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Interdisciplinary Research: Developing Strong Partnerships

Interdisciplinary Research: Developing Strong Partnerships. Kathleen A. Dracup, RN, DNSc, FAAN Professor and Dean University of California, San Francisco School of Nursing. Interdisciplinary Research. Everyone talks about it Many groups fund it

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Interdisciplinary Research: Developing Strong Partnerships

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  1. Interdisciplinary Research:Developing Strong Partnerships Kathleen A. Dracup, RN, DNSc, FAANProfessor and Dean University of California, San FranciscoSchool of Nursing

  2. Interdisciplinary Research • Everyone talks about it • Many groups fund it • Few people share what they know about the process

  3. Interdisciplinary Research • Historical perspective • Benefits • Models • Barriers • Strategies

  4. Collaboration - The Foundation of Interdisciplinary Research? • A research effort carried out by a team composed of members from different disciplines • Examples: • Nursing – Economics – Bench science • Medicine – Social/behavioral – Statistics • Psychology * Niles, JONA 2001;31:411

  5. Collaboration: The Alternative View To cooperate with an enemy invader of one’s territory

  6. Historical Perspective Traditional Model Physician Registered Nurses Ancillary Personnel Patients

  7. Historical Perspective Many physicians are aware of the nurse ‘doing her [sic] job over there, while I do mine over here; as long as they carry out my orders, and we get along….’ Tellis-Nayak, Soc Sci Med 1984

  8. Collaboration Inclusion Turf Exclusion Turf Wars

  9. RN-MD Collaboration • Physician’s role as ‘gatekeeper’ has changed • Nurse scientists are often better prepared educationally to conduct research than the physicians with whom they collaborate • In today’s fiscal environment, academic physicians have heavy clinical burdens and little protected research time Increased scientific role for RNs

  10. Collaboration Landmarks

  11. BENEFITS K. Dracup

  12. Why Do We Need Interdisciplinary Research? • Growth in knowledge and technology • Advances in biology, genetics, physiology, pathophysiology, disease processes • Increasing complexity in diagnosis, treatment, prevention • 10,000 published clinical trials/year • Need for large sample sizes

  13. Why Do We Need Interdisciplinary Research? • Demographics • aging population • increase in prevalence of chronic illness • 50% of population has more than one disease

  14. Why Do We Need Interdisciplinary Research? • To bridge the gap between • the behavioral and biological sciences • clinical trials and application in practice • scientists and the community

  15. Efficacy of interventionsin trials Potential Intention Information Effectiveness of interventions in practice Reality Action Behavior Gaps Hill, Circ. 1998;97:807-810

  16. Example: NHANES Hill, Circ. 1998;97:807-810

  17. Why Do Gaps Exist? • Emphasis on basic science and translation into clinical research has led to struggles in funding priorities and handicapped our understanding of how to implement interventions shown to be effective in RCTs Hill, Circ. 1998;97:807-810

  18. Why Do Gaps Exist? • We assume that: • practice guidelines will be followed and patients will improve • if we know the cause of illness, therapies can be applied, patients will adhere, the problem will be solved REALITY: • Healthcare providers and patients are influenced by several factors, many beyond their control • Physical and social environments, health care systems & policies influence adoption of therapies Hill, Circ. 1998;97:807-810

  19. Why Do Gaps Exist? • Organizational structures, staffing, and reimbursement of academic medical centers do not encourage interdisciplinary work, despite results from large, interdisciplinary RCTs Hill, Circ. 1998;97:807-810

  20. AHA Awards - 2001

  21. Interdisciplinary Research-Benefits • Promotes different theoretical perspectives • Brings diversity of talent • Access to special populations • Shared resources augment capabilities • Wider dissemination of research results • Increases opportunities for funding

  22. Wider Dissemination of Research • Jean Johnson • Most widely cited nurse researcher • Published in nursing, medical, psychology journals • http://isi2.isiknowledge.com

  23. NIH* NINR - $118M NIA - $880M NIMH - $1.2B NHLBI -$2.6B NHGRI - $427M NIAAA - $382M NIDDK - $1.5B NCCAM - $100M AHRQ Specialty organizations Private foundations Increased Opportunity for Funding * $ amounts = total budget requests for FY 2002

  24. Current Funding in Interdisciplinary Research MIND-BODY INTERACTIONS AND HEALTH: Exploratory/Developmental Research Program (R21) • “A central goal of this program is to facilitate interdisciplinary collaboration and innovation in mind-body and health research while providing essential and cost-effective core services in support of the development, conduct, and translation into practice of mind-body and health research based in centers or comparable administrative units.” • http://grants.nih.gov/grants/guide/rfa-files/RFA-OB-03-005.html

  25. Fogarty Center NCI NCCAM NEI NHLBI NIAAA NIAID NIAMS NICHD NIDCR NIDDK NIMH NINDS NIA NIDA Participating Institutes

  26. Interdisciplinary Models K. Dracup

  27. Interdisciplinary Groups • Often begin opportunistically • Depend on like-minded people having related aspirations and complementary skills

  28. Interdisciplinary Research Models Are Circular Nurse scientists Statisticians Psychologists Anthropologists Dietitians Sociologists Economists Physicians Patient care advocates Community leaders

  29. Interdisciplinary Models nursing medicine Interdisciplinary psychology nutrition

  30. Intra-disciplinary Intradisciplinary Models • Example: • Study of cognitive functionin elderly patients on chemotherapy • Might include nurse scientists in: • Cancer • Geriatrics • Genetics • Neurology

  31. Models Research Question Answered by Interdisciplinary Team

  32. Models Interdisciplinary Team Develops the Research Question

  33. Barriers K. Dracup

  34. Interdisciplinary Research-Barriers • Historical • competition • territorialism • traditions/stereotyping

  35. K. Dracup

  36. Interdisciplinary Research-Barriers • Structural • institutional organization • lack of role models • academic reward system that focuses on independence

  37. Interdisciplinary Research-Barriers • Interpersonal • ineffective communication • poor conflict management • lack of collaboration etiquette

  38. Strategies and Solutions-Structural & Historical Barriers • Structural • Establish supportive structures within the institution (e.g., centers, advisory boards) • Give priority for space and funding allocation to interdisciplinary teams • Frequent meetings and/or conference calls

  39. Strategies and Solutions- Interpersonal Barriers • Investigator-based • At the first project meeting discuss: • ground rules • strengths, skill sets, and responsibilities of all members • Encourage direct communication between team members • Acknowledge contributions of all team members • Publications - establish guidelines at the beginning for: • authorship • topics

  40. Criteria for Success for Surgeons(also apply to interdisciplinary research!) • Ability • Affability • Availability

  41. A Case Study in Interdisciplinary Research K. Dracup

  42. Exercise and Heart Failure: Effects on the Autonomic Nervous System, Immune Function, Health-Related Quality of Life, Clinical and Cost Outcomes (funded by American Heart Association)

  43. Purpose & Design • Delineate the safety and efficacy of using a combination of aerobic and resistance exercise training modalities in a population of adults with decreased left ventricular systolic function and clinical HF • Randomized, prospective trial

  44. echocardiography, electrocardiogram, heart rate variability cardiopulmonary exercise stress testing with expired gas analysis muscular strength determination pulmonary function testing serum norepinephrine (NE) skin tests to recall antigens immunologic assay health-related quality of life clinical outcomes/costs of care nurses physicians economists immunologists exercise physiologists Inter/Intra-disciplinary

  45. Survival Curves for All Cause Mortality Breslow p = 0.010 Tarone-Ware p = 0.018 Log Rank p = 0.043 K. Dracup

  46. Conclusion • Historical, structural, and interpersonal barriers can impede effective interdisciplinary collaboration • The benefits to overcoming these barriers are great • Interdisciplinary collaboration in science must also be rooted in education and practice

  47. Interdisciplinary Potential Research Practice Education

  48. It is not the strongest of the species that survives, And not the most intelligent, But the ones most responsive to change Charles Darwin

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