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Evidence Based Research Needs a SWAT

Dr Amy Price

Dr Amy Price

Getting Research Done Right

“I don’t think enough is being done to make new practitioners ask about the evidence when they are faced with “expertise” and opinion; and randomised trials need to become so much part of practice that they are the standard way of dealing with uncertainty and making choices” [Mike Clarke 2016].

It is one thing to study research and even to quote it but it is yet another thing to understand and apply it to every day practice. There will be much research that is outdated before it is even implemented. We need to know why so we can use research that we know already to optimally change practice before it grows old.

Sir Muir Gray states it this way “Knowledge is the enemy of disease; the application of what we know will have a bigger impact than any drug or technology likely to be introduced in the next decade” AND “In the nineteenth century health was transformed by clear, clean water. In the twenty-first century, health will be transformed by clean, clear knowledge.”

Research is not just about the research model as a profession it is about how research works in the real world and this is where SWAT matters. For clinical research to thrive ways to decrease RCT costs and increase efficiency are needed. Evidence Live 2016 is a great place to share research ideas, collaborate, and to learn what can make research better.

Why SWAT for Research?

SWAT is an acronym for Study Within a Trial. These studies can make full use of an ongoing funded trial by embedding practical concepts within the trial to produce better evidence to manage and problem solve uncertainties faced in running future trials. Embedding methodology research can decrease research waste and build value for minimal resource costs.  The results can be reported and the study concepts are free for anyone to use or adapt. Those who plan, conduct, and report trials will be better able to do so in ways that will improve health and wellbeing by using what works.

What Do We SWAT?

I am working on self-recruited online trials so some of my interests include what kind of reminders and encouragement work best; how does social media change reporting; what medium of engagement works best (tablet, phone text, computer); is there a difference between written and audio feedback; what form of interactive consent is best value for knowledge and more. I find the clear and concise way the SWAT methods are written up to be great examples for writing up methodology within protocols. The areas in process below are used by permission and are cited directly from the report: [Education section – Studies Within A Trial (SWAT). J Evid Based Med 2012;5:44–5. doi:10.1111/j.1756-5391.2011.01169.x]

A large cohort study of aging in Northern Ireland called NICOLA is testing the impact of different invitation letters (NICOLART:NCT01938898) This study also looks at means of collecting baseline data(NICOLA-QT: NCT01978522). The findings of these studies, SWAT-2 to SWAT-5, will influence future phases in the distribution of invitations to up to 20,000 people and the recruitment of 8500 people to NICOLA. Another series of SWAT relating to recruitment were conducted as part of the MOSAICC study, an observational cohort study on the etiology of myeloproliferative neoplasms (NCT01831635). These investigated the effects of providing information on end-of-study compensation to improve participation (SWAT-16), sending a letter or telephoning potential participants as a method of follow-up to improve recruitment (SWAT-17) and providing small gifts with the letter inviting people to join the study (SWAT-18).

Where Does SWAT Live?

The study within a Trial (SWAT) initiative is the work of the Northern Ireland Network for Trials Methodology Research and the Health Research Board Trial Methodology Research Network. The development of the SWAT collection was supported by the Medical Research Council Network of Hubs for Trials Methodology Research (MR/L004933/1-R50).

How Can Others Use SWAT to Make Research Better?

SWAT protocols for use in a trial and research about how they have worked for others are freely available. There is also a database available where other researchers can apply to build build and share SWATs. If you are interested in doing a SWAT, suggesting an outline or seeing the findings, please visit the website:

Using SWAT we can all learn something we did not know. Collaboration and curiosity will power discovery and innovation. The public is the sensor that provokes influence. We can learn from them and each other using studies within a trial and the public can work with us to build evidence into practice. Let us build this into discussion for Evidence Live 2016.

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