Evidence-based research proving vital for good healthcare

Research Lives: Prof Declan Devane, chair of midwifery at NUI Galway

A lot of your research focuses on evidence in healthcare. Why?
"In health, we want everything we do to be backed up by evidence, rather than doing things because they have always been done that way, or because it seems like intuitively it should work. I am interested in how we gather and synthesise evidence, and how we use evidence to inform healthcare and policy."

Where have you seen evidence changing accepted wisdom?
"I have worked as a midwife and as a researcher in maternity services for about 25 years, and I've been involved in studies that challenge the way things are done. For example, when continuous electronic monitoring of the fetal heartbeat in labour came in, the heartbeat would be monitored by a machine for about 20 minutes at the start of labour, rather than the previous approach of a midwife or doctor monitoring it intermittently. You might think that newer and electronic would be better, but in 2012 we carried out a meta-analysis that showed for low-risk women the older, intermittent checking was linked with a lower rate of birth by Caesarean section when compared to the electronic monitoring."

What is a meta-analysis?
"That's where we ask a research question and then go to the literature and find studies that already exist in that area. We set down criteria, and the data from studies that meet the criteria get pooled so we have a much larger dataset to interrogate. In the case of the heartbeat-monitoring study, it meant we could analyse existing data from about 13,000 labours."

What do you wish people knew about clinical trials?
"Randomised trials matter. They are the best way to evaluate how effective something is, such as a drug or another treatment. But it can be very hard to recruit enough participants. It is a big stumbling block: many planned trials across Europe don't recruit enough people to take part in them, then they need more funding and support to make that happen. It can also be a challenge to keep patients on the trial for its duration."

How can that be tackled?
In Ireland we have set up the Health Research Board Trials Methodology Research Network [HRB-TMRN] to look at these and other issues and to help people who want to improve how randomised trials are designed, conducted, analysed and reported."

What would you like to see happen in the clinical trial space?
"I would like to see the public more involved in randomised trials and more of a focus on the outcomes that interest patients as well as the ones that interest clinicians. There can be a difference between the two. I think if more people who are looking to do a clinical trial engage with patients in advance and find out the outcomes that are important to them, those kinds of outcomes could be part of the trial and that in itself might help with recruitment and make the trial more valuable across the board. But of course we won't know for sure until we gather and analyse the evidence."

Finally, do you have words of wisdom for anyone seeking to innovate?
"Challenge all of your assumptions (my own included!). Just because something is done a particular way, that doesn't mean it is the only or the best way. Think creatively about how to put those assumptions to the test, and you never know, the alternative could be much better."

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