Clinical Care vs. Clinical Research
Scientist Explains with Dr. Sanjeev Kumar
December 15, 2022
What is clinical care?
Clinical care encompasses a range of medical services provided by physicians or other members of a clinical team. When someone is experiencing a medical issue, generally their first point of contact is a family doctor. Upon assessment, the family doctor will either treat the person, or refer them to a specialist (e.g., referral to a memory clinic) for further investigation or treatment. If someone is experiencing issues with function or behaviour related to their medical issue, they may also be referred to additional care services (e.g., occupational therapist, psychologist, social worker, etc.). In Ontario, most clinical care services are covered by the Ontario Health Insurance Plan (OHIP). However, OHIP may not cover all medications prescribed by a clinical care team.
What is clinical research?
Clinical research is a key way to advance our understanding of diseases, and to improve future care. Clinical research studies are usually disease-specific, and can vary in scope. These studies can take place in research institutes, or hospitals, doctor’s offices, universities, or community clinics. The people running a clinical research study can be physicians or non-physicians (e.g., scientific researchers). The purpose of clinical research is not to provide a medical service to the participants, but to advance scientific and medical knowledge. However, participants may gain certain benefits through participating in clinical research – for example, having access to experimental tests or treatment interventions. They may also benefit from engagement with the research team.
All clinical research studies must be approved by a Research Ethics Board (REB), and are funded through different mechanisms such as government funding, industry, or philanthropic organizations. People do not have to pay for participation in clinical research, and most studies will compensate people for their time, or provide reimbursement for any expenses incurred.
Will participating in clinical research affect my clinical care?
No, participating in clinical research should never affect or replace clinical care. All people are entitled to receive a standard of care according to the guidelines for their condition. Clinical research provides participants with more avenues of exploration for their condition, on top of their existing clinical care plan. Additionally, participants can decide to withdraw from a clinical research study at any time. If the study is being run by a member of the participant’s clinical care team (e.g., family doctor, specialist), withdrawing from the study does not mean the participant must leave that person’s care or their clinic.
How do clinical care and clinical research intersect?
Clinical care informs research. First, research studies generally aim to recruit people diagnosed with certain clinical conditions, or who have certain symptoms. Therefore, clinical information can be valuable in determining someone’s suitability for a given study. Second, someone’s clinical status may determine their ability to safely participate in clinical research. For example, a study would need to exclude people who might be put at disproportionate risk because of a certain clinical condition. Sometimes, researchers may need to speak with members of someone’s clinical care team to determine if it’s safe for the person to participate.
Research informs clinical care. Certain procedures included in clinical research studies (e.g., brain scans, blood tests) may not be part of standard clinical care for a condition. Because of this, there may be incidental findings among some participants (e.g., tumor, rare conditions). These findings are reported to the participant’s clinical care team, allowing them to be promptly treated.
Clinical research can be embedded in clinical care. Certain research studies can use the data that is collected as part of routine clinical care. People undergo several assessments as part of clinical care; this is very rich data, which can be used to advance scientific knowledge. It can also be used to enhance care because it provides the opportunity to review care delivery, as well as identify gaps in care and related processes. TDRA’s Memory Clinics Research Database and Long-Term Care Home Research Database projects are good examples of this. In this type of data analysis, many precautions are taken to ensure that data is used ethically, and with appropriate privacy and permission considerations.
