Research is necessary to improve clinical care. But what proportion of research carried out achieves this goal? The annual global investment in biomedical research reached US$240 billion in 2010. Rather extraordinarily, it is estimated that around 85% of this investment may be wasted. As explored in a 2014 The Lancet series, this waste occurs at several stages: (1) when the wrong question is asked, (2) when an inappropriate study design is used, (3) through inefficient research regulation and management, (4) through biased under-reporting of data, and (5) when research reports are unusable by clinicians.
Within palliative care, the volume of research being carried out has increased dramatically over the past decades. But how much of this research translates into meaningful impacts for society? And how much would, according to The Lancet criteria, be considered wasted?
Are we asking the right questions? A National Institute of Health (USA) report on palliative care research trends and funding showed that while the number of research publications tripled between 1997 and 2010, gaps in important topic areas were identified. For example, two out of three of all publications concerned cancer, and few reflected the growing needs of patients with complex and multiple chronic conditions, health economics, or education and training.
Are we using the correct study design? Problems relating to research methodology are intrinsically related to the research workforce, and in palliative care, there is a serious shortage of skilled researchers able to lead research and train others.
Research regulation and governance can be burdensome, particularly in palliative care where patients are often frail and potentially vulnerable.