Two articles being published in Annals of Internal Medicine seek to set prioritized research agendas to fill the evidence gaps about two diverse conditions - bipolar disorder in young people and ductal carcinoma in situ (DCIS) in women. Both conditions present similar challenges to physicians and patients because the diagnosis is often not clear-cut and typical treatments come with a trade-off of benefits and serious side effects.
Using a process described by the Patient-Centered Outcomes Research Institute (PCORI), researchers collaborated with various stakeholders including clinical experts, patients, and advocates to identify and rank the important gaps in knowledge that should be the focus of new research. In bipolar disorder, the researchers noted that the condition can be difficult to distinguish from other behavioral disorders among young people. Despite clinical uncertainty, the use of antipsychotic drugs in this population has increased significantly over the past 20 years. Antipsychotics carry a high risk for adverse effects.
Looking at the available evidence, researchers identified 23 potential research needs in three areas: the comparative effectiveness of intervention strategies, the effect of antipsychotics on patient-centered outcomes, and the influence of various patient characteristics on the effectiveness of antipsychotics. In DCIS, there is considerable uncertainty about the optimal clinical management of the condition because of the lack of reliable methods for distinguishing DCIS that would never become symptomatic from DCIS that is likely to progress to life-threatening invasive cancer. The researchers identified knowledge gaps that should be addressed by future research, such as the incorporation of patient-centered outcomes, development of better methods to predict risk of invasive cancer, evaluation of a strategy of active surveillance, and testing of decision-making tools.