Monday, July 28, 2014

What is the new research paradigm referred to as Team Science?

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  Nash. Transdisciplinary training found @ http://www.ncbi.nlm.nih.gov/pubmed/18619393
  
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


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)


No comments:

Post a Comment