We seek research that is highly significant for oncology and oncology nursing, innovative, and that will in time contribute to improved care and care outcomes for our patients, their families, and their care communities. Our scope of interest is thus quite broad but at the very same time can be exclusive as not all studies meet the criteria in a peer-review process of topic significance, innovation, and the promise to improve oncology care. These very important criteria are led by the most central criterion: significance. Where do we look, then, for guidance on what constitutes significant ideas that have a future beyond a single study or a brief span of focus? Passion for a topic is by itself an insufficient basis from which to claim significance. Being the first to address a topic does not make the topic significant, although this is commonly noted by authors in research reports. Neither does being the first to replicate a study in a different sample make the topic significant. A topic can be significant at one period but not at a later period, or a topic that was only nominally significant at one time is unlikely to become more significant at a later time. But addressing the priority list generated by a recognized group of experts on topics of high relevance can begin to ensure significance of a research focus. Most particularly, addressing the topics of a priority list that are acknowledged for eluding scientific attention or methods—what I consider to be the “thin spaces” on a priority list—can effectively target the areas of much needed knowledge.
“Thin spaces” can guide a research career, for a very extended period, right to translation of research findings into care and the evaluation of the impact of the research on care outcomes. A consensus research priority list is most certainly not the only source of significant topics, but it becomes a documented starting point for the focusing of efforts and talents to a specific topic and can thus serve as a historic base for the dating of all subsequent efforts. The starting point can also help us with monitoring which priorities are tackled and the progress made using the methods reported and which priorities are not tackled or which priorities are addressed but elude real progress—furthering the thin spaces but now with information that can help to explain the thinness.
A current example stems from the reports from the Institute of Medicine (IOM) related to dying in America.1,2 The original report issued in 1997 focused only on adults (http://www.nap.edu/catalog.php?record_id=5801), and the 2003 report focused on children and adolescents as well as their parents (http://www.nap.edu/catalog.php?record_id=10390). Priority areas within the reports included clinical care, communication, goal setting and care planning, ethical and legal aspects, education of healthcare providers, financing care, and research priorities. The latter category included epidemiologic aspects of dying in America, symptoms and their management, costs and location of end-of-life care, and bereavement care. The published research that followed the availability of both reports is impressive in its quality and, in some priority areas, its volume. Equally informing is which priorities remain a thin space. Quite exciting is that a new IOM committee has been appointed (Transforming End-of-Life Care; http://www8.nationalacademies/org/cp/committeeview/aspx?key=49481) to address the progress made since the publication of both IOM reports by category and the priorities that remain or have emerged since the publication of the 2 previous reports. For each of the 3 committees, an interprofessional group was appointed to bring evidence to bear on a stated charge from the IOM. The group responsible for achieving consensus on the priority areas—the thin spaces—typically included nurses, physicians, lawyers, ethicists, economists, clergy, and administrators who additionally seek input from laypersons, affected family members, members and leaders of professional associations, and others who request to speak from their areas of life experience. The very interesting aspects of these 2 published reports and the work that will emerge from the efforts of the newly appointed committee are that the evolution of a body of work spanning a 15-year period and its social influences will be revealed—including its thin spaces.
Priorities generated in a systematic manner and across geographically distinct boundaries (ie, http://online.liebertpub.com/doi/abs/10.1089/jpm.2010.0345?journalCode=jpm, http://www.ncbi.nlm.nih.gov/pmc/articles.fmc2205967/, http://ec.europa.eu/research-health/infectious-diseases/neglected-diseases/pdf/nid-conference-final-report052007-en.pdf) further add to the likelihood that thin places and thus truly significant topics are captured in the final report. Such systematic processes have been similarly completed related to end-of-life and palliative care in international settings, and the overlapping thin spaces add credence to the significance of the topics. Citing thin spaces in a research report is a strong, compelling justification for topic significance. We welcome your work on thin spaces.
–Pamela S. Hinds, PhD, RN, FAAN
Department of Nursing Research and Quality Outcomes
Children’s National Medical Center
School of Medicine & Health Sciences
Department of Pediatrics
The George Washington University
1. Behrman R, Field M. When Children Die: Improving Palliative and End-of-Life Care of Children and Their Families. Washington, DC: Institute of Medicine of the National Academies; 2002.
2. Field MJ, Cassel CK. Approaching Death: Improving Care at the End of Life. Washington, DC: Institute of Medicine of the National Academies; 1997.