Sandpits have been used to bring together researchers from a broad range of disciplines to develop research ideas, particularly in areas that traditionally have been understudied. Funders are increasingly recognising the potential of sandpits as a means of funding pilot models to answer these specific research questions. In this guest blog, Dr Iain Frame, Director of Research at Prostate Cancer UK tells us about their recent sandpit, with some helpful tips for funders who might be thinking about setting up their own.
A few years ago, I read an article on alternatives to peer review by two of my ex-Wellcome colleagues Steven Wooding and Jonathan Grant, who were working at Rand Europe. I was immediately struck by the sandpit idea- not for peer review, but to answer specific research questions by building workable research proposals with groups of experts. Late last year we finally got down to testing it as a mechanism to accelerate funding to answer our own specific research question.
Why we did it
We know there are problems using PSA as a large-scale screening tool for prostate cancer, and that access to the PSA test in the UK can vary depending on both men’s awareness of the test and GPs’ opinion of using it. There’s also confusion about what should happen after a first test. So it comes as no surprise that Prostate Cancer UK identified the need to develop a risk-based assessment tool for men at high risk of clinically significant prostate cancer. This test would need to be suitable for a multi-ethnic population, simple to deliver at a reasonable cost in a primary care setting, and should reduce the number of unnecessary biopsies. We knew that similar tools had been developed outside the UK, notably in the US, Canada, Holland and Sweden but for various reasons none of them were entirely suitable for our purposes. We put out an open call for proposals to address this question, but after international peer review and consideration by an expert panel, we were unable to make an award. This sandpit meeting was our next move to fund research to answer the questions we asked in the original call.
We learnt a few lessons by going through this the first time. Lesson one: don’t be afraid to invite the right people for the job, even if they live on the other side of the world. We invited the researchers who had developed prostate cancer risk-based assessment tools in other countries, UK-based scientists, urologists, oncologists and GPs to our sandpit. Obviously, we could have invited many more, including other funders, but for this first run, we wanted to keep the meeting small enough to crack the problem, while knowing that we could call in other expertise if necessary, as the proposal developed. We held the meeting over two days. Many people have said it must have been difficult to get such a stellar guest list together at such short notice, but it really wasn’t. Everyone we spoke to thought that it was a great opportunity to “sort” something that had been stalled for some time in terms of getting prostate cancer risk-based assessment tools into practice internationally. Everybody was keen to play a part.
Lesson two: don’t spend too long on a formal agenda, and let the participants lead on how to approach the issue. At the same time, never let them wander off the point and lose sight of the question you want answered. It’s also worth considering whether you have adequate cover for any last minute cancellations. In reality, whilst we had world class epidemiologists and clinicians in the room, the fundamental issue was how any tool developed could be delivered through GPs, so their role in developing and delivering this tool will be key to the success of the project. We invited two GPs to the meeting, but in the end only one could attend. He did a fantastic job presenting the reality of primary care, and suggesting how he thought our tool needed to be designed to be acceptable to GPs, but perhaps he could have done with some back-up on occasion!
What we acheived
At the end of the two days, we had a proposal that all 14 people in the room were happy with. The initial stages will be delivered via collaborations between the UK, Holland and the States to model a test using existing data. We then will move on to testing that model, including user acceptability in GP practices, before rolling out to a larger trial. We didn’t end the meeting with a fully costed programme grant, but we did end with a very clear roadmap to success and we are continuing to push forward with developing the research proposal to a fundable state. It will still be peer-reviewed and considered by an expert panel before we make an award, but we’re confident that the expertise we drew together for our sandpit meeting has given us a much better chance of making an award and funding research that will make a real difference to men.
I don’t think that this is a mechanism that can be used for everything, but I strongly believe that when a funder has specific questions it wants answered, and knows who can help it answer those questions, this type of meeting is a great way to accelerate funding for research that will bring about change.