Closing the gap: applying the Theoretical Domains Framework to improve knowledge translation

Abstract

Knowledge translation is defined as the ''synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians…''. 1 The lag between the conduct of clinical research and its realization into practice is a vexing problem for health researchers worldwide. 2,3 A knowledge translation time lag of 17 years has often been quoted in the literature, and even then, implementation has ranged from 11-79% of recommended care. 2,3 The past decade has seen an intense interest in knowledge translation and implementation science to address the gap between knowledge and practice more effectively, including identifying the barriers and enablers to implementation. [1][2][3][4][5] With respect to the practice of anesthesiology, the adverse outcomes of inadvertent perioperative hypothermia (IPH) are well known. Yet, despite published guidelines and the wide availability of effective patient warming modalities, the prevalence of IPH remains problematically high. 6 The reasons for the gap between evidence and implementation are poorly understood, particularly as they apply to the practices of anesthesiologists. In their study, Boet et al. 6 interviewed 15 anesthesiologists using the Theoretical Domains Framework (TDF) as a guide in order to understand those factors that promote or hinder anesthesiologists' perioperative temperature management. The authors discovered nine relevant theoretical domains, including those pertaining to uncertainty about the impact on patient outcomes and individual performance, lack of clarity about the guidelines, and the organizational or social environment. The authors make specific recommendations for interventional strategies based on these findings.This study is noteworthy for several reasons. First, it addresses an often overlooked aspect of anesthesia care wherein relatively simple interventions may result in significantly positive impacts on perioperative and economic outcomes. The authors found that the lack of feedback on temperature regulation practices and patient outcomes was an important barrier to effective implementation of the guidelines. Based on this, the authors recommend the development of a comprehensive formal audit and feedback process to improve practices. Interestingly, their finding is in keeping with a recent study by Görges et al. 7 in which pediatric spine anesthesiologists were provided with both individual and team feedback regarding the time delay from the start of the case to the first temperature monitoring. The provision of intraoperative thermoregulation data resulted in a significant and sustained reduction in the time delays for temperature monitoring at the individual and team levels, which underlines the importance of providing feedback for consistency of practice.Second, this study illustrates the usefulness of qualitative methods in clinical research to probe for barriers and enablers to the implementation of practice guidelines. Typically, quantitative methodologies are characterized by deductive testing of pre-set ...

The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

“…Since then, there could have been changes in clinical practice, e.g., in the use of 'Enhanced Recovery After Surgery' (ERAS) pathways and muscle relaxant monitoring during and reversal at the end of surgery. Although the time gap between research findings and practice changes usually lasts longer than a decade [38][39][40], still could be that more immediate changes may affect the associations. Finally, we did not set any a priori effect threshold nor multiple comparisons…”

Intraoperative Driving Pressure and Postoperative Pulmonary Complications After Abdominal Surgery – A Posthoc Propensity Score–Weighted Cohort Analysis of the LAS VEGAS Study Comparing Open to Closed Surgery

“…Since then, there could have been changes in clinical practice, e.g., in the use of 'Enhanced Recovery After Surgery' (ERAS) pathways, as well as muscle relaxant monitoring during and reversal at the end of surgery. Although the time gap between research ndings and practice changes usually lasts longer than a decade, [38][39][40] it still could be that more immediate changes may affect the here found associations. Finally, we did not set any a priori effect threshold nor multiple comparisons correction; hence the results' statistical signi cance and the exploratory nature of secondary outcome analysis must be con rmed in future trials.…”

Applying the Theoretical Domains Framework to understand knowledge broker decisions in selecting evidence for knowledge translation in low- and middle-income countries

“…Determining the factors that influence successful dissemination and uptake of evidence-based, context-appropriate health practices has critical importance for reducing maternal and newborn mortality in low- and-middle income countries (LMICs), which carry the greatest burden of preventable deaths [1, 2]. The how and why of research uptake – a topic labelled as knowledge translation (KT) in the literature – has been widely studied to address the long-standing gap between health research evidence and practice [3]. The methods associated with health KT include filtering and packaging evidence to suit the needs of health system audiences, disseminating the knowledge and advocating for its application in decision-making [3–5].…”

“…The how and why of research uptake – a topic labelled as knowledge translation (KT) in the literature – has been widely studied to address the long-standing gap between health research evidence and practice [3]. The methods associated with health KT include filtering and packaging evidence to suit the needs of health system audiences, disseminating the knowledge and advocating for its application in decision-making [3–5]. Global commitment in the form of actions and communications from organisations such as WHO and PAHO, and multi-region programmes such as the Evidence into Policy Networks [5], point to the importance of KT.…”

“…Whether used alone or with other frameworks, the TDF has been shown to be useful by offering a broad range of constructs that may influence individual decisions to make use of evidence [3, 18].…”