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Research Collaborations Aim for Improved Results

March 20, 2019
PhD students
Katie Stipancic, third from left, talks with fellow PhD students Paulo Teixeira, Megan Schliep, and Katherine Marks in the Center for Health and Rehabilitation Research.

Lisa Wood has been researching the cause of clinical fatigue for over a decade, focusing on the role of inflammation fatigue in cancer survivors. But a series of conversations the nursing professor had with physical therapy researcher Janet Kneiss spurred a collaboration that is expected to produce innovative results on how to treat breast cancer survivors. 

“Knowing we wanted to collaborate and getting our research idea together went fast, but at first Janet and I were talking at cross-purposes,” says Dr. Wood, the School of Nursing’s director of research, who has been the Amelia Peabody Chair in Nursing Research and director of the Fatigue Research Lab since coming to the Institute in 2012. “We realized that what fatigue meant to each of us was different. To me, fatigue is a draining state of exhaustion that prevents people fully engaging in their lives. But to a physical therapist like Janet, it’s the ability of skeletal muscles to generate force during exercise. The challenge for us was how to link those two—how to take the subjective—and find an objective answer.” 

The result: a new study funded by the National Institute on Aging that looks at why 30 percent of breast cancer survivors who are cancer free suffer from persistent fatigue, which leaves people feeling wiped out no matter how much sleep or rest they get. 

It’s just one example of the kind of interdisciplinary teams that are focusing on improving the prevention, diagnosis, and treatment of a broad range of health problems and disabilities, not only between researchers focused on the same issues or from the same lab, but also with researchers like Wood and Dr. Kneiss, who come from different professions and points of view. 

Bob Hillman, director of the PhD in Rehabilitation Sciences program, says that was part of the plan when the IHP created the program six years ago and simultaneously began recruiting full-time faculty researchers to jumpstart a new research initiative. “It’s all about cutting across the different fields. That’s how the best research gets done, especially in patient care and rehabilitation,” says Dr. Hillman, the long-time IHP faculty member who also is co-director and research director of the Center for Laryngeal Surgery and Voice Rehabilitation at the Massachusetts General Hospital and a professor of surgery at Harvard Medical School. “No matter the discipline, the impact is multifactorial. Patient care is better managed when a team is involved, and that flows into the kind of research that needs to be done. If you look across the Institute, most people are doing interdisciplinary research.” 

Jordan Green, associate provost for research and director of the Speech and Feeding Disorders Lab, says when researchers come together to share expertise and best practices, it translates into better addressing real-world problems. “It’s baked into the cake here,” says Dr. Green, who came on board with Wood and Speech and Language (SAiL) Literacy Lab director Dr. Tiffany Hogan when the research initiative was launched. “Interdisciplinary collaboration is the most effective and efficient model for treating patients. At the clinic level, you see this kind of integration. At the research level, if we’re working in silos, we’ll never address big issues and problems.” 

Location, Location, Location 

With most of the researchers grouped together in the Center for Health and Rehabilitation Research in Building 79/96, located on the far end of the main campus, collaboration is inevitable, says Kaila Stipancic, a doctoral research fellow for Green in the Speech and Feeding Disorders Lab, who is pursuing her PhD at the Institute. 

“There is something about just being able to knock on someone’s door and get a quick answer to a question or being able to sit down and discuss a problem over coffee that makes working together easy,” says Stipancic, a speech-language pathologist who before coming to the IHP completed a clinical fellowship at the University of Wisconsin-Madison. “It means that the barriers to working in conjunction with other disciplines have, almost literally, been broken down.” 

Stipancic’s relationship with her fellow PhD students illustrates another example of collaboration. Working with Green on motor control of speech and swallowing in adults with neurologic diseases such as amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), Stipancic wondered how much intelligibility must decline before its impact is felt by a patient and before clinicians should intervene. When she looked for answers in the speech literature, she found virtually nothing. But when she mentioned the issue to physical and occupational therapist colleagues in the doctoral program, they pointed out that their disciplines were addressing the same problems and had found answers to similar questions. “The project I completed came directly from how other fields have dealt with this issue,” Stipancic says. “I was able to bring these concepts to speech pathology, where they had not been used before.” 

This ability to come at an idea from a different point of view isn’t just a nice bonus—it’s critical for doing serious research, says Marziye Eshghi, a postdoctoral research fellow in the MGH Institute’s Speech and Feeding Disorders Lab. 

“In medical fields, in particular, establishing standards for high-quality health care services depends upon interprofessional collaboration,” says Dr. Eshghi, who is part of a team of researchers who work with neurologists and other health care providers on speech and oromotor skills of patients who have ALS. “Conducting cutting-edge research is not possible unless professionals from different fields bring their in-depth specializations, skills, and experience to the table. This is how critical thinking, creativity, and learning flourish.” 

Two Sides of the Same Discipline 

Sometimes collaboration involves not just different disciplines but contrasting skills. When Alex Hoyt, an assistant professor in the School of Nursing, started researching scope-of-practice regulations for nurse practitioners across the country, he knew the health side from his experience working as an NP, and he knew the theory from his PhD in social policy. What he didn’t have was experience managing complex projects. 

“What I needed was someone to organize the information, interpret the descriptions of scope of practice, and apply a scoring methodology for all the records. I had a vision of a dataset containing 29 variables for all 50 states and Washington, D.C., going back 25 years,” Dr. Hoyt says. “That’s a lot to keep track of.” 

Enter Scott McIntyre, who shortly after starting his first year in the Master of Science in Nursing program learned of Hoyt’s study. A true career-changer, McIntyre had spent nearly three decades in sales and delivery roles in business technology, including consulting for IBM and IBM partners. He was an ideal match for Hoyt. “Scott brought a great level of organization and an eye for detail,” says Hoyt. “Where I was better suited to think about the design of the dataset, he had the organizational skills to make it happen.” 

And the collaboration wasn’t a one-way street. McIntyre says it changed his view of nursing and how he wanted to approach his new career in the field of gastroenterology. “I used to think I’d just want to see my patients, treat them, and be the best nurse practitioner I can be,” says McIntyre, who graduated in 2018. “Now I realize that part of being the best I can be includes not only knowing the most recent evidence-based practices to diagnose and treat, say, irritable bowel syndrome, but also doing research to contribute to my field and improve treatment protocols where I can. It’s important that part of my job includes doing such research, and I now know how to do it.” 

It’s this embrace of collaboration at the Institute that makes the research so effective, says Green: “If we’re working in silos, we’ll never address big issues and problems.” It’s also partly what keeps researchers like Yael Arbel so passionate about what they do. 

“For me personally, working in a team is ideal,” says Dr. Arbel, a speech-language pathologist and co-director of the Cognitive Neuroscience Group. While she uses electrophysiological and eye-tracking methodologies in her lab to study how children with developmental language disorders learn, fellow co-directors Dr. Lauren Zipse and Dr. Sofia Valilla Rohter use those methodologies to study learning in adults with acquired disorders. “You get to hear others’ perspectives, and three brains are better than one,” Arbel adds. “By interacting with researchers from other disciplines, you realize that sometimes a rose by any other name is still a rose, and that discoveries and theories of others can apply to your field of study. It’s hard for me to see how and why you wouldn’t collaborate.”