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      Improving KT tools and products: development and evaluation of a framework for creating optimized, Knowledge-activated Tools (KaT)

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          Abstract

          Background

          Positive impacts of quality improvement initiatives on health care and services have not been substantial. Knowledge translation (KT) strategies (tools, products and interventions) strive to facilitate the uptake of knowledge thereby the potential to improve care, but there is little guidance on how to develop them. Existing KT guidance or planning tools fall short in operationalizing all aspects of KT practice activities conducted by knowledge users (researchers, clinicians, patients, decision-makers), and most do not consider their variable needs or to deliver recommendations that are most relevant and useful for them.

          Methods

          We conducted a 3-phase study. In phase 1, we used several sources to develop a conceptual framework for creating optimized Knowledge-activated Tools (KaT) (consultation with our integrated KT team, the use of existing KT models and frameworks, findings of a systematic review of multimorbidity interventions and a literature review and document analysis on existing KT guidance tools). In phase 2, we invited KT experts to participate in a Delphi study to refine and evaluate the conceptual KaT framework. In phase 3, we administered an online survey to knowledge users (researchers, clinicians, decision-makers, trainees) to evaluate the potential usefulness of an online mock-up version of the KaT framework.

          Results

          We developed the conceptual KaT framework, and iteratively refined it with 35 KT experts in a 3-round Delphi study. The final framework represents the blueprint for what is needed to create KT strategies. Feedback from 201 researcher, clinician, decision-maker and trainee knowledge users on the potential need and usefulness of an online, interactive version of KaT indicated that they liked the idea of it (mean score 4.36 on a 5-point Likert scale) and its proposed features (mean score range 4.30–4.79).

          Conclusions

          Our findings suggest that mostly Canadian KT experts and knowledge users perceived the KaT framework and the future development of an online, interactive version to be important and needed. We anticipate that the KaT framework will provide clarity for knowledge users about how to identify their KT needs and what activities can address these needs, and to help streamline the process of these activities to facilitate efficient uptake of knowledge.

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          Most cited references8

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          Increasing value and reducing waste in biomedical research: who's listening?

          The biomedical research complex has been estimated to consume almost a quarter of a trillion US dollars every year. Unfortunately, evidence suggests that a high proportion of this sum is avoidably wasted. In 2014, The Lancet published a series of five reviews showing how dividends from the investment in research might be increased from the relevance and priorities of the questions being asked, to how the research is designed, conducted, and reported. 17 recommendations were addressed to five main stakeholders-funders, regulators, journals, academic institutions, and researchers. This Review provides some initial observations on the possible effects of the Series, which seems to have provoked several important discussions and is on the agendas of several key players. Some examples of individual initiatives show ways to reduce waste and increase value in biomedical research. This momentum will probably move strongly across stakeholder groups, if collaborative relationships evolve between key players; further important work is needed to increase research value. A forthcoming meeting in Edinburgh, UK, will provide an initial forum within which to foster the collaboration needed.
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            Optimal matches of patient preferences for information, decision-making and interpersonal behavior: evidence, models and interventions.

            A comprehensive review was conducted of the theoretical and empirical work that addresses the preference-match strategy in physician-patient communication. Searches were conducted on Medline, PsychINFO, InFoTrac One File Plus, Sociological Abstracts, and Dissertation Abstracts through 2004. The following keywords were used: patient preferred and received information; patient preferred and actualized treatment decision-making; patient-physician beliefs in shared decision-making; patient-physician match, fit, or concordance; reciprocal relationship or mutuality; doctor-patient affiliation, control, relationship; match/fit between patient and physician in affiliation, control, or relationship. Findings revealed varying degrees of support for the positive effects of matching patients' preferred levels of information, decisional control, and consultative interpersonal behavior. Findings justify not only continued but expanded research efforts in this area that would incorporate recommended changes in research design and implementation. PRACTICE AND RESEARCH IMPLICATIONS: Assessment strategies and match interventions are discussed that, if evidence continues to be supportive, might routinely optimize patient-physician encounters toward more positive outcomes. Methodological guidelines are suggested that can improve future preference-match studies of the patient-physician interaction. Practitioners need to consider adoption of patient-match assessment and intervention strategies in addition to recent exclusive concentrations on patient-centered and shared decision-making approaches.
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              A critical second look at integrated knowledge translation.

              Integrated knowledge translation (IKT) requires active collaboration between researchers and the ultimate users of knowledge throughout a research process, and is being aggressively positioned as an essential strategy to address the problem of underutilization of research-derived knowledge. The purpose of this commentary is to assist potential "knowledge users", particularly those working in policy or service settings, by highlighting some of the more nuanced benefits of the IKT model, as well as some of its potential costs. Actionable outcomes may not be immediately (or ever) forthcoming, but the process of collaboration can result in group-level identity transformation that permits access to different professional perspectives as well as, we suggest, added organizational and social value. As well, the IKT approach provides space for the re-balancing of what is considered "expertise". We offer this paper to help practitioners, administrators and policymakers more realistically assess the potential benefits and costs of engaging in IKT-oriented research. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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                Author and article information

                Contributors
                monika.kastner@utoronto.ca
                julie.makarski@nygh.on.ca
                leigh.hayden@nygh.on.ca
                laiy@smh.ca
                joyce.chan.77@gmail.com
                vtreister@gmail.com
                kegan.harris55@gmail.com
                sarah.munce@uhn.ca
                Jayna.Holroyd-Leduc@albertahealthservices.ca
                igraham@ohri.ca
                sharon.straus@utoronto.ca
                Journal
                Implement Sci Commun
                Implement Sci Commun
                Implementation Science Communications
                BioMed Central (London )
                2662-2211
                8 May 2020
                8 May 2020
                2020
                : 1
                : 47
                Affiliations
                [1 ]GRID grid.416529.d, ISNI 0000 0004 0485 2091, North York General Hospital, , Centre for Research and Innovation, ; 4001 Leslie Street, Toronto, Ontario M2K 1E1 Canada
                [2 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Institute of Health Policy, Management and Evaluation, , University of Toronto, ; Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6 Canada
                [3 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Li Ka Shing Knowledge Institute of St. Michael’s hospital, , University of Toronto, ; 30 Bond Street, Toronto, ON M5B 1W8 Canada
                [4 ]GRID grid.231844.8, ISNI 0000 0004 0474 0428, University Health Network, ; Toronto, Ontario Canada
                [5 ]GRID grid.22072.35, ISNI 0000 0004 1936 7697, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, , University of Calgary, ; Calgary, Alberta Canada
                [6 ]GRID grid.28046.38, ISNI 0000 0001 2182 2255, School of Epidemiology and Public Health, Clinical Epidemiology Program, , University of Ottawa and Ottawa Hospital Research Institute, ; Ottawa, Ontario Canada
                [7 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Department of Medicine, , University of Toronto, ; Toronto, Canada
                Article
                31
                10.1186/s43058-020-00031-7
                7427906
                32885176
                b7d3ba86-580c-494e-8805-753729d52a9b
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 13 September 2019
                : 13 April 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000226, Ontario Ministry of Health and Long-Term Care;
                Award ID: 06688
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                knowledge translation,kt tools, interventions,framework,knowledge user needs,delphi study,survey

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