Multimorbidity as an index condition for clinical trials, meta-analyses and clinical guidelines - is a paradigm shift needed?

The Advanced Care Research Centre (ACRC) is a new, multi-disciplinary, £20M research centre at the University of Edinburgh. The ACRC will lead society’s response to the grand challenge of an ageing population that is growing in size, longevity and needs through the pursuit of research intended to deliver “high‐quality data‐driven, personalised and affordable care to support the independence, dignity and quality‐of‐life of people living in their own homes and in supported care environments”.

This project sits within the ACRC Academy , a dedicated Centre for Doctoral Training, co-located with the ACRC, whose students will deliver key aspects of the ACRC research agenda through a new doctoral-level research and training programme that will also equip them for careers across a wide range of pioneering and influential leadership roles in the public, private and third sectors.

The PhD with Integrated Study in Advanced Care is a novel, structured, thematic, cohort-based, programme of 48 months duration. Each PhD research project within the Academy has been devised by a supervisory team comprising academic staff from at least two of the three colleges within the University of Edinburgh. Each annual cohort of around twelve will include students with disciplinary backgrounds spanning from engineering and data science to humanities, social science, business and commerce, social work, medicine and related health and care professions. This unique level of diversity is a key attribute of our programme.

Project  

Aim

To explore how clinical trials in the future can become more representative of ‘real life’ populations.

Objectives

1. How is multimorbidity handled in Cochrane reviews?  
2. Do trials, that are included in Cochrane reviews, reflect the UK’s population (multimorbidity, protected characteristics and socioeconomic status)?  
3. In individual patient datasets (IPD) are there clusters of diseases that predict response to treatment, frequency of adverse effects and prognosis?  

Description

Multimorbidity, defined as at least two different chronic diseases, is becoming more common as the population ages, and people from low socioeconomic groups are more likely to have comorbidity. Yet evidence about the effectiveness of treatments typically focuses on single diseases; thus leading to difficulties translating the results of clinical research into clinical practice. This PhD will address the critical question of whether a paradigm shift is needed in our approach to clinical trial design. There will be three broad elements to this work a) how Cochrane reviews approach comorbidity, b) exploring in those trials which are included in Cochrane reviews the extent to which patients with comorbidity are represented and c) in large datasets of individual patients, is it possible to identify patterns, or clusters of comorbid disease, who have similar prognosis and respond in similar ways to different treatments? Patient and public involvement will be integral to this work-right from the start when the research questions are refined, to dissemination and knowledge exchange. This interdisciplinary project is suitable for a clinical researcher from any discipline, and represents an outstanding opportunity to work with leading experts in the field of multimorbidity in clinical trials-and to develop into an independent researcher in this field. 

Eligibility 

We welcome applications from people from any clinical discipline, or with a biomedical or epidemiological background and will provide or add suitable career mentorship tailored to the needs and discipline of the successful candidate.

We are specifically looking for applicants who will view their cutting-edge PhD research project in the context of the overall vision of the ACRC, who are keen to contribute to tackling a societal grand challenge and who can add unique value to – and derive great benefit from – training in a cohort comprising colleagues with a very diverse range of disciplines and backgrounds. We advise prospective candidates to engage in dialogue with the named project supervisor and/or the Director of the Academy prior to submitting an application. 

You must read How to apply prior to application

Please Apply here