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Translating Research into Policy and Practice: Who’s Influencing Whom?

Translating Research into Policy and Practice: Who’s Influencing Whom?. Jon F. Kerner, Ph.D. Deputy Director, Division of Cancer Control & Population Sciences Academy Health Research Translation Interest Group National Health Policy Conference February 13, 2007. Who Makes Policy?.

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Translating Research into Policy and Practice: Who’s Influencing Whom?

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  1. Translating Research into Policy and Practice: Who’s Influencing Whom? Jon F. Kerner, Ph.D. Deputy Director, Division of Cancer Control & Population Sciences Academy Health Research Translation Interest Group National Health Policy Conference February 13, 2007

  2. Who Makes Policy? Who Influences Policy?

  3. Who Controls Major Federal Programs for Children and Families: Rube Goldberg Revisited. The Institute for Educational Leadership. Washington DC: 1995.

  4. Tobacco Control • Diet • Physical Activity • Sun Exposure • Virus Exposure • Alcohol Use • Chemoprevention Focus • Communications • Surveillance • Social Determinants and Health Disparities • Genetic Testing • Decision-Making • Evidence-Based Health Care • Quality of Cancer Care • Epidemiology Cross Cutting Issues THE CANCER CONTROL CONTINUUM Cancer Control Continuum Prevention Detection Diagnosis Treatment Survivorship • Informed Decision Making • Clinical Follow-up • Imaging • Pap Test • Mammography • FOBT • Endoscopy • PSA Informed Decision Making • Health Services and Outcomes Research • Clinical Trials • Palliation • Coping • Health Promotion

  5. http://appliedresearch.cancer.gov/

  6. Translating Research to Reduce the Burden of Cancer The Translation Continuum Basic Science Discovery Early Translation Late Translation Dissemination Adoption (of new drug, assay, device, behavioral intervention, educational materials, training) • Phase III trials • Regulatory approval • Partnerships • Production/commercialization • Phase IV trials –approval for additional uses • Payment mechanism(s) established to support adoption • Health services research to track adoption • Promising molecule or gene target • Candidate protein biomarker • Basic epidemiologic finding • Partnerships and collaboration (academia, government, industry) • Intervention development • Phase I/II trials • Adoption of advance by providers, patients, public • Payment mechanism(s) in place to enable adoption • To community health providers • To patients and public • Dissemination & Implementation Research to study how best to support D&I • Data collection to support outcomes research, intervention refinement, health services and other research; and to inform provider practices Source: Reuben SH. 2005

  7. Counts Context Public Health Practice Primary Care Practice Disease Specialty Practice THE DISCOVERY-DELIVERY CONTINUUM Delivery Discovery Development Translational Research Research Translation What about policymaking?

  8. Diffusion … the passive process by which a growing body of information about an intervention, product, or technology is initially absorbed and acted upon by a small body of highly motivated recipients (Lomas, 1993).

  9. Increase the number of systems providing evidence based cancer control Increase the number of practitioners providing evidence based cancer control Increase the number of individuals receiving evidence based cancer control Bridging the Gap: A Synergistic Model Getting Evidence - Based Cancer Control Interventions Into Practice GOAL: To increase the adoption, reach and impact of evidence - based cancer control Delivery Capacity Science Push Market Pull/ Building the capacity Documenting, Demand of relevant systems to improving, Building a market deliver the and communicating and demand for the intervention the intervention for intervention wide population use - - - ULTIMATE GOAL: Improve population health and well being Tracy Orleans ( RWJF) – Designing for Dissemination Conference Presentation, 9/ 02

  10. Dissemination Active process through which the information needs (pull) of target groups working in specific contexts (capacity) are assessed, and information is “tailored” to increase awareness of, acceptance of, and use of the lessons learned from science.

  11. http://cancercontrolplanet.cancer.gov

  12. 17:14 It takes 17 years to turn 14 per cent of original research to the benefit of patient care Original research 18% variable Negative results Dickersin, 1987 Submission 46% 0.5 year Kumar, 1992 Koren, 1989 Acceptance Negative results 0.6 year Kumar, 1992 Publication Expert opinion 35% 0.3 year Poyer, 1982 Balas, 1995 Lack of numbers Bibliographic databases 50% 6. 0 - 13.0 years Antman, 1992 Poynard, 1985 Reviews, guidelines, textbook 9.3 years Inconsistent indexing Implementation E.A. Balas, 2000

  13. Bench to Bedside Bench to Trench

  14. TRANSLATION Evidence-based Knowledge Public Health & Clinical Practice “The transfer of evidenced-based knowledge into routine or representative practice” Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22: Disseminating Behavioral Medicine Research: Making the Translational Leap.

  15. What is Evidence…..? OBJECTIVE SUBJECTIVE • Surveillance Data • Systematic Reviews of Multiple Research Studies • Expert Opinion/Narrative Reviews • A Single Research Study • Program/Policy Evaluation • Word of Mouth/Media • Marketing/Lobbying • Personal Experience ...like beauty, it's in the eye of the beholder

  16. INTEGRATION Explicit Evidence- Based Knowledge Informed Application Tacit Clinical and Contextual Knowledge “The informedcombination of evidence-based knowledge and local contextual knowledge into policy & practice applications.” Adapted from Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22: Disseminating Behavioral Medicine Research: Making the Translational Leap.

  17. Integrating Research with Practice/Policy • Integrating research with practice/policy requires the development of a common language and common understanding about the meaning of knowledge translation, knowledge integration, and the nature of evidence. • New and expanded investments in dissemination and implementation research are needed to review existing models and develop new conceptual frameworks to integrate science with service practice and policy. • Research/practice/policy partnerships will be critical in all aspects of future intervention, dissemination and implementation research, as well as diffusion, dissemination and implementation of research results.

  18. http://cancercontrol.cancer.gov/d4d

  19. Making Translation Decisions: Do We Have the Right Stuff? Tacit & Contextual Knowledge From Experience Explicit Knowledgefrom Research Evidence

  20. Does the impact of research on policy application depend on the relationship between research and application agencies?

  21. Our goal is to turn knowledge into applications that benefit people. “To him who devotes his life to science, nothing can give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of his studies immediately find practical applications.” ~Louis Pasteur

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