Evidence-based health care proposes the use of scientific research evidence to inform clinicians’ decisions in line with patients’ wishes and values. Over the last 20 years there has been a massive increase in the profile and range of research evidence that influences healthcare. The internet informed public is demanding more information about options, benefits and risks of healthcare. The media is publicly questioning policy decisions and promoting new research with varying levels of accuracy. So the production of and demand for research continues at a pace. However what is not so clear is the public benefit of this research industry. We are living longer, but is our quality of life better? Are we clearer about what to do to maintain and improve health? New drugs are being promoted while others are being discontinued as we find out more about their side effects. We know so much more about healthy lifestyles yet obesity is rising in most countries. Are we consistently using all the research results that we know? Are we equipped to challenge new research to determine its applicability?
We know about some clear barriers to using research in clinical practice. It takes time to write up research reports, publish academic articles, and inform the relevant healthcare professionals. As this new knowledge spreads, not everyone understands or agrees with it. Some people may need more knowledge and others need time to debate with colleagues before they are willing to change practice. Sometimes it is not clear which patients will benefit and whether the results are applicable for everyone. Other times the change just doesn’t fit in with the way things are being done, it costs more money, it requires new equipment, or it means other activities should stop. Sometimes patients are not clear about what is happening and may think they are losing something valuable.
This whole area of complexity is referred to by many different terms; such as knowledge translation, research utilisation, and implementation science. They all recognise that knowledge IS required but on its own it is not enough to force a change in practice. We know that every situation is slightly different and there will be factors that help or limit the flow of knowledge. Sometimes this will happen directly or in response to something else. It is complex and sounds chaotic. But it is not totally random, as there is some order in there. We know that some things work better in certain places and at specific times. This field of knowledge translation is about trying to understand the drivers, facilitators and barriers for individual clinicians and patients to change. This also requires an understanding of how organisations and health policymakers support and influence change and how expectations can match this whole process.
Some people claim that knowledge translation is just common sense, or that it is better to do something than nothing. However, we need to develop ways to learn from our mistakes and to really understand the harms from some of our well-intentioned actions. There is a need to be more systematic about how we approach change so that we can be more efficient and successful in integrating research evidence in clinical practice. This blog will aim to educate, inform and entertain. Please comment and challenge along the way. Working in this area requires more than linear thinking, so questions and dialogue will continue to develop and translate our shared knowledge.