The complex compass of caring

27 September 2019

Professor Rory O’Connor.

This month, a study was launched in Leeds which could improve the care of men with prostate cancer. But the study is about more than the cancer itself. It looks at the complexity of what makes each of us who we are and how that can help us to find the best healthcare approach for each person. Professor Rory O’Connor, Faculty of Medicine and Health Pro-Dean for Research and Innovation at the University of Leeds explains how it works.

When scientists discover a breakthrough it’s often headline news. That’s especially so if it involves saving or transforming lives, such as in medical research. Therein lies a priceless blend of curiosity, capability and compassion.

Scientist  studying test results.

The size of our national investment in medical research is pause for thought. In 2017 to 2018 the Medical Research Council spent £814.1 million on research.

But we are more than our biology. We are complicated beings, with passions, professions, perspectives, families and communities. Each of us is an individual, yet together we comprise and help shape the societies and cultures in which we live.

The development of illness is a result of complex interactions between our biology, psychology (mood, personality, behaviour) and social factors (environment, culture, family, material status). Neither a biological model nor a social model can explain how illnesses develop, how we respond to treatment and what our outcome will be: only a biopsychosocial model can fully take into account these factors.

The biopsychosocial model was proposed by George Engel in 1977 as being the basis for medical research and delivering healthcare effectively. Forty years later, it is even more important as the basis of personalised medicine.

So does, or should, clinical research have a social value?  A BMC Medical Ethics Journal article recommends that clinical research should take place only once its anticipated social value can be demonstrated.

Family and friends socialising

This underpins the fundamental importance of the social and biological in clinical research and medical practice.

The Leeds Centre for Personalised Medicine and Health, part of Leeds Academic Health Partnership, is coordinating a study in Leeds which is, in effect, testing a test.

Developed and already used in the US by Myriad Genetics, the Prolaris test identifies how vigorously a man’s prostate cancer is growing and therefore the level of risk it poses. For some men who develop prostate cancer, these test results could mean they avoid having unnecessary surgery.

The Leeds study isn’t looking at whether the test ‘works’. Instead, it is exploring how healthcare professionals and their patients react to being given the personalised information from their test results. Does that information influence what they decide to do next, and if so why and in what way?

Through a series of questionnaires, it will also explore each person’s quality of life at various stages during the test. Again, the study aims to understand the wider impact on people’s lives of having the personalised test results.

At the same time, we’re remembering that our healthcare professionals are people made up of the same complex mix of influences.  We also want to understand how the test affects their professional decisions and recommendations for each person.

Is this the biopsychosocial approach in action?

It’s certainly an approach we are embedding across all the work of the Leeds Centre for Medicine and Health. That is, to consider the whole life, perspective and circumstances of each person so we can help them make more informed, personalised decisions about how to live healthier for longer.

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The Prolaris study is a partnership venture between The Leeds Centre for Personalised Medicine and Health, Leeds Teaching Hospitals NHS Trust, the University of Leeds and US company Myriad Genetics.

Rory O’Connor is Charterhouse Professor of Rehabilitation Medicine and a Pro-Dean for Research and Innovation at the University of Leeds. In the NHS, he is Lead Clinician and honorary consultant physician in Leeds Teaching Hospitals NHS Trust. He is also Deputy Clinical Director and Rehabilitation Technology theme lead for the NIHR Devices for Dignity MedTech Co-operative.