Lack of research OR lack of knowledge translation?
Today on Evidence ConneKTion, we look at how the rubber meets the road between knowledge synthesis (KS) and knowledge translation (KT). KS is an integral part of KT – bringing to light existing evidence and assessing when that evidence is strong enough to put into practice. A recent Alberta study on a patient-priority setting project provides us with a great example of the importance of KS in patient priority-setting projects and in broader KT processes.
For both types of efforts, including KS is critical for:
• Identifying specific research gaps
• Recognizing opportunities for KT
• Preventing duplication of research
In this post, we look at the patient priority-setting process and how the KS component of the process is foundational to subsequent research and KT efforts.
Historically, for a number of diseases, patient and researcher priorities have been mismatched. Often, the research agenda has been biased toward commercial interests of funders and personal interests of researchers. As a result, research agendas do not always align with patient priorities. For example, 86.3% of registered trials compare drug efficacies while only 2.6% compare drugs to non-drug therapies , such as psychotherapy versus anti-depressants, which may be of more interest to patients.
However, there is a worldwide movement in research to more meaningfully include patient voices. The Strategy for Patient-Oriented Research in Canada, the Patient-Centered Outcomes Research Institute in the US, and the James Lind Alliance in the UK have all been launched recently to incorporate the patient voice in health research. Patient participation in research priority-setting projects is proving to be an excellent method to thoughtfully involve patients with lived experience of a particular condition. Patient priority-setting projects help ensure that research agendas reflect the interests of patients, researchers, clinicians, and other stakeholders, in turn increasing the use and value of subsequent knowledge generation and translation.
The steps to any patient priority-setting process follow a general pattern:
1. Identify a broad topic of interest based on research interest and public feedback
2. Assemble a participating stakeholder group that includes as many relevant stakeholders as possible (e.g. researchers, clinicians, policy makers, patients etc.)
3. Through the stakeholder group develop and distribute a public survey of potential research priorities
4. Consolidate proposed priorities
5. Rank the priorities
6. Review of the literature to determine if the proposed research priorities have been previously answered.
The last bullet, the KS component of research priority setting, is a key element of the process, as illustrated by the study mentioned above. The study describes the Alberta Depression Research Priority Setting Project (ADPSP): a 2016 effort to identify Alberta’s top research priorities in the area of depression. The work was led by the Alberta Strategy for Patient-Oriented Research SUPPORT Unit (AbSPORU) Patient Engagement Platform in partnership with the Alberta Health Services Addictions and Mental Health Strategic Clinical Network and the Canadian Depression Research and Intervention Network and was supported by five other partner organizations. In the end they published 11 top research priorities.
To examine the extent and nature of existing evidence relating to the ADPSP’s top 11 priorities the AbSPORU Knowledge Translation Platform undertook a series of 11 rapid reviews of the relevant research. The goals were to prevent duplication of research efforts (research waste) and to identify research gaps and opportunities for KT. The following excerpt from the paper summarizes some general observations:
“Among the patient-identified priorities, there are questions where extensive evidence exists (i.e., hundreds of primary studies), yet uncertainties remain. It might be tempting to conclude that ‘more research is needed’; however, a close examination of what is known and what remains uncertain is critical to guide implementation of proven strategies and judicious investment in future research efforts. For example, there is evidence supporting the effectiveness of many non-pharmacological interventions (including psychological interventions and exercise) to reduce depressive symptoms. However, targeted research is needed that addresses comparative effectiveness of promising interventions, specific populations of interest (e.g., children, minority groups) and adverse effects.“
There’s the rub: the authors discovered that some priorities the public identified already had extensive research evidence, illustrating a KT gap. For example, there is evidence to support that cognitive behavioural therapy is effective in preventing and treating workplace depression, yet interventions that are effective in preventing and treating workplace depression was number nine on the list of research priorities.
This finding highlights that priority-setting projects can uncover the information stakeholders want to inform their decisions, but that is not necessarily the same thing as identifying a gap in research that should be prioritized. None of this is to say that priority-setting processes need revision. Rather, it reinforces the importance of KS in priority-setting and the need to do the literature searching before finalizing research priority lists. Furthermore, this study showed that not only can priority-setting projects identify relevant research agendas, the KS component can identify and increase awareness of priorities that require KT.
KS is explicitly included as a step in priority-setting. However, there is limited guidance as to how to conduct the KS step to yield findings that are comprehensive enough to inform research prioritization. Have you found in your own experience that priority setting projects uncover KT gaps as well as research gaps? Should an explicit goal of a priority-setting projects be to identify KT gaps? ConneKT with us by sharing your thoughts in the comments below
To read the full manuscript and the results of the 11 rapid reviews please visit here.