Last April, Dorothy Jones received a request from Stand Up To Cancer, a nonprofit organization that funds medical research. Could she produce a series of web-based educational modules that would teach nurses how to manage symptoms caused by cancer immunotherapies (which stimulate the immune system to attack cancer cells) by the end of the calendar year? Jones, a professor at the Connell School, said yes, then immediately wondered how she could meet such a tight deadline. The answer came to her just as quickly: She had to form a team.
Jones enlisted two colleagues, Associate Professors Jane Ashley and Jane Flanagan, as well as several nurses from Dana-Farber Cancer Institute and Massachusetts General Hospital, to help develop the modules. She also recruited Boston College staffers from the Center for Teaching Excellence (to help produce video, graphics, and other elements of the modules), Information Technology Services (to get the modules online), and Continuing Education (to ensure module users received credit). Jones鈥檚 group worked through the summer and fall, and plans to have the modules completed and available to nursing students at 蝌蚪直播 and nurses at other institutions by December 2016. 鈥淭hat鈥檚 unbelievably fast,鈥� says Jones. 鈥淚t鈥檚 a testament to the people involved.鈥� And it鈥檚 an example of how collaboration among people from different disciplines is often necessary to confront scientific challenges and move health care forward today.
"In order to effect change in health care, you can never work alone. You have to have a team."
鈥擜ssistant Professor Holly Fontenot
鈥淭eam science鈥� has emerged as the depth and breadth of scientific knowledge expands, making it increasingly difficult鈥攁nd often impossible鈥攖o explore new ideas within academic silos. Getting together with colleagues, frequently from other disciplines, is essential to tackling today鈥檚 complex biomedical problems, says L. Michelle Bennett, director of the Center for Research Strategy at the National Cancer Institute, who studies the science of team science. Bennett points to the need for collaboration among disparate disciplines in confronting public health crises such as the emergence of the Zika virus, which has required expertise in infectious disease, epidemiology, fetal development, and other fields. 鈥淵ou need a team to understand how the different elements come together,鈥� says Bennett.
Jones is one among a number of nurse scientists at the Connell School who are collaborating with researchers and clinicians from across the Boston College campus and in other institutions to study chronic disease, sexually transmitted infections, health care delivery, and other critical issues. 鈥淚n order to effect change in health care,鈥� says Assistant Professor Holly Fontenot, 鈥測ou can never work alone. You have to have a team.鈥�
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One day in the fall of 2013, Fontenot got a piece of advice that changed the course of her research in human papillomavirus (HPV). As a nurse practitioner, Fontenot treats adolescent patients at the Sidney Borum Jr. Health Center at Fenway Health, a community-based center that specializes in treating the lesbian/gay/bisexual/transgender community and people with HIV/AIDS. As part of her research, Fontenot studies ways to promote wider use of the HPV vaccine, which prevents cervical cancer and head and neck cancer. She鈥檚 particularly interested in increasing vaccination rates in underserved populations, notably young males who have sex with males.
Fontenot met frequently with a mentor, Ken Mayer, MD, co-chairman of the Fenway Institute, the research arm of Fenway Health, who urged her to talk with Greg Zimet, a nationally renowned clinical psychologist at Indiana University who studies attitudes about the HPV vaccine. Not long after an e-mail introduction from Mayer, she was collaborating with Zimet. The pair, along with groups of physicians and other nurse clinicians, have co-authored several papers and articles in the last year. Fontenot was first author and Zimet a co-author of 鈥淚ncreasing HPV Vaccination and Eliminating Barriers: Recommendations from Young Men Who Have Sex with Men鈥� in听Vaccine, and 鈥淧arental Attitudes and Beliefs Regarding the Nine-Valent Human Papillomavirus Vaccine鈥� in the听Journal of Adolescent Health.
鈥淭here鈥檚 a great synergistic effect,鈥� says Fontenot of her teamwork with Zimet. And talking with patients regularly gives her valuable information about their values and beliefs. For example, many have told Fontenot that they wished more health care information and resources were available as smartphone apps. That, she says, is helping her to plan future studies. 鈥淢y clinical experience informs the science.鈥� 听听
Meanwhile, Zimet has served as a mentor鈥攕omeone who has taught her a great deal about writing grant proposals, study design, and other essentials for conducting research. He has also introduced her to other investigators, which has led to further collaborations. Their work as a team, Fontenot says, 鈥渉as helped me take my thinking about HPV science to the next level.鈥�
Interim Associate Dean for Research and Associate Professor of Nursing Ellen Mahoney describes a similar kind of synergy in her cross-disciplinary work with a collaborator she has known all her life: her brother, Kevin Mahoney, a professor in Boston College鈥檚 School of Social Work. The two have joined forces on several research projects that focus on challenges of aging and older adult health. 鈥淜evin has expertise and background in aging and social policy. I have a history of working with caregivers of people with chronic disease and disabilities,鈥� says Mahoney. 鈥淪o the theoretical underpinnings of our disciplines are often complementary, but they鈥檙e also different.鈥�
Recently, the Mahoney siblings examined the role of caregivers of people who use participant-directed services (PDS), which help people with chronic conditions and disabilities live independently and determine and manage the mix of personal assistance and services best suited to their health care needs. Kevin recruited and Ellen and several students interviewed dozens of parents, spouses, and adult children from around the country who care for people who use PDS. Their research found that the unpredictability of day-to-day needs increases the complexity of caring for these patients. 鈥淲e melded our expertise to work together on this project,鈥� says Mahoney of the study, in which they teamed up with colleagues at the University of Illinois at Chicago and National Council on Aging, among others.
"The theoretical underpinnings of our disciplines are often complementary, but they鈥檙e also different.鈥�
鈥擡llen Mahoney,听Interim Associate Dean for Research and Associate Professor of Nursing
Of course, team science is not without challenges. 鈥淚t takes a while to learn others鈥� priorities, and to learn their language,鈥� says Assistant Professor Tam Nguyen, whose research examines the prevention of chronic disease, especially in minority populations. Nguyen has collaborated with investigators outside of nursing on several projects, and is currently part of a large and diverse team that is applying for funding from the Patient-Centered Outcomes Research Institute to study ways to prevent type 2 diabetes in Asian Americans. The team also includes Professor of Social Work Thanh Tran, two physicians from local clinics, a diabetes educator, leaders of several nonprofit agencies, and two pre-diabetic patients.
Nguyen explains that collaborating with non-scientists often means she must manage expectations and preach patience. 鈥淎 lot of the time, they鈥檙e ready to听go,鈥� she says. They鈥檙e not aware that a study can鈥檛 get off the ground before researchers have applied for and obtained institutional review board approvals and grants. 鈥淯nless you live in the world of a researcher, you don鈥檛 understand how long that can take,鈥� says Nguyen.
Taking certain steps can help ensure success in team science. Nguyen recommends drafting formal terms that define who does what, and by when, and having all members sign off on the agreement at the outset of a collaborative project. Choosing the right personnel is another key to success in team science, says Jones. 鈥淧ick people you know you can work with,鈥� she says. A principal investigator forming a team may be tempted to recruit a co-scientist known for his or her wisdom and deep experience. 鈥淏ut what if they can鈥檛 work with anybody?鈥� asks Jones, who says she has candid conversations with prospective team members to ensure they understand their roles and can work as part of a unit.
And when a team clicks, members share a common goal, respect one another, and are open to listening to others and changing their minds about critical matters, says Fontenot, who notes that collaboration has another important upside. 鈥淚 don鈥檛 like doing things by myself,鈥� she says. Working to solve challenging scientific problems as a team, Fontenot adds, 鈥渋s way more fun.鈥�
鈥擳imothy Gower, artwork by Christine Hunt