Examining a Holistic Framework for Evaluating Clinical Outcomes in Parallel With Non-Clinical Outcomes

Abstract

Rationale

While clinical research seeks to evaluate outcomes of various types, no framework has been identified that permits a sufficiently broad approach to evaluating clinical outcomes, in parallel with non-clinical outcomes.

Aims and Objectives

The objective of this paper is to examine a unifying framework for evaluating clinical outcomes in parallel with non-clinical outcomes by drawing on different understandings of the Common Good. The proposed framework must have broad application, accounting for the various types of outcomes that may emerge within different disciplinary approaches and identifying the benefits or harms that might be experienced by the clinical research participants.

Method

Six different definitions of the Common Good originally described by Boltanski and Thévenot are presented. The six conceptions of the Common Good identify organising principles by which an outcome is evaluated as beneficial or harmful. It also identifies the various ways that the researched persons, and the researchers, are subjectified. Academic literature that reported outcomes for persons living with dementia was purposively sampled to demonstrate the application of the six definitions of the Common Good.

Results

A wide range of outcomes from clinical research may be evaluated in parallel, based upon the assumption that the Common Good may be expressed as a plurality of perceived goods extending beyond purely clinical, technically measured outcomes.

Further, the subjects of interventions may be described in non-clinical language, thus respecting the many roles that may be important to them as human persons and agents.

Conclusion

Boltanski and Thévenot's Economies of Worth framework allows research outcomes to be evaluated consistently against the six definitions of the Common Good. The definitions of the Common Good inhere six different Worlds: Civic, Domestic, Industry, Inspiration, Market and Opinion (or Celebrity). Each World is structured around a Higher Common Principle by which the Common Good is defined within that specific world.

The example of research amongst people living with dementia demonstrates the robustness of this framework by identifying a wide range of non-clinical outcomes. These extend the understanding of the practical ways in which participants, their families and associates, researchers, and also organisations, are variously presented as subjects according to the different definitions of the Common Good.

Implications

This theoretical approach has the potential to inform and support research in clinical settings and guide funding bodies in the evaluation of research projects that give rise to clinical and non-clinical outcomes.

A matrix that applies the structure of the definitions of the Worlds could be developed to support the comparison of research outcomes arising from diverse objectives and methodologies.