Lessons from a translational chronobiology workshop
Scientists at the Universities of Surrey and Padova carried out a translational chronobiology workshop to assess evidence in chronobiology and produce consensus statements. This article outlines the tools used and lessons learned.
Translating research into impact is easier said than done. The gap between academic research and application is so notorious in the biomedical sciences that it's been dubbed "the translation gap" and, more dramatically, "the valley of death".
Bridging this gap involves several steps, one being the delivery of a consensus truth to the rest of the world. There’s no one right way to do this, but one group that have a rich toolbox of techniques at the ready are clinical scientists who frequently have to assess evidence and provide advice. Tapping into this wealth of tools, a team of scientists and clinicians from Surrey and Padova ran a workshop to assess evidence in chronobiology with the aim of producing a recommendation at the end.
They first identified PICO questions (Population [P], Intervention/Exposure [I], Comparator [C], Outcome [O]). This method focuses in on a specific area of research. They produced two questions:
Do healthy individuals (P) have an increased risk of road traffic accidents (O) during Daylight Saving Time months (April-October) (I) compared to standard time months (November-March) (C)?
Are delayed school start times (I) associated with longer sleep duration (O) in high school students (P) compared to standard school times (C)?
The evidence was graded using the Levels of Evidence (LoE) scale by the Oxford Centre for Evidence-based Medicine, mostly receiving the lower grades of LoE 3 or 4. This highlighted a common issue in chronobiology: a lack of randomized controlled trials (RCTs). While high-quality research exists, feasibility issues often prevent RCTs, which are considered the gold standard in clinical research but are not always possible for chronobiology. This standard, understood by policymakers, makes the research more likely to be accepted. For translational purposes, it would be great to have more RCTs in chronobiology research, but as long as feasibility is an issue, perhaps the bigger consideration is how can research be designed and presented so it can be trusted by stakeholders?
After assessment, the evidence was presented to a Delphi panel. In Greek mythology, the oracle of Delphi would communicate directly with the Gods and her prophecies were so trusted that leaders of the ancient world would make decisions on state matters based upon them. Modern Delphi panels differ significantly – instead of Gods, research papers are consulted, and instead of a single oracle, the final message is decided and conveyed by a group of experts. The common feature here is the influential knowledge that has been divined from sources that may otherwise seem inaccessible. This is an approach that is used by both clinicians and politicians to produce a consensus recommendation. A powerful common language, and a technique that is recognised on the decision-making stage.
Part of what made this process so useful for translational purposes was the inclusion of experts from diverse fields such as engineering and economics, transforming it into a knowledge exchange that enabled more informed conclusions. This led to two conclusions:
No statement could be formulated regarding the link between Daylight Saving Time and road traffic accidents.
Delayed school start times, as short as 20 minutes, are associated with longer sleep duration in high school students.
Whilst the specific issue of DST and road traffic accidents may need further research, the issue of delaying school start times appears fairly clear cut. Now, one simple but highly considered statement can be communicated to stakeholders, and perhaps drive some change.
So, what lessons were learned from this workshop?
A lack of RCTs can limit perceived research quality but should not discourage evaluation and evidence presentation.
Diverse expertise in discussions strengthens recommendations as it prioritizes knowledge exchange over simple evidence dissemination.
Where research may directly inform policy, consider factors affecting implementation and identify potential "winners and losers." Compelling risk/benefit and economic arguments will play a role in translating evidence to social change.
Change is more likely if evidence aligns with policymakers' objectives and involves various stakeholders.
For more information, you can read the full paper based on the workshop or get in touch with the authors.
Lorena Rosen, edited by Sara Montagnese
13 December 2024