Basic Research in KT: Square Peg in a Round Hole?
By Trish Roche
The role of basic biomedical researchers in KT is a topic that continues to be debated — does KT apply to basic discovery research, where often the end user isn’t known, and the effect on changing health care and services is still a number of steps (and years) down the road? Do peer-reviewed articles and conference presentation suffice to serve the purpose of KT in basic research? What about commercialization — working with industry to design and patent novel drugs or treatments — is this KT? Or is it something else, like “translational research”? What’s the difference?
If you take a look at the most cited works on Scopus for “knowledge translation”, do you find basic research mentioned at all? If so, how is KT described for this kind of work? These are the questions I am seeking to answer. So I searched the database for “knowledge translation”, and dug a little deeper into those highly-cited articles.
The top hit is Graham et al.’s seminal 2006 paper, aptly titled “Lost in knowledge translation: time for a map?”. In the paper, cited by over 1,100 peer-reviewed articles, the authors state that “translational research (the transfer of basic science discoveries into clinical applications) does not fall under our conceptualization of KTA [knowledge-to-action] because translational research falls short of widespread adoption” [1].
Similarly, although Straus et al. acknowledge that strategies for translation of biomedical research will vary, the authors contend that KT isn’t commercialization or technology transfer, because this type of activity “does not take into consideration the various stakeholders involved (including patients, health care providers and policy-makers) or the actual process of using knowledge in decision-making” [2]. Other highly cited publications on KT don’t even mention basic discovery research in discussions of what KT ‘is’.
On the other side of the coin, a number of groups do include basic biomedical research as part of the KT spectrum. One review that looked at over 2,500 KT articles found mentions (though few of them) of translational research, and technology transfer–common descriptors for KT of basic research findings [3].
Grimshaw et al. highlight the role of basic research in knowledge translation, distinguishing between “T1” and “T2” translation. T1 refers to ‘bench to bedside’ translation (i.e. basic to clinical research), and T2 refers to the movement of evidence to practice, with the latter being what is most commonly referred to as ‘KT’. In terms of T2 translation, Grimshaw et al. note that, contrary to traditional T2 methods — where the stakeholder groups include clinicians, patients, and the public — the primary knowledge users of basic research are most often other researchers (basic or clinical) or industry [4].
To further confuse things, there is at least one instance where T1 translation is actually what is referred to as “knowledge translation”, where T2 is “translational medicine” [5]. The National Institutes of Health (NIH) doesn’t even subscribe to the term “knowledge translation”, preferring to use “translational research” instead, in a paradigm that encompasses the entire spectrum of health knowledge, from basic biomedical research to real-world application [6].
Coming back to the KTA Framework, which we most often use at CHI to model and understand the process of KT — where does basic research fit in this cycle? It could be argued that it is in fact the foundation of the KTA cycle, the very first step — knowledge creation. Clinical studies that inform practice are based on animal studies, which are in turn based on preliminary ‘bench’ studies. There is great value and need to translate the findings of basic discovery research — though the lay of the land will be different and present its own unique challenges. Basic and clinical researchers are applying to the same granting agencies that require would-be grantees to develop comprehensive KT strategies for their work, in the push for relevant and applicable health research. If biomedical research “isn’t KT”, or basic researchers view themselves at outside of the KT ‘continuum’, then what do they put in the KT section of their grant?
- Do they simply dismiss KT as not relevant to their work (at least not yet), and fill the KT strategy section with plans for traditional dissemination (like journal articles and conference proceedings)?
- Or is this a missed opportunity to break the boundaries of traditional methods of dissemination and think outside the box (or microscope, as it may be)?
If we make room for biomedical research in the KT spectrum and recognize its importance as the foundation of the KTA cycle, these researchers can become part of the growing KT movement, whether it be through technology transfer and commercial innovation, or perhaps even beyond academics and industry, where we see basic researchers sharing their work and expertise with the public through mediums like video and mainstream media.
Let’s not leave basic researchers out of the loop. Rather, let’s take a page from the KTA Framework, and adapt KT to the local context, whether its drug discovery or drug delivery.
References
1. Graham ID, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof, 2006. 26.
2. Straus SE, Tetroe J & Graham ID. Defining knowledge translation. CMAJ, 2009. 181(3–4): p. 165–168.
3. McKibbon KA, et al. A cross-sectional study of the number and frequency of terms used to refer to knowledge translation in a body of health literature in 2006: a Tower of Babel? Implementation Science, 2010. 5(1): p. 16.
4. Grimshaw JM, et al. Knowledge translation of research findings. Implement Sci, 2012. 7: p. 50.
5. Greenhalgh T & Wieringa S. Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. Journal of the Royal Society of Medicine, 2011. 104(12): p. 501–509.
6. Sampson, UKA et al. Implementation Research. Global Heart. 11(1): p. 153–158.
7. Straus SE, Tetroe J & Graham I. Knowledge Translation in Healthcare: Moving from Evidence to Practice. BMJ Books, 2013.
About the Author
Trish Roche is a Knowledge Broker with @CHImbca, passionate about moving basic science beyond the bench.
