Barriers to Respiratory Care Research in the United States

Discussion

The study aimed to identify barriers and research interests for RTs. The most common barriers identified for RTs to conduct research were lack of secured time, opportunity to participate in research, and formal research training. Most respondents reported that improving patient outcomes was the primary reason for doing research. The top research interests were invasive mechanical ventilation, advanced monitoring, and airway clearance, although there was significant variability among respondents.

A survey of respiratory research among RTs, nurses, physical therapists, occupational therapists, and other allied health professionals in Canada identified lack of infrastructure support and funding as the top barriers to conducting respiratory research.⁵ The same study included chronic disease management and aging as the top respiratory research priorities. These results differ from our study and are likely due to different respondent characteristics. Our study only included RTs, and the majority had graduate degrees, whereas their respondents were multidisciplinary health care professionals and most had bachelor’s degrees.

Many respondents in our survey indicated that research training was either self-taught or received on the job, which may have contributed to the perceived lack of training as a barrier to RT research. Most RT programs in the United States are associate’s degree programs that generally do not incorporate research training in their entry-to-practice curriculum, as their primary focus is preparing students for clinical practice. A study of RT degree programs in China found that graduates with a bachelor’s degree were more likely to perform tasks with advanced skills, such as lung ultrasound, ECMO, and clinical research.¹⁶ In the United States, however, a bachelor’s degree is not usually required to perform advanced skills such as intubation.^17,18

The AARC Issue Paper regarding Entry to Respiratory Therapy Practice 2030 described the need to advance the minimum education for RT from an associate’s to a baccalaureate degree for several reasons.¹⁹ For example, RTs are increasingly called to make complex decisions and provide advanced care for patients. A baccalaureate degree provides a more in-depth education that can better prepare graduates for these demands. Additionally, RTs with baccalaureate degrees may be better equipped to identify and mitigate risks for patients, improve patient outcomes, and reduce health care costs. This is consistent with research in other health care professions where advanced education has shown to be beneficial.^20,21 As a result, the AARC Strategic Direction 2022–2025 included an operational goal to create a task force to advance credentialing, academic degrees, and advanced practice RT.²²

Raising the minimum standards for entry to practice and increasing the availability of advanced degree programs might produce graduates with the necessary competencies to critically appraise, conduct, and analyze research. This might aid in the advancement of respiratory care research. However, enrollment in RT education programs has declined 27% since 2010, and only 10% of programs are at capacity.⁸ Additionally, there is an ongoing nationwide shortage of RTs that existed even prior to the COVID-19 pandemic.^23,24 The pandemic has further intensified the shortage of all health care workers.^25,26

The majority of respondents reported data collection as their primary type of research role, whereas few were investigators or coordinators. This suggests that few RTs are driving the intellectual work of research or formulating research questions. Additionally, RTs are underrepresented in Delphi studies focused on consensus for respiratory care practices, despite having a primary role in respiratory therapies and relevant experience.²⁷ A review of RT involvement found that RTs were rarely included as panel experts for respiratory research topics of mechanical ventilation, high-flow nasal cannula, respiratory management of COVID-19, home oxygen, cardiopulmonary monitoring, or disease-specific guidelines.^27,28 Likewise, over half of the respondents in this survey reported publication in a peer-reviewed journal, whereas only 35% were lead authors.

Notably, Ring²⁹ investigated RT scholarly activity published in respiratory care over a 10-y period. The study found that publications with at least one RT author increased from 47.5% in 2011 to 60.2% in 2021, and co-authorship for original research publications increased to 84.6%.²⁹ Whereas these results are promising, the data are representative of a single journal specifically geared toward RTs. An analysis of publication diversity from the Canadian Critical Care Trials Group identified only 0.3% of publications from 1994–2020 included RT authors in any authorship capacity.³⁰ Importantly, RTs often contribute to clinical trials but may not be included as co-authors due to limitations on the number of authors allowed from each center in large, multi-center studies. For example, in a clinical trial published by the ARDS Network, RTs contributed to the study and were not included as co-authors but acknowledged in the appendix as a network participant.³¹

The role of the RT has evolved from oxygen orderlies who would clean cylinders and administer therapy without critical thinking to being involved in complex clinical decision making and providing valuable contributions to multidisciplinary care teams.³² Training requirements have advanced from on-the-job training in hospitals to successful completion of an accredited educational training program to practice as an RT. Despite this progress in advancing the profession, room for improvement remains in the area of RT-driven respiratory care research to further support the legitimacy of the RT profession.³² Most RT researchers have learned research methodologies in an apprenticeship-type model after graduation.³³ The best time (pre- or post-program graduation) to provide research training is unclear, and the feasibility of incorporating research training into entry-to-practice programs should be explored.

The development of formal mentorship programs and multi-center collaborations provide additional opportunities for RT participation. Even when RTs have the requisite skills, they still need the opportunity to participate, and it is essential that non-RT researchers consider the technical and clinical expertise RTs can offer for respiratory research. Additionally, RT departments could invest in research by protecting time, funding additional training, and providing necessary resources to support research programs in the department.³⁴

There were several limitations to this study. The topic may have primarily attracted the attention of RTs with research experience, as most participants had over a decade of working experience. This may have resulted in a lack of perspective from RTs new to the field or those who had never participated in the research process. Likewise, most participants had a bachelor’s degree or higher, whereas only a few had an associate’s degree. Thus, the viewpoints from those RTs might differ from our findings. Further investigations including practitioners with and without research experience are warranted. By inviting RTs to complete the survey through AARC Connect, participation was limited to AARC members who utilize the online forum. RTs not engaged in AARC Connect or who are not members of the AARC likely missed the opportunity to complete the survey. This recruitment method resulted in a small sample size that is not representative of all practicing RTs.