The organisation and diffusion of translational research: Can cardiovascular medicine learn from oncology? Case studies of pharmacogenomics in the NHS

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This project sets out to understand the critical factors affecting the adoption of PGt/x in NHS cardiovascular practices. Cardiovascular diseases (CVDs) are the most common causes of mortality in the UK and a number of important cardiovascular drugs have PGt/x indications that may be employed to personalise therapies making them more effective by optimising dosages, reducing adverse drug reactions and overall providing better care for patients with significant returns for the NHS. Can we learn from oncology where PGt/x knowledge is already at a relatively advanced stage of implementation in clinical practice? We shall unpack institutional and organisational arrangements to identify innovation management practices that favour the application of PGt/x and personalised approaches in cardiovascular medicine.The focus of the study is the contextualisation of PGt/x knowledge in the NHS. Studies have shown that while there has been tremendous investment in early-stage research from basic science to human studies in the UK, less effort and investments have been given to the translation and implementation of new knowledge in clinical and health decision making. Thus, our contribution aims at understanding the institutional, organisational and innovation management issues driving and/or hindering translation of advanced PGt/x and clinical knowledge in a personalised approach to heart and circulatory diseases. To this end, this research will deep-dive into how the behaviour of NHS professionals become institutionalised. This means understanding the socio-technical dimensions of how new routines emerge, how organisations innovate and how this change process (medical innovation) is managed to introduce PGt/x knowledge on the cardiovascular wards of the NHS. We use the ongoing progress in oncology and personalised cancer therapy to reflect upon the supporting/inhibiting factors affecting the implementation of PGt/x knowledge in the CVD domain. The project capitalises on a strong multidisciplinary team incorporating complexity and medical innovation scholars, pioneers in pharmacogenetic research and its applications in medical practice, oncology and cardiovascular clinicians.The research plan comprises 4 phases to be carried out over 36 months. Phase 1) consists in mapping the knowledge available on PGt/x - drug associations and conduct a review of the literature. These will be used to draw a typology of factors underlying the implementation of PGt/x knowledge in practice. Phase 2) and Phase 3) will develop cases studies in oncology and cardiovascular medicines respectively. The rationale behind this choice is due to the diverse penetration of PGt/x within the two medical fields. Phase 4) shall comprise the systematic comparative analysis, the preliminary report, validation and engagement with the wider academic communities in medical and social science disciplines, patient advocacy groups and policy makers.The study will be conducted within a number of active clinical units in the NHS identified as early adopters of PGt/x in clinical practice. The methodology developed will contribute to advancing our understanding of the general principles to implementing PGt/x in cardiology with a socio-technical focus on the necessary technologies, institutional and behavioural changes within the organisation. These can be broadly seen as innovation management steps beginning with the identification of stakeholders who are key to implementation, testing/care with practical repercussions on the implementation of PGt/x guidelines in cardiovascular medicine.The project will benefit from oversight and guidance of an advisory board comprising academics, a clinician and a patient representative. Em.Prof Stan Metcalfe (UoM), Prof Alex Faulkner (Sussex), Prof Ellen Moors (Utrecht), Prof William Newman (NW - Genomic Medicine Service Alliance), Ann Bamford (GM - Integrated Stroke Delivery Network).