CMSA Today - Issue 6, 2012 - (Page 29)
Conducting Case Management Research Ethically
ase management’s body of knowledge must evolve if case management is to be understood as its own discipline that contributes to the social good. The skills that case managers employ and the information they use to perform case management functions must not be entirely derived from other professions because that would mean that case management has no content of its own, is not in command of itself, and does not confer any unique beneﬁts on its clients. Consequently, research in case management is mandatory for case management to prosper. Needless to say, that research must be done ethically. the latter might not be evil or malevolent, but it won’t secure the patient-centered goals that are at the heart of case management.
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BY JOHN BANJA, Ph.D.
The fourth bears on a favorable risk-benefit ratio. As in all research, risks must be deﬁned and minimized, while beneﬁts should be heightened as much as possible. Thus, if a researcher only wants to ﬁnd out the answer to a question that has no practical value, the research could not claim a clinical (or human welfare) beneﬁt. The ﬁfth involves independent review. Here case managers must be able to justify their methods, aims, and projected outcomes to others who are knowledgeable but not involved in the research. Doing so will help assure the objectivity of the research and the quality of its ﬁndings. The sixth requirement concerns informed consent. Obviously, research participants must know why the research is being conducted, what its risks and beneﬁts are, their responsibilities as research subjects, their right to withdraw, the fact that they won’t be penalized for withdrawal, and so forth. Informed consent lies at the heart of ethical research because coercing research participation or failing to inform potential research participants about what they can expect violates their rights. The seventh requirement involves respect for research participants. Here the researcher must protect research participants’ privacy and conﬁdentiality, inform them of new discoveries that might aﬀect their continued participation, inform
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Since this column is devoted to ethics, I thought it might be worthwhile to recall various characteristics of ethical research. A paper published in 2000 by Ezekiel Emanuel, David Wendler and Christine Grady entitled “What Makes Clinical Research Ethical” (JAMA, Volume 283, No. 20, pp. 2701-2711) did just that and, in the last 10 years, has become something of a classic. The authors identify seven requirements for ethical research that I’ll brieﬂy list and apply to case management.
The second is scientiﬁc validity. Has the researcher used an accepted methodology, perhaps including statistical techniques, which produce valid and reliable ﬁndings? Case managers who customarily don’t do research should always have their research questions and methodology scrupulously examined by research specialists, so that they will be investigating a wellframed question or hypothesis that can be answered by data gathering methods appropriate to the task. Research projects whose data are neither valid nor reliable won’t pass scientiﬁc muster and will ultimately prove a waste of time. The third is research participant selection. If they’re using human subjects, case management researchers must select research participants who represent the population in general or who represent the likely users of whatever is being studied, rather than people who are conveniently available for recruitment, or who will make whatever drug, device, or method being studied look better (or worse) than it is (because they are younger, healthier, sicker, etc.).
7 REQUIREMENTS FOR ETHICAL RESEARCH
The ﬁrst is social or scientiﬁc value. Will whatever is being studied contribute to the well being of case management clients or will it only beneﬁt the selfserving interests of case managers? Research that only accomplishes
Issue 6 • 2012 • DIGITAL
Table of Contents for the Digital Edition of CMSA Today - Issue 6, 2012
VA Connecticut Healthcare System Improves Cancer Care
Operation: We Care
The Path to Payment for the Medicare and Medicaid EHR Incentive Programs
CMSA CORPORATE PARTNERS
VIEW FROM CAPITOL HILL
CASE MANAGEMENT AND THE LAW
INDEX OF ADVERTISERS
CMSA Today - Issue 6, 2012