Written by Professor Jennifer Tieman, Matthew Flinders Fellow, College of Nursing and Health Sciences. Research Centre for Palliative Care, Death and Dying.
Covid-19 has upended health and social systems all around the world as governments and communities seek to manage complex decisions that impact all of us. Research and evidence has been playing a critical role in this process and the urgency of the problem is driving rapid responses from health professionals, researchers, community organisations and policy makers. So what role is research and evidence playing?
The most fundamental role of research and evidence has been helping us to understand what we are seeing, to provide a focus for the issue and to identify its scope and impact. From the initial first clinical description of cases of an unfamiliar pneumonia to identification as a pandemic, different disciplines have been framing our understanding. In particular, our understanding has been shaped by clinical descriptions of the illness and interventions, epidemiological analysis of “at risk” populations, data modelling and public frameworks for social interventions, and virology to understand the structure, classification and evolution of the COVID-19 virus.
Evidence and research approaches have been critical in shaping our health system and public health responses. By looking at data from around the world it has been possible to identify critical health system needs such as ventilators and PPE to intervene in the likely trajectory of transmission and illness progression. Modelling of public health options have been able to show how social and hygiene interventions can impact on transmission and infection and consequent illness and death. This work is being done under immense time pressures and sometimes with incomplete datasets. Researchers and teams have responded with enormous commitment, often not recognised in the more urgent processes of moving society to social distancing and working from home.
Research focused organisations have also understood that the nature of this pandemic means that in-process research is likely to be affected and may need to pause while urgent new research may need to be commissioned and fast-tracked. This is an unprecedented interruption and disruption of Australia’s research environment impacting funders, universities, research institutes and those responsible for research ethics and governance. World-wide, approximately 300 clinical trials of potential COVID-19 treatments have been initiated since January 2020, and researchers have similarly re-focused activity towards COVID-19 vaccine development . (1) However, within this fast-paced research response the importance of coordination to generate robust evidence has been recognised and international collaboration towards this outcome is now evident.
Sharing our evidence, experience and research relating to COVID-19 is an essential part of our response. Across all arenas, there has been a rapid deployment of the COVID-19 knowledge base. Underpinning this has been a move to making accessible datasets, published and pre-published studies, rapid reviews of evidence and newly developed and country specific guidelines during the pandemic. There has also been deployment of experts and teams to create guidance and resources.
Palliative care has been very active in this space, nationally and internationally. This work has focused on clinical guidance for the palliative care sector and incorporating within the health system response the need for compassionate care and management of symptoms and concerns at the end of life. In Australia, this work is being led by the Australian COVID-19 Palliative Care Working Group (ACPCWG).
CareSearch, one of RePaDD’s projects, is a member of the Working Group and has developed a Palliative Care and COVID19 Hub for the Working Group. RePaDD has established a new palliative care COVID-19 resource for researchers to provide rapid COVID-19 retrieval within PubMed and across the web for a range of palliative care related topics. It builds upon Flinders’ expertise in database evidence retrieval. RePaDD has undertaken this work because we know that evidence is critical to our response to this pandemic and that being able to access relevant evidence easily is a critical need not just for researchers but also for health and social care professionals, funders, and those involved in guideline development and policy making.
1. Mullard A. Flooded by the torrent: the COVID-19 drug pipeline: The world is rushing to test potential COVID-19 treatments. But do we really need so many trials? Asher Mullard reports. 2020, April 18; 395