ARCHE provides expertise for healthcare decision-makers

ARCHE recently completed work to support a U.S. task force on screening for gestational diabetes.

When Lisa Hartling and Jennifer Pillay view their work in action, they know it is making a difference. The two Department of Pediatrics members are part of a team that provides expertise to Canadian and international health agencies, a major focus of the knowledge synthesis work at the Alberta Research Centre for Health Evidence (ARCHE). Knowledge synthesis is an area of health services research that involves identifying, evaluating, and analyzing all the available scientific evidence on a topic and contextualizing it for those making healthcare decisions; these could include healthcare professionals, patients and families, and policy makers, among others.

Hartling, ARCHE director and professor in the Department of Pediatrics, and Pillay, research program lead, work in partnership with organizations such as the National Advisory Committee on Immunization (NACI), the Public Health Agency of Canada, and the United States Preventive Services Task Force (USPSTF) to synthesize scientific evidence and inform recommendations to address high priority health issues. “The most rewarding part of our job is when we can identify the uptake of our work immediately,” says Pillay.

ARCHE recently completed work to support the USPSTF on screening for gestational diabetes, one of the most common complications of pregnancy. The USPSTF provides direction for preventive health services across the U.S. and beyond. The review completed by ARCHE included seven research questions about the benefits and harms of screening, accuracy of different screening strategies, benefits and harms of treatment, and associations of different testing thresholds and health outcomes. They also provided evidence about four contextual questions (such as long-term health consequences of a diagnosis of gestational diabetes for the mother and child) to help inform the USPSTF recommendations. The Journal of the American Medical Association recently published their review alongside the USPTF recommendations. An editorial, which accompanied this paper, highlighted the importance of gestational diabetes within the context of diabesity (i.e., diabetes and obesity) as a major public health problem, in particular the “transgenerational circle” of this health issue as it has short- and long-term implications for the mother, fetus/newborn, and child.

Another ARCHE contract is with the Canadian Task Force on Preventive Health Care, which sets national recommendations for primary care providers for screening programs and other preventive services. If a patient talks to her physician about breast cancer screening, ARCHE would have played a role in informing the screening guidelines and the related knowledge translation tools to help inform clinical and policy decisions. Hartling and Pillay also help with the communication around changes to guidelines or practice recommendations because patients may not understand why these shifts happen. “Science changes and it’s not a bad thing. There’s a lot of discussion about trust in science out there right now. It is important to know that our understanding of a disease or an intervention changes as we accumulate more evidence,” says Hartling.

Their work mainly involves systematically reviewing scientific literature and keeping up to date with the research. The subjects range from risk factors for COVID-19 severity to effectiveness and patient preferences for cancer screening and ARCHE can review evidence on between five and 10 different clinical topics in a year. “There are many steps to detect and manage illness, especially when it’s concerning cancer. How do you first identify it, and how do you find it earlier, and if you identify it earlier, do those people then have better outcomes? In some areas, the treatments are improving or more precise,” says Hartling. Their findings are used together with information about equity, feasibility, acceptability and other considerations when making recommendations.

As the research grows, Hartling and Pillay inform health agencies about the certainty of evidence on health outcomes important to people in order to enable trustworthy and evidence-based recommendations. It takes time to identify the evidence, comprehend it, and then take their knowledge to the decision makers to make the most informed decisions. “We aim to support recommendations based on how confident we are in the underlying science,” she adds.

“Affecting the health and the lives of Canadians is really rewarding,” confirms Pillay.