Clinician-researcher dual role: What are the implications for planning, supervision and governance of ethically and methodologically sound research?

Jean Hay Smith1, Mely Brown1 Gareth Treharne2, Lynley Anderson3,

1 Department of Medicine, University of Otago, Wellington, New Zealand
2 Department of Psychology, University of Otago, Dunedin, New Zealand
3 Bioethics Centre, University of Otago, Dunedin, New Zealand

Clinician-researchers may find it difficult to shed their ‘clinician skin’ when moving to a research role with participants who are patients, even where there is no pre-existing clinical relationship with the researcher. This engrained orientation to patients’ needs may generate tension for the clinician-researcher within their research role, creating a need to grapple with the unavoidability and implications of dual role. Little is known about the range and implications of dual role experiences. The aim of this research was to develop a typology of common dual role experiences to help clinician-researchers (and those planning, supervising and approving research) grapple with ethical and methodological sequelae.

Five databases were systematically searched (inception to 28.07.2014). Full text of included articles was loaded in NVivo and coded for all examples of dual role. Searching located 7135 records. Forty-four primary investigations or first-person reports of clinician-researcher dual role were eligible. The majority of clinician-researchers in these identified studies were nurses or doctors, carrying out research that ranged from clinical trials through to in-depth qualitative studies. Our research identified 10 ways in which dual role is experienced regardless of research type, setting, or researcher’s profession including: managing participant questions; dealing with participant ‘agendas’; deciding when to assist colleagues with non-research tasks; making an incidental diagnosis; participants confusing research with therapy; unwarranted assumptions about participant data; reluctant participants; non-research related participant revelations; over-identification with clinical role; and manipulating participants.

These dual role experiences typically arise after ethics approval and research commencement. Equipped with this typology, clinician-researchers, their supervisors, and/or ethics committees may critically assess a developing research protocol for potential ethical concerns associated with dual role and act to mitigate or manage any issues that may arise.


Biography

Lynley Anderson teaches ethics and professional issues to undergraduate and postgraduate health professional students. Lynley has carried out research on the ethical issues in sports health care, and from that has written codes of ethics for health professional bodies including the Australasian College of Sports Physicians (2008), the NZ Physiotherapy Board and Society (2011), and NZ Sports Physiotherapists (2014). Lynley was a founding editors of the Journal of Bioethical Inquiry and editor of the New Zealand Bioethics Journal. She served on the Ethics Committee for Assisted Reproduction Technologies (ECART), and currently chairs the New Zealand’s Health Research Council Ethics Committee.