The K in KT: knowledge creation

Sharon E. Straus, MD, MSc, FRCPC
Eman Leung, PhD

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The K in KT: Knowledge Creation

  • At the center of the Knowledge-To-Action Cycle is the “Knowledge Funnel”
  • This represents the process through which knowledge is refined, distilled, and tailored to the needs of knowledge end-users such as health care professionals and policy makers

The “Knowledge Funnel”

1. Knowledge Inquiry

  • Describes the act of deriving knowledge from the multitude of primary studies such as randomized trials
  • The product of studies such as these is referred to as ‘first generation knowledge’
  • This knowledge in its natural state is largely unrefined
  • Example

    • Primary research studies reported inconsistent effect of antibiotics on URTI such as sore throat
    • Use of antibiotics associated with development of resistant organisms

2. Knowledge Synthesis

  • ‘second-generation knowledge’- it represents the aggregation of existing knowledge
  • The process of aggregation involves application of explicit and reproducible methods to identify, appraise, and synthesize studies relevant to a specific question in order to minimize bias and random error
  • Examples of knowledge syntheses include systematic reviews, meta-syntheses, scoping reviews, and realist reviews
  • Example

    • When the day-3 and week-1 effects of antibiotics on sore throat were aggregated across all primary studies with respect to their sample size, the meta-analysis revealed only modest effects;
    • The number of patients that needed to be treated for the treatment to be considered beneficial in preventing one sore throat was 6 and 21 for day 3 and week 1 respectively
      (Arnold & Straus, 2005; Cochrane Database of Systematic Reviews)

3. Knowledge Tools/Products

  • Synthesized knowledge is used to create knowledge tools and products
  • Two examples of knowledge translation tools include: clinical practice guidelines and patient decision aids
  • Clinical practice guidelines:

    • help clinicians and patients make decisions about appropriate health care for specific clinical circumstances
    • inform decisions make by health care policymakers and clinical managers
  • Patient decision aids

    • help clarify the value patients place on benefits versus harm
    • guide the process of decision making
    • translate best available evidence into patient-friendly tools to inform patients about their options
  • Example

    • The Centres for Disease Control and Prevention in the United States developed a guideline stating that antibiotics should not be prescribed for acute uncomplicated respiratory track infection in otherwise healthy adult patient
      (see Cooper et al, 2001; Snow et al, 2001a,b)