A list of 10 key research priorities intended to help standardise vascular access research were delivered to attendees at this year’s Vascular Access Society of Britain and Ireland (VASBI) annual scientific meeting (29–30 September, Glasgow, UK). Presenter Jonathan de Siqueira (University of Leeds, Leeds, UK) stated that these priorities were devised via a “democratic and objective process” involving many different medical specialties, as well as patients, and have been made freely available for researchers to use in their own applications in an effort to overcome historic inconsistencies in UK vascular access research.
De Siqueira began by detailing the methods that shaped this ‘top 10’ priority list, which initially involved setting up a special interest group (SIG) to identify the areas that are most important to both patients and clinicians. SIGs, he reported, are subgroups of the Vascular Society for Great Britain and Ireland’s (VSGBI) central research committee, with a total of nine having been established to date, spanning vascular access, but also amputation, wounds, veins and other areas.
“The first thing I want to say […] is that it is not a bunch of vascular surgeons sat in a dark room somewhere plotting how they are going to take over all research in vascular access—it is actually quite the opposite of that,” said de Siqueira. “We are a multidisciplinary team […] made up of a vascular surgeon or two, a nephrologist, a nurse specialist, a transplant surgeon, a radiologist, and also a vascular scientist. And the idea is that everyone within this group is research focused and research orientated.”
De Siqueira was keen to impress that, alongside these numerous medical specialties, the SIG also includes a patient representative, as patient inclusion is a “core value” within the group.
Discussing the motives behind creating a SIG, he noted difficulties in developing high-impact, high-level research across vascular surgery more generally, citing the lack of a “huge, dedicated funding body” like, for example, Cancer Research UK, and the “culture of competition” between different medical specialties that tends to override collaboration attempts. Previous grant applications have been “all over the place” depending on different physicians’ personal priorities and there has been “no consistency” to date, he asserted.
After consulting with the James Lind Alliance (JLA)—a non-profit making initiative focused on healthcare research—in 2019, the VSGBI split into several priority setting partnerships (PSPs) and ultimately identified vascular access as one of nine key priorities in vascular surgery moving forward. With a SIG established, and in spite of the COVID-19 pandemic beginning to majorly impact the healthcare system across the country, paper and electronic surveys were distributed to the relevant patient groups to ascertain what is most important to vascular access patients and should therefore be prioritised.
“What was evident really early on was that access patients do not see themselves as vascular patients,” de Siqueira claimed. “And so, when you send a survey around saying ‘tell us about your experiences as a vascular patient’, they think ‘that is not me’, and they do not respond.” As such, it was signposted “very clearly” in these surveys that ‘access’ refers to dialysis/arteriovenous access, to make it visible to those patients that “we really do want to hear from them”.
Through group debates, hosted within an online prioritisation workshop, with patients and a number of medical specialties all being represented, the SIG established its final top 10 priorities in vascular access. Among these priorities, which have since been added to the JLA website and published in the Journal of Vascular Societies Great Britain and Ireland, are ways of making fistulas or grafts last as long as possible; key patient education as well as staff education on dialysis patients’ experiences; improving the accuracy of access needling; reducing serious bleeding risks associated with fistulas; and preventing infections related to dialysis lines.
De Siqueira acknowledged a handful of imperfections in the way the SIG arrived at these priorities, including the front end of the process being “loaded with vascular surgery opinion”, the inevitable obstacles raised by the pandemic, and the fact it was a fairly small group who decided on the final top 10, potentially creating an increased risk of subjectivity. However, the speaker went on to note that they arrived at a “relatively fair representation of important questions” that, crucially, was derived from a “democratic and objective process”. The individual points that came out on top were “perhaps predictably, but encouragingly, the things that scored really highly [among] patients”, he added.
Turning to what the future may hold here, de Siqueira said that—across all specialties—the National Institute for Health and Care Research (NIHR) has since set up a special funding stream specifically for projects that address a ‘JLA top 10 priority’. This means “you are not competing with everybody, you are only competing against people who can show that their project directly addresses […] a key priority”, he continued, with this protected funding pot now being made available multiple times a year “for the foreseeable future”.
Moving forward, the NIHR is also prioritising ‘platform studies’ that have common outcome measures and multiple treatment arms, and are therefore better equipped to answer questions more definitively—meaning larger, multicentre trials are likely to be favoured over numerous, smaller and more disparate studies with slightly different inclusion/exclusion criteria, outcome measures and, ultimately, conclusions.
“So, there is a real drive to establish collaborative networks for large, multicentre studies that look at multiple interventions,” de Siqueira concluded, “and I think there is an opportunity to build a really formal network and prepare for some very big funding calls that can deliver high-impact research.”