Knowledge synthesis in medicine

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Contents

Last Update

  • Updated.jpg 11 February 2014

Metadata & synonyms

  • bench to bedside | evidence-based translationist | implementation research | research into practice | translating knowledge | translational medicine | translational research
  • knowledge brokering | knowledge dissemination | knowledge exchange | knowledge management | knowledge mobilization | knowledge transfer | knowledge translation | knowledge synthesis | knowledge utilization

Introduction

See also Accreditation | Bioinformatics | Digital Communities of Practice (CoPs) | Evidence-based health care | Knowledge management | Translational medicine

Knowledge synthesis in medicine is related to knowledge translation, and refers to processing information from medical research and finding ways to put it into practice. This includes conducting systematic reviews and meta-analyses to summarize evidence and creating recommendations and practice guidelines for use in clinical practice. According to the Institute for Healthcare Improvement, on average, it takes 17 years for new evidence-based findings to reach clinical practice. Surely this important knowledge should be integrated more quickly than 17 years? Why is this important? See also Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. JRSM. 2011;104(12):510-520.

First, knowledge is at the core of problem-solving in medicine and can be examined from three perspectives: 1)knowledge as an object ~ in fact, knowledge exists independently of human intelligence in a sense and is therefore an asset to be managed; 2) next, knowledge as "in the minds" of those who have it only exists when shared; and, finally, 3) knowledge systems must be developed to support its quick and ready use. Here, knowledge can be understood as embedded within health care and is a product of its context but should be properly recorded and preserved (or, it will be difficult to find, or lost). Much attention at the moment is focused on getting at knowledge, finding ways to translate it into practice and building systems to manage it. The idea of tacit knowledge or soft knowledge is important in the area of knowledge mobilization where experience, skills and cultural knowledge are embedded in daily practice. This is not always easy to uncover let alone get into practice. Computer-based tools such as web 2.0, discussion forums, electronic bulletin boards and chat are well-suited to revealing hidden knowledge in organizations but so are traditional forms of sharing such as meetings, journal clubs and presentations. In communities of practice, the process of soft knowledge is aided by social interaction, a major reason why social learning theory is so popular at the moment.

All parties involved in research expect the knowledge created through research will be useful, whether the objective is to free knowledge, share it with others or apply it to the needs of people in society. The challenge is to find appropriate channels to disseminate knowledge and then once made openly-available to encourage its uptake within organizations.

Knowledge synthesis

  • Knowledge synthesis is the integration of research findings into the larger corpus body of knowledge in a given discipline. A knowledge synthesis must be reproducible and transparent in its methods and use quantitative and/or qualitative methods. It can take the form of a systematic review and follow methods established by the Cochrane Collaboration; or, it can be developed as a result of a consensus conference, expert panel, qualitative or quantitative study. Realist synthesis, narrative synthesis, meta-analysis, meta-syntheses and practice guidelines are all forms of knowledge synthesis.
  • CIHR places considerable value on knowledge synthesis. It requires applicants to apply for funding to conduct randomized controlled trials (RCTs) but they must include systematic searches with proposals to establish the need for the trial and put into context the trial in the existing body of knowledge. To support synthesis, CIHR has developed a knowledge synthesis funding program which has funded 175+ scoping and full reviews. It is part of CIHR's category of 'integrated knowledge-translation research' http://www.cihr-irsc.gc.ca/e/39033.html

Knowledge translation

Knowledge translation is defined as:

"...the exchange, synthesis and ethically-sound application of research findings within a complex set of interactions among researchers and knowledge users... In other words, knowledge translation can be seen as an acceleration of the knowledge cycle; an acceleration of the natural transformation of knowledge into use.' Within the context of health research, KT therefore aims to ‘accelerate the capture of the benefits of research . . . through improved health, more effective services and products, and a strengthened health care system’..." — CIHR, 2004
  • Knowledge translation aims to address the knowledge to evidence-based gap in patient care. Sub-optimal usage of evidence is described as a knowledge gap between what we know and what is done in practice (Davis et al., 2003; Grol, 2000; Grol & Grimshaw, 2003). The term knowledge translation is used in fields such as public health, medicine and rehabilitation (Brandt & Pope, 1997; CIHR, 2004; Davis et al., 2003; Glasgow, Lichtenstein, & Marcus, 2003; Jacobson, Butterill, & Goering, 2003; Tingus, Berland, Myklebust, & Sherwood, 2004).

Knowledge mobilization (KMb)

  • According to the Institute for Community Engaged Scholarship, knowledge mobilization is a proactive process to ensure that knowledge, especially that created through publicly-funded programs, is informed by the needs and reaches of their intended audiences. In Canada, knowledge mobilization has a national profile within the Social Sciences and Humanities Research Council of Canada (SSHRC) which has its own division of Knowledge Products and Mobilization and produces a knowledge mobilization strategy. See also Centre for Community Based Research (CCBR)
  • Knowledge mobilization (KMb) is related to both knowledge translation and synthesis but bears more similarity to knowledge translation as its goal is to find ways to get knowledge into the system to benefit society as a whole. In medicine, knowledge mobilization refers to getting the results of systematic reviews and clinical studies into patient care but may also refer to finding better ways to mobilize the knowledge gained by health professionals through experience. Both research knowledge and experiential wisdom are part of the knowledge mobilization paradigm.

Key concepts in KT & KMb

  • an environmental scan was commissioned to determine best frameworks and best practices related to the topic of public engagement and to understand the current Alberta landscape regarding knowledge translation in public engagement
“Knowledge brokering” is sometimes used see CHSRF publications http://www.chsrf.ca/ (they use “knowledge exchange” and “knowledge translation”) as is “knowledge utilization” – great site including database and useful weekly current awareness bulletin available via the CHSRF/CIHR Chair on Knowledge Transfer and Innovation site (http://kuuc.chair.ulaval.ca/english/index.php) at the Université Laval. Terms like "bench to bedside" and "mouse to man" are also used in less formal settings. Also, "translational science/research/medicine" is used especially in the US although sometimes in talking about the application of basic science in clinical / applied research - see Zerhouni. Translational and clinical science — time for a new vision. N Engl J Med. 2005;353:1621-1623.
"Many terms are used to describe the process of putting knowledge into action [Graham ID et al]. In the United Kingdom and Europe, the terms implementation science and research utilization are commonly used in this context. In the United States, the terms dissemination and diffusion, research use, knowledge transfer, and uptake are often used. Canada commonly uses the terms knowledge transfer and exchange. In this book, we use the terms knowledge translation (KT) and knowledge to action interchangeably." p.3

"Some organizations may use the term knowledge translation synonymously with commercialization or technology transfer. However, this narrow view does not consider the various stakeholders involved or the actual process of using knowledge in decision making." p.4

  • Renée Lyons, professor and Canada Research Chair, Atlantic Health Promotion Research Centre (AHPRC), Dalhousie University
  • This monograph grew out of a symposium on health and knowledge translation (KT) held at Green Templeton College, Oxford http://bit.ly/lgj4Wa OR http://bit.ly/lwfIKf

Knowledge synthesis grants

Knowledge synthesis journals and websites

  • the purpose of this learning module is to build knowledge and skill in the area of evaluation of health research initiatives (including knowledge translation)

Social media & KT

References

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