Knowledge Translation - Turning Research Into Practice

[medhope15]

Just wanted to start a discussion on this topic and see what people think.

There are hundreds of studies published every month about this and that...but does any of this impact patient care delivery?

 

I'm just thinking as someone with a couple of years experience in health care, for all of the research that is published, I have not seen any great changes in practice (aside from maybe severe cases like Ebola preparedness driven by public panic). For example, research might show some cognitive benefits to early therapy in brain injured patients but I have not seen any change implemented in my hospital to fund brain injury clinics or concussion management/education.

Similarly there may be evidence about how nursing education of new grads is structured but the program / delivery of teaching has not changed as far as I can see in a long time.

 

The only place where maybe there would be prompt follow-up is in the pharma world where research that shows some positive or adverse outcome might stimulate a prompt change in practice (although this too is questionable as there are studies that show that doctors do not follow best practices due to either poor training / picking up bad habits, not being aware, or hospital policies around drugs that are not in line with what may be best practice, hospitals not funding / supplying other meds).

 

 

What is the point of all this research??

[bclionsfan]

Hey man, I think your field of vision is too narrow

i.e-you're looking at insignificant research/low-impact "supplementary studies". Supplementary studies are still important because they are tiny pieces to the big puzzle. 

 

there are numerous studies where changes happen (i.e- big big pieces to the puzzle). go to NEJM website, look up the massive clinical trials

here i'll provide u a one-stop link

 

https://scholar.google.ca/citations?hl=en&vq=en&view_op=list_hcore&venue=IKEvlTw-e8IJ.2014

 

just open one of these papers and read the abstract (or more), and u'll see how they have changed the care of thousands if not millions of patients.

 

once a group of investigators prove or disprove something, its ultimately up to hospitals and clinical heads to decide if they want to implement changes/abandon old standards of care.

 

Having said that, some areas of research are "controversial"/different experts will have different opinions. but there are major "landmark" studies that are so convincing/well-designed, that everybody agrees with the results. i.e- if a study says ur gonna get wet on a rainy day if ur not wearing a raincoat, then not many people will disagree with that. (bar specific circumstances when you wouldn't get wet)

 

It's up to YOU(i.e- department heads and hospital officials) to implement the changes, it's not the study investigator's job to do it

 

no offence, I'm going to be blunt, your post comes off as a bit immature and short sighted but I think you have good intentions asking the question

[medhope15]

Sure I get what you are saying. I'm not at all implying that the researchers have a duty to knock on every hospital door and demand their research goes into practice.

What I'm wondering is why this doesn't occur? is it that front line staff don't care? don't keep up to date? hospitals don't care? don't want to spend the extra money?

 

Lots of valuable research out there just sadly becomes wasted knowledge.

 

and again I think it is a bit better in terms of pharma because perhaps the results can be more quickly adapted to practice and can be more or less "life saving issues"

[Bede]

What is the point of all this research??

 

I'm a post doc. I ask myself this question every day.

 

Some research ends up being ground-breaking. Other research sets the foundation need for the ground-breaking research. But the sad truth is, the majority of research (mine included), will end up in the scrap heap. Something like 50% of publications will never receive even a single citation. 

[Selstaar]

You guys touch on a number of KT challenges today and I hope I can contribute a little to the discussion.

 

First, though the evidence-practice gap and the push for evidence-based medicine have been acknowledged in the literature for decades, the translation of evidence into practice is evidence into practice is complicated by a number of things:

(1) KT is still a relatively nascent field, that's heavily theory driven. This means (1) there isn't an abundance of theories on how to best translate research findings into clinical practice and (2) there isn't a lot of robust empirical data supporting any given approach. This results in a lot of people paying no more than lip service to KT and evidence-based practice.

(2) Some professions have repeatedly (and quite dubiously) reported high research use in clinical practice for decades, making it difficult to truly ascertain to what extent KT efforts are making a dent in transforming practice.

(3) Changes in health systems and their impacts on patient outcomes can really only be assessed longitudinally. This is problematic for governments and, sometimes decision-makers who have to make decisions based on what they think will make them appear to be doing something to fix things in the here and now (at least if they want to be re-elected). There's at least one systematic review out there suggesting that governments end up disregarding health services data when it comes down to decision-making (for a number of reasons which we shouldn't discuss here).

(4) Like you mention medhope15, there are also contextual barriers to KT. The stem from sources running the gamut from individual training, attitudes and preferences...to disciplinary (i.e., health professional) culture...to unit and organizational culture...and sometimes even systems issues.

 

I may have drunk the EBM koolaid in my time at Mac. However, I think others who haven't would agree with me in saying it'd be erroneous to alter practice based on one RCT...no matter how well designed. Or even a sole, methodologically sound meta-analysis. But, I agree with some of the opinions already stated about how it's the responsibility of physicians and other healthcare professionals to drive the change we want to see in practice and in the healthcare system at large. We need to get involved in policy decision-making; We need to get involved in government; We need to be there in administrative positions ready to facilitate implementation, and We have a responsibility to continue to develop KT as a science.

[LeBronto2019]

Some research ends up being ground-breaking. Other research sets the foundation need for the ground-breaking research. But the sad truth is, the majority of research (mine included), will end up in the scrap heap. Something like 50% of publications will never receive even a single citation. 

 

It's very depressing to hear that!