
study designs discussed in class. The research topic involved the role of
nutrition in assisting older adults with cancer to maintain their weight while undergoing
chemotherapy.
Multidisciplinary
Research: Knowledge that is drawn from
diverse disciplines but research questions and methods stay within the distinct
boundaries of each discipline. Multidisciplinary research may consist of “multiple
silos" or “parallel play” research. Members of different disciplines
consult with one another and at the same time contribute their independent perspectives.
Common Assumptions: Each discipline needs to recognize
the limitations of their perspective; disciplines can hold contrary assumptions about the appropriate
questions to be asked or the nature of the phenomenon under investigation. Cross-disciplinary
understanding may result as the team members recognize the relevance of others'
findings.
Theoretical Framework &
Analysis:
Research questions are constructed
from each disciplinary theoretical framework, constructs, and world view.
The analysis is done independently from the perspective of each individual
profession. The study is done in parallel though the research questions to be
answered are independent of each other but contribute to the overall study
aims.
Example of a Study using Multidisciplinary approach:
Aims: The goals of this
research study are to describe and explore the changes in the nutritional and
functional status of older adults who are receiving chemotherapy
Methods: Mixed methods, both quantitative & qualitative descriptive
study
Research Team & Area of Interest:
RN/ PI: Quantitative: gather data on
physical function performance status, instrumental activities of daily living, functional
status, a mini-nutritional assessment (albumin/pre-albumin), and frailty
assessment pre and post chemotherapy.
Dietician: Ask for diet diary,
evaluate & look through the medical record to measure weight change,
determine kilocalories, micronutrients and macronutrient, dietary changes over
time (i.e., diet ordered, kilocalories intake over time)
Oncologist: Measure the dose of
chemo, toxicities (including nausea and vomiting), and dose or treatment delays
Geriatric anthropologist:
Qualitative interviews: How being a cancer patient undergoing chemotherapy has
affected the meaning of food and eating habits (including social interaction
r/t food). How eating has changed during the cancer diagnosis, conducts interviews
on dietary likes/dislikes, social effects.
Pharmacist: Look at drug dose, drug
interactions and effects on appetite, anti-emetics that may improve appetite
depending on drug interactions with specific chemotherapy protocol
Interdisciplinary
Research:
Analysis, synthesis and harmonizing of links between disciplines into a
coordinated and coherent whole, integrative and reciprocally interactive
approach that synthesizes diverse disciplinary perspectives. In
interdisciplinary research two or more disciplines mutually conduct research
guided by a structure that reflects a blurring of disciplinary boundaries in
the integration of perspectives of each involved discipline.
Common Assumptions: Ideally suited to complex and real
word problems, individually each discipline is inadequate to solve the
phenomena of interest, and more importantly interdisciplinarity assumes
disciplinary perspectives are partial and biased.
Theoretical Framework & Analysis:
Bridge
epistemologic gaps between disciplines and building on theories posited by
all disciplines involved.
Example of a Study Using an Interdisciplinary Approach:
Aims: An interdisciplinary approach
to maintaining healthy weight in the elderly patient experiencing chemotherapy
Key
disciplines: Nursing, Pharmacy, Dietitian, Behavioral
Health Specialists, Physician
Methods: Qualitative with interviews with caregivers; Baseline data
on patients
Insights and lived experience with
regard to this patient problem from caregivers perspective. The questions will be crafted by a
nutritionist, nurse, social worker, and medical oncologist. Each question will ensure integration among
the disciplines.
Transdisciplinary
Research: Integration
of natural, social and health sciences, holistic approach, creates a common
conceptual-theoretical-empirical structure for research. There are no boundaries between disciplines; in
fact it may result in a new integrated discipline such as neuroscience.
Common Assumptions: Disciplinary boundaries must be
dissolved in order to develop novel methodologies, traverses all disciplines,
concepts are transdisciplinary in nature, and the knowledge in between
disciplines is as important as those within the disciplines.
Theoretical Framework and Analysis: One theoretical framework is
developed which crosses all disciplines. The Socio-ecological
Framework provides one model for the transdisciplinary approach
Example of a Study using a Transdisciplinary Approach:
Research Question: How can older adults undergoing chemotherapy maintain
weight through nutrition?
Team: Aging Services, City planning, Geriatric Oncologist, Nutritionist,
Gerontologist, Dentist, Oncology nurse scientist, Geographer
Factors: taste changes, nausea, mucositis, lack of energy to prepare
meals, lack of support system, lack of availability of food, lack of accessibility
to food sources, e.g. transportation
Research Design: Descriptive study on how these factors affect older adults' nutrition
& weight
Methods One model would be created but
each discipline might contribute as follows:
·
Geography- GIS mapping
·
Aging services & city planning- explore
existing resources and what are lacking (gap analysis)
·
Dentist- Assessment tool to assess oral health
·
Nutritionist- history, biomarkers, monitoring
intake, weight
·
Geriatric oncologist & nurse scientist- type
of chemo, clinical factors, antiemetic intervention efficacy
Patient
Engaged Research: focuses on patient and family
engagement in research to help inform the research questions, study design, and
interpretation of results.
Common Assumptions: The whole patient needs to be
considered, the patient/family/community all contribute to research, the
patient is representative of the community as a whole.
Theoretical
Framework and Analysis: Patient engagement is conceptualized to
include self-awareness, clinical alliance, tool for health self-management, citizen
empowerment and effective disease self-management. Reference: http://www.jopm.org/evidence/reviews/2014/06/11/the-challenges-of-conceptualizing-patient-engagement-in-health-care-a-lexicographic-literature-review/
Example of a Study Using Patient-engaged Research Approach:
Research
Title: Using technology to delivery
personalized meal plans for the older adults who receiving chemotherapy
Rationale: Even though older adults may have technology challenges,
there is study reporting that old people are willing to use technology to get
personalized care. Remote technology has interactive features that will allow
older adults to have timely information regarding their care plan meanwhile
reduced travelling and caregiver burden.
Aims: Engage patients, families or caregivers in the
research design and implementation –One example is to conduct focus groups but this
is a low level of engagement. A better approach is
to build partnerships with medical
and non- medical stakeholders in the research design and implementation. One
focus might be to describe the barriers to, facilitators of smartphone use
as an approach to engage patient and family or caregivers in the personalized
meal plan in older adults who receiving chemotherapy
Methods: Mixed Methods: two stage
·
Focus group with older adults receiving
chemotherapy to determine what current nutritional interventions they are doing
and identify unique dietary needs of this population. Additionally the focus
group will be asked regarding their use of technology (internet, smart phones, and
tablets).
·
After needs are identified, an intervention study will be designed by all members of the research team including
nutritionist, case management nurse, social worker, medical oncologist, as well
as members of the focus group.
What is noteworthy about the
examples is the team members may be the same but how they work together as team
scientists is quite different!
CHALLENGES OF THE NEW PARADIGM
Conflict,
controversy, tension between the paradigms
Beside group dynamic challenges can
occur when working with researchers that hale from several different
disciplines. There are some other potential conflicts that can arise when team science
evolves to an interdisciplinary, transdisciplinary or patient-engaged approach.
Historically infrastructure and incentives in academia have rewarded
“independent investigator-initiated” research. Conflicts can arise from
ambiguity among the disciplines related to integrated research approaches; unclear
expectations and norms; differences in language and terms used to describe
similar phenomena; engaging with unfamiliar would-be competitors in an
unsupportive environment; confusion in identity for securing grants and sharing
funds ;and the devaluation of multi-authorship
publications toward tenure. .
Barriers
to adoption of new models
A patient-engaged research approach requires
patient involvement which is becoming paramount to conducting health care
research; however there can be barriers to sustaining such research. Currently
there is funding and incentives for patient-engaged projects; however there is
a concern about how such research can be sustainable once the funding and
incentives expire. There can also be disagreements between academia, private
industry, and consumers in identifying which projects should be funded as a
priority in improving our nation’s health. Other potential barriers pertain to
proprietary rights to research innovation. In order to conduct rigorous and
ethical transdisciplinary or patient-engaged research, a good infrastructure and
shared norms need to be in place. Training and practices that incorporate
ethical principles, group cohesiveness strategies and a commitment to learning
from mistakes is essential.
POTENTIAL IMPACT
The potential impact of research
conducted within the new transdisciplinary paradigm can be significant. Each
different discipline brings a diversity of research methods based on
theoretical frameworks in which to generate hypothesis that would not be possible
via an interdisciplinary approach. Levels of analysis between disciplines can
be bridged to bring about conceptual theories that are utilized to improve
health interventions. Involving patients as stakeholders in research can have
an effect on designing interventions that are practical and acceptable, eliminate
health disparities, decrease gaps in knowledge and promote the efficient use of
health care resources.
FUTURE DIRECTIONS AND QUESTIONS
The new paradigm of team science
that includes transdisciplinary and patient-engaged research is still
evolving. The Affordable Care Act of 2010 established the Patient-Centered Outcomes Research Institute
(PCORI) in order for health care research efforts to be truly
patient driven and focused. PCORI research can be conducted via a
transdisciplinary approach as it encompasses many different stakeholders from
many different disciplines with the same goal: to improve the health of the
Nation. Future directions of team science should include research that focuses
on preventing disease, improving health care systems, disseminating and
implementing research into practice and decreasing health disparities. There is
no doubt that mistakes and new questions will arise as research is conducted in
the new paradigm; however a key component to success is prompt identification and
resolution of such concerns and never losing sight of the intended goal of the
research.
RECOMMENDED READINGS OR LINKS FOR
MORE INFORMATION
Relevant
Readings
ü
Fawcett. Thoughts about multidisciplinary
research found @ http://www.ncbi.nlm.nih.gov/pubmed/24085679
ü
Hall. Feng. moving the science of team science
found @ http://www.ncbi.nlm.nih.gov/pubmed/?term=hall+and+feng+and+moving
ü
Interdisciplinary research in Hartford Program
found @ http://www.ncbi.nlm.nih.gov/pubmed/22881481
ü
PCORI-Patient-and-Family-Engagement-Rubric
found @ http://www.pcori.org/assets/2014/02/PCORI-Patient-and-Family-Engagement-Rubric
ü
pcori.agenda found @ http://www.pcori.org/assets/PCORI-National-Priorities-and-Research-Agenda-2012-05-21-FINAL1.pdf
Some Other Useful Links
“The Science of Team Science: Dr.
Stephen Fiore” www.youtube.com/watch?v=R1FnxSvjoh0
Created by Participants in Nursing 7106 Context
for Advancing Science (and Improving Health)
University of Utah College of Nursing PhD
Program Summer 2014
Submitted by:
Tracy A. Ruegg MS, CNP, AOCN and Meghan Routt MSN RN GNP/ANP, AOCNP
(Lead Authors)
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