Section 2.3: Knowledge Translation Tools

[ Table of Contents ]

Melissa C. Brouwers, PhD
Associate Professor and Lead of Health Services Research,
Dept. of Oncology, McMaster University
Associate Member, Dept. of Clinical Epidemiology & Biostatistics, McMaster University

Dawn Stacey, RN, PhD
Assistant Professor, School of Nursing, University of Ottawa
Associate Scientist, Ottawa Hospital Research Institute

Annette M. O'Connor, RN, PhD, FCAHS
Professor, School of Nursing, University of Ottawa
Senior Scientist, Ottawa Hospital Research Institute

Products / Tools

Key Points:

  • Systematic reviews form the foundation of many knowledge translation activities
  • Implementation efforts should ensure high quality clinical practice guidelines and patient decision aids are used
  • Implementation of patient decision aids can improve quality decision

Knowledge Tools

  • Clinical Practice Guidelines
  • Patients Decision Aids
  • Used to assist clinicians and patients to make evidence-based decisions
  • Provide an explicit evidence-based description of the risk and benefits of an intervention
  • Outline where evidence is lacking

What are Clinical Practice Guidelines (CPGs)?

  • Systematically developed statements aimed to assist clinicians and patients in making decision about appropriate health care for specific clinical circumstances

Systematic vs. arbitrary

Assist and not supplant decision making

Not formulaic protocols

CPGs – Essential Elements

  • Establish multidisciplinary team
  • Identify question
  • Systematic review of evidence
  • Appraise and interpret evidence
  • Draft recommendations
  • External review of draft
  • Revise recommendation
  • Dissemination
  • Implementation

CPGs - Do They Work?

Systematic review by Grimshaw et al*

10% improvement in processes and outcomes of care

* J Gen Intern Med 2006 Feb;21 Suppl 2:S14-20
* Health Technol Assess 2004 Feb;8(6):iii-iv, 1-72

CPGs – Determining Quality

AGREE

  • International standard of guideline development, reporting and evaluation
  • 6 quality domains (23 items)
    • Scope and purpose
    • Stakeholder Involvement
    • Clarity of Presentation
    • Rigour of Development
    • Applicability
    • Editorial Independence

GLIA (Guideline Implementability Appraisal) Tool

  • Provides perspective by assessing extent to which recommendations are implementable

Patient Decision Aids – What are They?

  • Translate evidence into patient friendly tools to:
    • Inform patients on options
    • Clarify value placed on benefits vs harm
    • Guide in processing of decision making

Patient Decision Aids – Essential Elements

  • Evidence-based information on condition, options and outcomes tailored to patient clinical situations
  • Risk communication regarding outcomes and uncertainty
  • Values clarification - what is most important to the patient
  • Guidance in deliberating and communicating with others

Patient Decision Aids - Do They Work?

Coulter and Ellins, review of reviews (2007)

  • Improve participation in decision-making
  • Patient's knowledge of options
  • Facilitate agreement between values and subsequent decisions

Patient Decision Aids - Determining Quality

  • International Patient Decision Aids Standards Collaboration
  • OHRI - Patient Decision Aids
  • Domains of quality include:
    • essential content
    • development
    • evaluation

Evidence Gaps – What is Required?

  • Research efforts should focus on areas to advance our understanding of knowledge tools, including:
    • Strategies to enhance understanding and implementation of systematic review (syntheses) and guidelines and patient decision aids
    • Impact of patient decision aids on important clinical outcomes
    • Studies of validity and reliability of the International Patient Aids Standard
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