Example of an engagement and impact plan plan - Shared decision-making for high risk surgery
Researchers who apply for funding from NIHR research programmes are expected to include an engagement and impact plan in their application. This plan should outline how you will engage with research users to deliver impact from your research.
This case study outlines the dissemination and engagement plan in an application to the NIHR Research for Patient Benefit (RfPB) programme, with the text in red indicating the key features that help make this plan effective.
Funding stream: Programme Grants for Applied Research
PI: Professor Rupert Pearse
Aim: To help older patients better understand the risks of surgery through developing a shared decision-making tool
Co-applicants: 16 in total. Ten academics including one improvement scientist costed in for 50%, one with expertise in participatory research design and one leading academic in influencing policy; four clinicians including two surgeons, one GP and a senior director from the Royal College of Surgeons; two patients and members of the public.
Good mix of academics, those with frontline operational expertise and those who know how to make change happen. Excellent that Royal Colleges involved, because Royal Colleges have significant reach. Well-balanced team with access to the right knowledge and networks.
Methods: Co-design of shared decision-making tool, including testing the intervention in later stages with clinician and lay volunteers using simulations before it will be tested in a clinical trial.
Many research teams develop tools, usually without sufficient input from those expected to use the tools. The proposal suggests that this tool will be properly designed.
Patient and public involvement and engagement (PPIE): Two people with experience of surgery, one with previous experience working on research studies and one who is new, which will provide a different perspective. Have roles in all aspects of the study including co-design of the tool, data collection and steering committees. Will chair the shadow programme steering group, made up of members of the public and people with lived experience of major surgery to ensure programme remains patient centred.
Two PPIE co-applicants involved throughout suggest PPIE is being properly interwoven.
Resources: 11% going to improvement scientist and others who know how to make change happen. £37k to clinicians. £21k to PPIE. Time dedicated to dissemination and engagement not clear, partly because inherent in research methods.
Allocated enough financial resource.
Dissemination and engagement plan
The research idea was generated in response to:
- questions from James Lind Alliance, such as ways of improving communication between surgical teams and their patients
- doctors’ stated needs for specialist aids and training in the field of surgical decision-making.
Responding to robust way of identifying research questions of relevance to service users and doctors.
The researchers plan to spread the shared decision-making tool through the Perioperative Medicine Advisory Board hosted at the Royal College of Anaesthetists (RCoA). This group was convened to promote innovation and quality improvement, in particular for high-risk surgical patients. The group has representatives from 30 different organisations and stakeholder groups including patients, NHS managers, NHS England, Scotland, and Wales, the Association for Perioperative Practice (nurses and allied health professionals), and various Royal Colleges representing surgeons, general practitioners, geriatric medicine, and more. Improving the quality of shared decision making for high-risk surgical patients is a central interest of this Advisory Board.
In addition, the RCoA Perioperative Medicine Programme has 173 local Perioperative Medicine leads covering every NHS trust / health board in the UK. By implementing the decision support intervention through the RCoA Perioperative Medicine programme, the researchers will directly target the senior doctors with a specific interest in this issue who can lead local implementation by engaging with stakeholders in surgery, anaesthesia and medicine, as well as nurses and allied health professionals.
This network has the right practitioners, policymakers and patients involved to make a difference. With a lead in every NHS trust and health board in the UK, the infrastructure is in place to give this tool a real chance of spreading across the NHS, if it has enough champions.
In addition to working with the Perioperative Medicine Advisory Board and publishing scientific papers in open access journals, the researchers plan to:
- Promote the intervention to doctors through the Royal Colleges and specialist societies via meetings and e-newsletters, with patient reps communicating to the doctors.
Linking into the Royal Colleges should help them to reach a wide variety of stakeholders.
- Use health coaching to promote awareness of the intervention amongst potential high-risk surgical patients through charities and other patient groups, social media and the press.
Using this combination of charity, patient group and social media networks can be powerful in reaching a range of stakeholders at local, national and international level.
- Disseminate findings throughout the study to patients and doctors via newsletters and social media as each individual research project ends iteratively.
This will help build a following that they can capitalise on when the study ends.
- Make the decision support tool widely available through a website and app stores.
- Provide user operation information on the website.
- Advertise training days on integrating into shared decision-making practice.
The research team is using a variety of methods to reach the public and their targeted audiences through a mixture of face-to-face encounters, press, social media, and commercialisation, which means that they are more likely to have an effect. A brief mention of training was made; depending on its nature and duration, this would be an important lever (see document on effective knowledge mobilisation methods). Further details will evolve as the study progresses.