Incomplete descriptions are a waste of healthcare research
Researchers, explain yourselves.
10 March 2017
Most of us have probably tried to recreate a meal we’ve enjoyed in a restaurant. But would you attempt it without a recipe? And if you had to guess most of the ingredients, how confident would you be about the end result?
Worryingly, a similar situation frequently occurs in healthcare. Health professional often have to guess the details of the intervention that will help their patients. The intervention might be a drug, or a non-drug treatment, such as an exercise, psychosocial, or dietary advice.
Part of this problem lies with researchers who inadequately describe interventions in research reports — one of the contributors of waste in research. Estimates suggest up to 85% of health research is wasted.
For an intervention to be useful in practice, clinicians need to know details such as: when and how much of the intervention (e.g. intensity, number and schedule of sessions), details (including any training) of the intervention provider, the actual steps involved in providing the intervention, and any materials (information or physical) needed as part of it.
But these crucial details are missing in up to 60% of trials of non-drug interventions. While this problem is more common in studies of non-drug interventions, the problem also occurs in drug studies. In a 2015 study of cancer chemotherapy trials, only 11% reported all the essential elements of the interventions.
Why does this problem occur?
Authors of research reports are often unaware of what a complete description of an intervention means. Upon request, they will often provide missing details.
But deficiencies in intervention reporting are often not detected by peer reviewers or editors. Some authors do not provide intervention details as they may not have access to all the details, or have concerns about word limits or the copyright implications of sharing intervention materials.
For such a prevalent problem, the issue of inadequate intervention reporting has received little attention until recently.
In 2014, my colleagues and I published in BMJ a reporting guide to increase authors’ awareness of the problem, and provide them with a checklist for the essential elements of a intervention description.
The guide makes it easier for authors to describe their interventions, for reviewers and editors to assess the descriptions, and for readers to use the information.
When including all intervention details in the main paper itself isn’t possible, the guide encourages authors to use other means to provide this information and to state where it can be located. This includes online supplementary materials, permitted in about 75% of journals, additional journal articles, study or university websites, or online repositories such as Figshare.
While the guide implores researchers to include intervention details in new papers, the information remains missing in many studies that have already been published. For drug interventions, doctors at least have access to drug formularies, where they can look up basic information, such as the active ingredient, dose, and route of administration.
Equivalent resources for non-drug interventions typically do not exist. One exception is a new handbook recently developed by the Royal Australian College of General Practitioners, which gives general practitioners the details they need to provide evidence-based non-drug interventions.
Authors, reviewers, and editors have a responsibility to improve the comprehensivity of intervention reporting. Without adequate details, effective interventions cannot reliably be used by others. Clinicians, patients, and policymakers can’t reliably use effective interventions and researchers are unable to replicate or build upon the research. Given the cost of conducting trials, this is an enormous waste.
Tammy Hoffmann is a professor of Clinical Epidemiology at Bond University. She tweets @Tammy_Hoffmann