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’s group worked through the summer and fall, and plans to have the modules completed and available to nursing students at 51˛čąÝ and nurses at other institutions by December 2016. “That’s unbelievably fast,” says Jones. “It’s a testament to the people involved.” And it’s 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."
—Assistant Professor Holly Fontenot
“Team science” has emerged as the depth and breadth of scientific knowledge expands, making it increasingly difficult—and often impossible—to explore new ideas within academic silos. Getting together with colleagues, frequently from other disciplines, is essential to tackling today’s 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. “You need a team to understand how the different elements come together,” 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. “In order to effect change in health care,” says Assistant Professor Holly Fontenot, “you can never work alone. You have to have a team.”
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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’s 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 “Increasing HPV Vaccination and Eliminating Barriers: Recommendations from Young Men Who Have Sex with Men” inĚýVaccine, and “Parental Attitudes and Beliefs Regarding the Nine-Valent Human Papillomavirus Vaccine” in theĚýJournal of Adolescent Health.
“There’s a great synergistic effect,” 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. “My clinical experience informs the science.” ĚýĚý
Meanwhile, Zimet has served as a mentor—someone 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, “has helped me take my thinking about HPV science to the next level.”
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’s School of Social Work. The two have joined forces on several research projects that focus on challenges of aging and older adult health. “Kevin has expertise and background in aging and social policy. I have a history of working with caregivers of people with chronic disease and disabilities,” says Mahoney. “So the theoretical underpinnings of our disciplines are often complementary, but they’re also different.”
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. “We melded our expertise to work together on this project,” 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’re also different.”
—Ellen Mahoney,ĚýInterim Associate Dean for Research and Associate Professor of Nursing
Of course, team science is not without challenges. “It takes a while to learn others’ priorities, and to learn their language,” 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. “A lot of the time, they’re ready toĚýgo,” she says. They’re not aware that a study can’t get off the ground before researchers have applied for and obtained institutional review board approvals and grants. “Unless you live in the world of a researcher, you don’t understand how long that can take,” 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. “Pick people you know you can work with,” 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. “But what if they can’t work with anybody?” 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. “I don’t like doing things by myself,” she says. Working to solve challenging scientific problems as a team, Fontenot adds, “is way more fun.”
—Timothy Gower, artwork by Christine Hunt