Your research proposal comes back with a simple question:
“How were consumers and stakeholders involved in the project design?”
Then you remember yesterday’s shift. The tourist with a broken wrist. The elderly patient waiting for transfer. The patient whose migraines return every few months. The nurse talking about leaving clinical practice.
Suddenly, the question feels much less simple. Who exactly is the consumer in rural emergency medicine research?
The new NHMRC Statement on Consumer and Community Involvement in Health and Medical Research highlights the importance of involving consumers, carers and communities throughout the research process. The Statement emphasises principles such as inclusion, respect for lived experience, trust, reciprocity, equity, safety, transparency and accountability. Drawing on frameworks such as the IAP2 spectrum of public participation, it encourages researchers to move beyond tokenistic consultation towards collaborating with and empowering stakeholders, ideally at the highest level of involvement practical for the project.
This may strike a chord with many rural clinicians, who are often consulted about changes to rural health systems without feeling genuinely involved in shaping them.
But emergency medicine presents some unique challenges for stakeholder involvement. Few people identify strongly as an “emergency department patient” in the way someone might identify as a cancer survivor or a person living with diabetes. Most of us hope emergency care remains occasional and temporary — a bad day rather than part of our identity. This may help explain why a recent scoping review found relatively little published literature on patient and public involvement in emergency care research.
The Sheffield Emergency Care Forum in the UK responded to this challenge by gradually building a stakeholder community around emergency medicine research. The group included a retired primary school science coordinator, carers and retired health advocates, and evolved from advisory and document review roles to helping shape research design, interpretation and dissemination.
Rural emergency medicine adds another layer of complexity. In rural communities, people often wear multiple hats within the same health system. A rural emergency clinician may also be a patient, carer, researcher, educator or community member. The NHMRC Statement recognises that people may hold more than one role — something particularly relevant in rural emergency care research focused on workforce sustainability, burnout and family support. In these settings, clinicians and their families may themselves hold important lived experience and stakeholder perspectives.
For broad discussions about emergency care systems and priorities, many rural community members could bring important perspectives on distance, limited local resources and stretched services. A study exploring the healthcare needs of refugee fruit pickers would benefit from voices within the local refugee community. Research on stroke pathways may involve patients and carers with lived experience of telehealth, retrieval and transfer systems. A project exploring grey nomads presenting to rural emergency departments may seek perspectives from travellers who have returned home after receiving care far from their usual supports.
Perhaps the challenge in rural emergency medicine research is not simply finding “a consumer representative” to involve. The more important question may be the one hidden inside the original request: who should help shape this project, and how should they be involved? In rural emergency medicine, the answer will probably differ for every research question — and that may be exactly the point.
International Association for Public Participation Australasia. The IAP2 framework.