A Call to Action: Narrowing the Evidence-Practice Gap

David J. Kerr, CBE, MD, DSc


July 07, 2022

This transcript has been edited for clarity.

I'm David Kerr, professor of cancer medicine at University of Oxford. I've spent a clinical academic lifetime producing what I think is high-quality research, from basic research on the biology of cancer through large, pragmatic clinical trials, particularly around colorectal cancer, my favorite tumor type.

What I've never done, though, is examine the gap between evidence and clinical practice. I conduct a large trial that's a 7-year experiment. I write up the results, I publish it in a high-quality journal, and I think that my job is over. It's not. The gap between me providing what we thought would be practice-changing evidence and its uptake is highly variable. This evidence-practice gap seems to be getting wider.

There's, again, a provocative article published recently in The Lancet, asking for improved funding for research that closes that gap, for us to understand better what the delays and barriers are to uptake of practice-changing clinical trials.

If we look at implementation research, this is formative research in which it's possible to definitively study what the gaps are. These include acceptability, adoption, appropriateness of the treatment for any particular population in any particular country, cost, feasibility, fidelity, reach, access, and of course sustainability. These are also linked with the service outcomes that are usually embedded as endpoints in a clinical trial, including effectiveness, safety, and equity.

If I believe that my job is done when I make the publication, nothing could be further than the truth. I think this paper describes a call to the funding bodies to take this form of research much more seriously. If we are ever to close the health equity gap between rich and poor, then these are some of the elements of work that we need to do.

This covers the entire spectrum of cancer control — prevention, screening, therapeutic intervention, and so on. Unless we focus more on this level of formative research, and unless it's funded, then the health equity gap — the gap between evidence and practice — will grow ever wider and the academic work that we're doing will become less relevant and more marginalized.

It's a call to action and a call to arm to funding bodies to see how is it that we can actually do better to pull the investment levers on implementation research, particularly in oncology, in our own field. I think it's something that should be supported and I think we should consider training a new generation of young researchers.

It could be particularly important in low- and middle-income countries, in which the pressures of adoption of new treatments are much higher and the barriers to entry of new gadgets and new drugs are much higher. Therefore, that would be a fascinating place for us to start and grow this movement of implementation research.

Please have a look at the article. I'd be really, really interested in your comments. I think it's something that needs to be taught, and I think that it could become equally as important an academic discipline as those of us who are involved in delivering clinical trials, basic insights into cancer biology, and so on.

As always, Medscapers, thanks for listening. For the time being, ahoy, and over and out. Thank you.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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