Improving the Publication to Practice Pipeline: Effective Dissemination of Research Results

When results are available from a clinical trial, they are typically presented at a scientific conference or published in a medical journal. Yet, from there, a surprising amount of time can pass before the results are reflected broadly in clinical practice. A common estimate suggests that the process takes about 17 years on average—a lag that has profound implications for patients.

Below, Ruth Carlos, MD, MS (pictured), a radiologist at the University of Michigan Rogel Cancer Center and health care delivery researcher, discusses this phenomenon and shares potential ways to improve the dissemination of research results.

What is the current research on the dissemination of research results and translating results to clinical practice? 

We know that translation of evidence into practice takes an average of 17 years, which is an extremely startling and disappointing piece of information. This long pipeline can be explained in part by the potential challenges of changing both individual and system behavior. These challenges may be at the patient level, the physician level, or the practice level. The ways in which we deliver care may not always provide the appropriate incentives to ensure that the latest evidence-based practice is implemented. Anyone who has tried to stop eating their favorite food knows just how hard changing behavior can be. Organizations can also be thought of as beings, with habits and incentives—both internal and external—that either reinforce the status quo or promote change.

The discoveries produced through clinical research are primarily consumed by other researchers and, eventually, practicing clinicians and their systems. Patients are often excluded from this dissemination process, which is troubling because patients are crucial to conducting clinical research in the first place. This exclusion is not necessarily intentional, but instead reflects a lack of understanding about the patient perspective. In recent years, researchers have focused on integrating the patient experience and perspective into trial development. Now, the focus should expand to include involving patients in the dissemination process. What information would they prioritize? What are the best methods or tools for sharing information in their communities?

What are some of the available communication channels?

A variety of mechanisms are already in place to reach people in their communities, such as health advertisements or public service announcements. Researchers can utilize similar channels to disseminate study results. An important question to consider is: How do we craft messages to ensure patients are getting the information that they need and deserve? At a minimum, all patients who participate in a clinical trial should receive a summary of the results at the time that the results are published in a journal. This would help reinforce the value of their participation. Dissemination can also serve as a motivator for advocacy and partnership with patients and our lawmakers.

What are some of the challenges to disseminating results in a timely manner?

Professional advancement in academia is closely tied to factors such as the number of papers a researcher publishes or the number of grants they secure. The system does not incentivize or reward disseminating research results in the community. The field of implementation science is studying this—how to implement evidence-based practices at institutions and how to disseminate evidence-based practices in communities. A key component is communication with all stakeholders, including patients.

How can advocates help address these challenges?

If a patient or advocate was involved in helping to develop a clinical trial, they should also be part of the team that writes the results manuscript for publication. Patients should be involved in that process and then also in summarizing the information for different communities. Should the results be presented as an infographic? Should they be packaged as a series of email communications? Should they be presented by a physician spokesperson at each practice, knowing that sometimes care is very local, and patients rely heavily on their physician’s guidance?

Another way advocates can help is by distilling the results in a way that is not too scientific. Lay language summaries of trial results should be available for all studies that are published in scientific journals.

Can you share any examples in which this work is being done successfully?

At the Journal of the American College of Radiology, an advocate serves on the editorial board. Part of her role is to take ACR Appropriateness Criteria or clinical guidelines and summarize them in patient-friendly language. The American College of Radiology and Radiological Society of North America host a website where patients can look up specific tests or symptoms and view the recommended clinical tests in lay language.

Dr. Carlos is chair of the ECOG-ACRIN Cancer Care Delivery Research Committee, co-chair of the Cancer Control and Survivorship Committee, and a member of the Principal Investigator Committee.