The Research Paper of the Year, awarded by the Royal College of General Practitioners, highlights the best research published in the previous year across six clinical categories, with one overall winner. One theme that was evident this year was the importance of partnership with patients.
The overall winner of the Research Paper of the Year 2014 was a fascinating study by Jon Banks and colleagues.1 They presented 3469 people with vignettes describing different sets of symptoms, giving them information about the risk that these symptoms represented cancer, along with details of likely treatment and prognosis if cancer was identified. This is very topical, given the recently published National Institute for Health and Care Excellence guidelines on investigation of suspected cancer, which are based on a general principle of recommending investigation for symptoms with a positive predictive value of ≥3%. However, the striking finding in this paper was that 87% of people would opt for investigation even for symptoms with a risk of cancer as low as 1%. This is a well-written, engaging, and thought-provoking paper that raises many questions about how GPs should discuss and share decisions with patients as well as for public policy.
The winning paper in the cardiovascular and respiratory category also reflects an interest in a new and more open partnership with patients in discussing treatment. Building on their earlier TASMINH2 trial,2 Richard McManus and colleagues undertook a randomised controlled trial of self-monitoring and medication self-titration in hypertensive patients at high risk of cardiovascular disease.3 The results showed substantial benefits in blood pressure control from the intervention. Although we are familiar with patients altering their own medication dosage in asthma and in diabetes, the same approach has not been common in hypertension and the principle of letting people monitor and optimise their own treatment could be applicable to many other conditions as well.
Another winning paper (in the health services research and generic category) demonstrated partnership with service users in the research process. A collaborative team including domestic violence advocates as well as academics supported a survivor of domestic violence herself to design and deliver a service user-led study.4 The domestic violence survivor conducted a small number of in-depth and revealing interviews about women’s experiences of discussing domestic violence with GPs and referral to a domestic violence service. This paper, by Alice Malpass and colleagues, is very moving and leaves the reader with a sense of optimism about the potential of good general practice as a positive agent for change in people’s lives.
The sense of partnership in relationships with patients also comes across in Jane Roberts’s paper on talking to adolescents about psychological distress, which won the mental health category.5 This qualitative study based on interviews with GPs demonstrates how they tend to use different approaches. Some are ‘fixers’, some are ‘future planners’, and some are ‘collaborators’ more interested in building a therapeutic relationship with the young person than attempting to solve the immediate problem. For a GP, this paper is well worth reading to reflect on one’s own style.
The remaining winning papers also raised interesting questions. Sonia Saxena and colleagues undertook a database study that suggested wide variation in the dosages of penicillins prescribed to children in primary care, with many not being prescribed the recommended dose.6 Antje Lindenmeyer and colleagues used a qualitative study in practices with high or low rates of screening for diabetic retinopathy to identify a range of modifiable strategies that could be used to improve uptake of screening.7 Both papers have clear actionable messages for GPs.
The winning papers in this year’s competition represent the wide range of topics and methodological approaches used in contemporary primary care research. The winning papers last year were published in the BMJ, the Lancet, and JAMA. This year, four of the six winning papers were published in the BJGP, perhaps reflecting the increasingly high quality and relevance of papers published in this journal.
- © British Journal of General Practice 2015