THE EVIDENCE SANDWICH MODEL Research priority setting exercises

THE EVIDENCE SANDWICH MODEL Research priority setting exercises: how to reach and address needs of disadvantaged groups Dr. Soumyadeep Bhaumik Bio. Medical Genomics Centre, Kolkata drsoumyadeepbhaumik@gmail. com No Competing Interests & Not Funded

Agenda of Medicine… ‘We live in a world with infinite possibilities. Hearts are transplanted, DNA is decoded, and new medical discoveries are made every day. Yet we continue to be stymied by how best to reach those in resourcepoor settings with the most basic care and medicines that we take for granted. What could break through this conundrum? ’ Bill Frist & Richard Sezibera. The Lancet, 2009; 374: 1485 -1486

Formulating Research Agenda Epistemic Deliberation over priority clinical and public health questions. . . Evidenc e Practical Equity Research Agenda Systematic Review and Metaanalyses on priority questions Evidence Clinical Expertise Patient Preferences Evidence Informed Medicine

What is needed more … Ø Acceptability Ø Feasibility Ø Affordability Ø Potential Ø Answerability Ø Applicability Ø Deliverability Ø Equity Ø Existing Research Capacity Effect on disease burden Ø Potential for further research Ø Impact

Evidence Sandwich Model DEFINING OBJECTIVES, MARKING DOMAINS AND ELUCIDATING CRITERIA EVIDENCE PRIORITY SETTING EXERCISE

EVIDENCE SANDWICH MODEL DEFINING OBJECTIVES, MARKING DOMAINS AND ELUCIDATING CRITERIA Role of Epistemic community to set the ball rolling…

Defining Objectives/ Scope of Priority Setting Exercise 1. To review existing evidence in relation to the problem identified 2. To prioritize research questions that need to be answered in relation to laboratory, clinical studies, treatment trials and prevention approaches. 3. To develop plans for collaboration, networking and advocacy in relation to research, policy and training 4. To identify potential bottlenecks in the actual implementation of research including availability of funds 5. To limit the scope and limits of priority setting

Consideration’s for setting priorities within a domain Ø Burden of Disease ØStatus of diagnostic/treatment options – their D efficacy, adverse event profile, consensus E on its use I F I in practice or guidelines R A L Cdiagnostic / treatment ØPotential availability of better E R options A E S E ØAffordability of available diagnostic / treatment H. T. options L … L A EN Eof Health H Systems Ø Needs C T N O NLY ØFeasibility and Implementation ability O

EVIDENCE SANDWICH MODEL RAPID SYSTEMATIC REVIEW & EVIDENCE MAPPING What is already known and what is not ?

Elucidating Research Questions � Identify the key stakeholders(including decision makers) affected by the results of this research agenda? � Stakeholder engagement is long-term. � Derive research questions from stakeholders as well as from data sources including from systematic reviews on relevant topics. � Research questions should not be only on clinical/public health safety and efficacy issue but also on implementation , ethics , training, capacity building etc. � Considerations defined previously to be refined

Evidence in Priority Setting Exercise • Population of interest • • Formulatio • n of PICO • Intervention to be experimented/ evaluated Control to act as a comparison Outcomes of importance Protocol • Comprehensive Search such that no research evidence is missed Search For • Screening through studies to obtain further studies for analysis Evidence • Grey Literature Search • Data Collection & analyses Analysis • Interpretation and Review • Summary of Finding & Review Brief

Evidence Mapping

EVIDENCE SANDWICH MODEL PRIORITY SETTING EXERCISE DELIBERATIVE PROCESS & GROUP DISCUSSIONS • Making research practical & relevant

Priority Setting Process All evidence summaries and priority questions to be send to stakeholders and open to modification Survey of Priorities from patients/ affected groups Thematic session with slots for basic science, clinical medicine, laboratory medicine, clinical researchers & identified interdisciplinary work Qualitative Lectures on community experiences Final session consensus on priority recommendations, discussion on potential collaborations & advocacy

Within a session … Deliberative quest • To ensure voice of all stakeholders are heard Group Discussion • With the aim of reaching consensus on priorities • Translating between different spheres of Use foresight and Don’t Shy from expertise stepping back.

Successful Priority Setting Needs Having the Sandwich Again DEFINING OBJECTIVES, MARKING DOMAINS AND ELUCIDATING CRITERIA EVIDENCE PRIORITY SETTING EXERCISE

Why the Evidence Sandwich Model ? �Broad format with adaptability. �Structured to guide process. �Collaborative & Transparent. �Common ground with sense of ownership. �Introspection within at every step. �Needs of disadvantaged groups addressed. �Ensures Equity. �Remains open-ended. �Ensures balance between best science versus trade-offs.

More Resources : www. capsmg. cochrane. org drsoumyadeepbhaumik@gmail. com Dr. Soumyadeep Bhaumik Bio. Medical Genomics Centre Kolkata, India