CLINICAL RESEARCH FOCUS
Knowledge translation in transfusion medicine. Part 1: The
basics and the frameworks
and Ivan D. Florez
linical research provides new knowledge with
the goal not only to inform, but also to impact
patient health so that the most effective and
safe care approaches are adopted. Clinical
research can elucidate which clinical care options are
appropriate for implementation and which ones are not
effective or potentially harmful. For example, in transfu-
sion medicine the historical teaching of transfusing 2
units of red blood cells (RBCs) at a time is not supported
by evidence; liberal transfusion does not benefit patients
or confer good quality care.
Indeed, the Choosing Wisely
program identifies several common care options—some
that are costly—that should be “deimplemented” or
avoided because there is a lack of evidence of
Despite considerable resources used in the creation
and interpretation of research results, only 14% of medical
research findings are implemented to benefit patients.
Often, implementation of clinical research evidence is
arbitrary and unsystematic, and it may take a mean of 17
years from the time of discovery to effective application.
This significant delay denies the patient treatments of
proven benefit. Thus, while knowing the best care options
is an important first step, knowledge alone is insufficient
in ensuring that clinicians and the health system act on
this knowledge. This is a phenomenon known as the
knowledge-to-action (KtoA) gap.
To bridge this gap, an
evidence-based process to facilitate the uptake of that
clinical evidence is required. Knowledge translation (KT)
is a set of methods that can help address KtoA gaps and
maximize the extent to which patients receive evidence-
based therapies in a timely fashion.
hospital-based or team-based KT intervention plans that
account for context may be needed. Upholding ethical
principles and social values in health care delivery should
result in deliberate actions to question current practice
and get evidence in use.
KT is a complex science involving an understanding of
human psychology, human context such as system struc-
tures and tools, and barrier analysis. The term “knowledge
translation” was coined by the Canadian Institutes of
Health Research (CIHR) in the year 2000 (http://www.
cihr-irsc.gc.ca/e/29418.html). CIHR defined KT as “a
dynamic and iterative process that includes synthesis, dis-
semination, exchange and ethically sound application of
knowledge to improve patient health, provide more effec-
tive health services and products and strengthen the
health care system.” Therefore, KT in health care is not
only data driven but also action oriented; that is, it is
based on the active participation of health professionals.
KT frameworks can provide a systematic approach to
develop, manage, and evaluate interventions. There are
more than 60 KT frameworks that can inform how to think
about and understand a health care problem, how to
identify clinical and system solutions based on research
evidence, and/or how to design and implement strategies
to enable the adoption of research and evaluate out-
Some frameworks are broad with flexible applica-
tions allowing researchers and knowledge users the ability
ABBREVIATIONS: CIHR 5 Canadian Institutes of Health
Research; KT 5 knowledge translation; KtoA 5 knowledge-
Department of Pathology & Laboratory Medicine
(PaLM), Schulich School of Medicine & Dentistry, Western
University, London, Ontario, Canada; the
Oncology and the
Department of Health Research
Methodology, Evidence, and Impact, McMaster University,
Hamilton, Ontario, Canada; and the
Department of Pediatrics,
University of Antioquia, Medellin, Colombia.
Address correspondence to: Ziad Solh, 800 Commissioners
Road East, Room D1-236, Victoria Hospital, London Health Sci-
ences Centre, London, ON N6A 5W9, Canada;
ZS is supported by a knowledge translation grant from
Physicians’ Services, Inc.
Received for publication December 11, 2017; and
accepted December 11, 2017.
Volume 58, March 2018 TRANSFUSION 629