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September 2017

Addressing the Challenges in Tonsillectomy Research to Inform Health Care Policy: A Review

Author Affiliations
  • 1evidENT, Ear Institute, University College London, London, England
  • 2Department of Otolaryngology, Sheffield Teaching Hospitals, Sheffield, England
  • 3Centre for Health Policy, Imperial College London, London, England
JAMA Otolaryngol Head Neck Surg. 2017;143(9):943-947. doi:10.1001/jamaoto.2017.0964

Importance  Eighty-five percent of investment in medical research has been wasted, with lack of effect on clinical practice and policy. There is increasing effort to improve the likelihood of research being used to influence clinical practice and policy. Tonsillectomy is one of the most common otorhinolaryngologic surgical procedures, and its frequency, cost, and morbidity create a clear need for evidence-based guidelines and policy. The first systematic review on tonsillectomy was conducted 40 years ago and highlighted the lack of definitive evidence for the procedure. Since that study, the body of evidence has still not been able to sufficiently inform policy. This review provides an overview of the key challenges in research to inform tonsillectomy policy and recommendations to help bridge the evidence-policy gap.

Observations  The challenges in using research to inform policy can be summarized as 4 main themes: (1) non–policy-focused evidence and lack of available evidence, (2) quality of evidence, (3) communication of research findings, and (4) coordinating time frames. Researchers and decision makers should be aware of the limitations of research designs and conflicts of interest that can undermine policy decisions. Researchers must work with decision makers and patients throughout the research process to identify areas of unmet need and political priority, align research and policy time frames, and disseminate research findings. Incentives for researchers should be reorganized to promote dissemination of findings.

Conclusions and Relevance  It is important to consider why evidence gaps in tonsillectomy research have not been addressed during the past 40 years despite considerable investment in time and resources. These findings and recommendations will help produce research that is more responsive to policy gaps and more likely to result in policy changes.

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