A career in applied healthcare research is immensely rewarding, especially when we can demonstrate a positive impact on patient outcomes. Researching is all about exploring the unknown and generating new knowledge. As Albert Einstein said, “If we knew what it was we were doing, it would not be called research, would it?” However, as a researcher, I find it increasingly challenging to get to the position of actually doing research. There seem to be so many obstacles that stand in our path. Writing and submitting a research grant application for highly competitive funding are demanding of time and effort, with the most likely outcome being rejection. Gaining ethical approval is equally challenging. I recall many years ago when I started my research career that a consultant surgeon I was working with received “blanket approval” to carry out whatever research studies he thought were justified. How times have changed. In the United Kingdom, following ethical clearance nationally, we need approvals and letters of access from the research and development departments for all the local sites involved in a study, each with its own research and development manager, its own ways of working, and its own specific requirements. In addition, we have further ethical clearance to obtain from our university ethics committee. The starting date for a research study drifts further from our grasp, and we wonder why we put ourselves through this; is it worth it?
Instead of lamenting the challenges, we could take a different perspective and ask why these obstacles exist. Yes, it is increasingly challenging to put together a research grant, but research studies should be robust, of a high quality and subject to scrutiny by our peers. Researchers should provide a sound justification for why the study is needed and should be able to clearly articulate the benefit for patients. In terms of ethical approval, it is increasingly challenging to get through all the hoops, but the hoops are there to protect patients from harm, promote safety, and facilitate patient benefit. Times have changed in many positive ways. Most of my research has focused on meeting the information needs of people with cancer. Back in the mid-1990s, we examined the information needs of women with breast cancer and found priority needs related to likelihood of cure and spread of disease. I recall presenting this information to a group of nurses who were horrified at my suggestion that oncology nurses could provide “sensitive” information to patients. One nurse in particular said that I would “tip them over the edge.” At the time, I was most concerned that the work we were doing could be viewed as causing harm. Nowadays, nurses look at me with surprise when I recall this story as their view is entirely different. This is a positive step forward, emphasizing the considerable skills that oncology nurses have developed. As I concentrated my research focus on the time period after completion of treatment (now called survivorship), and the role of specialist oncology nurses, I sought to compare traditional hospital follow-up by doctors with telephone follow-up by specialist nurses. This was met with great skepticism in the late 1990s, and no hospital in my region would contemplate carrying out any sort of trial in this area. Even if patients were only returning to clinic every year, there was a view that “something would be missed” if a doctor did not carry out a clinical examination. As time moved on, and after a number of years of pilot work, I did find specialist nurses who believed that telephone follow-up would benefit patients and that they had the skills and knowledge to deliver the telephone intervention, meeting patient information and psychosocial support needs. It is clear that without close collaborative partnerships between clinical and academic staff we cannot hope to change practice; providing research evidence alone is never enough. In the United Kingdom, we now have the National Cancer Survivorship Initiative that informs us that the way in which we follow up patients after treatment does not meet their information needs, and we need to evaluate new strategies. Telephone follow-up by specialist nurses is no longer radical; it is acceptable and commonplace, introducing a positive shift from paternalism to patient empowerment and supported self-management. Researchers and oncology nurses have to deal with bureaucracy, negative attitudes, and policy changes. However, at the heart of what we do is the desire to continually improve practice and the care we give to our patients. Many years ago, a distinguished professor of cancer nursing said to me that as long as I believed in the value of what I was doing and that my research endeavors would benefit patients, then it was worth all the challenges you faced along the way; she was right.