Article Summary: Translational Research from the Perspective of Basic & Clinician Scientists

By Trish Roche

In the interest of exploring the perspectives of basic researchers in regards to knowledge translation, this post summarizes a recent systematic review and narrative synthesis that looks at the concept of translational research (‘bench-to-bedside’ knowledge translation) from the perspective of basic and clinical scientists [1]. The majority of the 26 studies reviewed were published between 2009 and 2014 — aligning with a growing interest in translation of research evidence into clinical benefit — and include qualitative, quantitative, and mixed method approaches. The setting of these studies spans the globe and includes laboratories, hospital-university collaborations, clinics, and research networks. Through a ‘narrative synthesis’ (i.e. text/word-based description), the authors describe the findings in terms of 5 main themes:

Theme 1: Conceptualization of Translational Research

Interestingly, despite the diversity in terms used to describe translational research (like T1 research, among others), only one study explicitly asked scientists to define the term. The authors state that respondents were generally “unclear” as to the actual definition and provided “minimal definitions such as ‘to try and move stuff from the lab to the clinic’” (though that seems like a pretty accurate description to me).

A more important finding is the contrast between systemic and individual perceptions of translational research. Organizational and institutional conceptualizations are usually represented by a linear model or ‘pipeline’, with a unidirectional flow of information from the lab to the clinic. Not surprisingly, scientists’ perception of translational research — as an iterative or circular process — seems to more accurately reflect how translational research happens in practice. Many attest that the linear model of translation only serves to hinder the flow of knowledge between basic and clinical research.

Theme 2: Research Processes

Most of the findings under this theme fall into the “barriers” category — such as complex and time-consuming regulatory and ethical processes (especially in stem cell research). Also described as problematic is the all-too-prevalent assumption that animal studies will lead to clinical trials in humans — which is usually not the case. For example, in cancer research, less than 8% of animal model studies are successfully translated to clinical cancer trials [2]. The tension between the “rigor of animal studies” and “relevance of human studies”, in addition to pressures to publish, are also cited as barriers to translational research. The authors also lump in lack of training in translational research, and lack of access to resources (such as information technology systems and bioinformatics) under this theme.

Theme 3: Research Vs. Clinical Care

Responses in this theme seem contradictory — though the authors describe a “perceived cultural divide” between basic and clinical research, they go on to say that the “boundary” between these two realms is “ambiguous, fluid, and flexible”. Either way, the two groups report different challenges in translational research. Clinician scientists struggle with:

• A lack of training in translational research
• The time-intensive nature of training
• Lack of time
• Demanding clinical roles
• Lack of professional recognition for translational research
• Challenges in career progression for translational research activities
• Competition with full-time researchers for translational research funding

The motivation for clinician scientists to do translational research summarized by the authors as “strongly linked to perceived patient benefit of the research; research considered likely to have low patient benefit was viewed as disruptive to clinical care”.

In the case of basic scientists, barriers included the fact that for many, translational research just isn’t central to their research agenda. They also find reward and recognition more difficult in translational research, and worry that their peers will not view translational research as “authentic knowledge”. Basic scientists also highlighted the tendency of translational research policy to focus on clinician scientists as another barrier (which is intriguing since clinician scientists were worried about competing for funds — which is it?).

At least from the authors’ perspective, translational research appears to be more closely aligned with the professional interests of clinician scientists in answering health-related questions; clinician scientists also perceive themselves as “mediators and collaborators” of the relationship between ‘pure’ clinicians and scientists in translational research.

Theme 4: Interdisciplinary Collaboration

This theme is almost entirely positive — interdisciplinary collaboration is key to successful translational research. So what does collaboration do?

• Provides ‘knowledge exchange’ opportunities
• Offers “distinct forms of expertise”
• Fosters an environment of communication and cooperation

Since it is obvious that interdisciplinary collaboration is important to translational research, the authors further explore this theme by looking at the factors affecting collaboration itself.

Facilitators of Collaboration:

• Physical proximity of experts
• Cohesiveness between bioinformatics & clinical-informatics
• Accommodating infrastructure and environment
• Former working relationships
• Prior collaboration experience
• Presence of “key members” that could act as knowledge brokers

Barriers to Collaboration:

• Working in silos
• Poor leadership/mentorship
• Lack of experience in collaboration

Theme 5: Entrepreneurial Science

Many scientists felt the increased focus on entrepreneurialism to be a driver of translational research and entrepreneurial skills an “advantage to secure funding for translational research”. Also categorized in this theme is the concept of an “entrepreneurial hospital” — that is, publicly funded hospital-university collaborations — which are seen as a benefit for translational research, both in providing accessibility to patients and attracting industry interest.

The relationship between universities (as producers of basic research) and industry (as mobilizers of research) is viewed by some as a hinderance to collaboration and translational research. In the United Kingdom specifically, respondents report a lack of interest and support for technology transfer as a barrier to translational research —but I’m not so sure this is the case in North America, at least not here in Manitoba — where we have dedicated technology transfer specialists to assist researchers (i.e. the University of Manitoba’s Technology Transfer Office).

As a whole, the article provides insight into some of the challenges basic and clinician researchers face when doing translational research — which seem to consist primarily of organizational barriers such as the ‘pipeline’ model and a general lack of institutional recognition of the benefits of translational research, leading to a lack of training and recognition in the field.

What do you think? Do institutions need to do more to foster collaboration and translational research for basic and clinician scientists? Do you do translational research? What are your major challenges and facilitators? Let us know in the comments or on Twitter @KnowledgeNudge

References

1. Fudge et al. Optimising Translational Research Opportunities: A Systematic Review and Narrative Synthesis of Basic and Clinician Scientists’ Perspectives of Factors Which Enable or Hinder Translational Research. PLoS One, 2016;11(8): e0160475.
2. Mak et al. Lost in translation: animal models and clinical trials in cancer treatment. Am J Transl Res, 2014;6(2): 114–8.