Views on Translation: (Rapid) Knowledge Synthesis in Times of COVID-19
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MHSc in Translational Research

Christopher A. Klinger, Ph.D. (TRP Translator) and Raza M. Mirza, Ph.D. (TRP Translator) for the TRP, November 2020

As the COVID-19 pandemic, unfortunately, continues to hold its grip into the fall of 2020, the TRP Team has successfully started the academic year with an online orientation session for the new cohort of students on September 1, 2020. WELCOME ONBOARD everyone and WELCOME BACK cohort of 2019! As your course facilitators for the (relabeled) LMP 2348H Knowledge Translation and the Community course module, we will try our best to enable a meaningful, inclusive and engaging experiential learning experience as we all strive for a (temporary) ‘new normal’ together.

As outlined in a previous TRP Up-Close Blog contribution, (rapid) knowledge synthesis and knowledge translation efforts are high on the agenda – including in the caregiving field. The featured scoping study on knowledge gaps regarding informal caregiving at the end of life in North America – following Arksey and O’Malley’s framework – has meanwhile been completed with the support of (now former – CONGRATULATIONS on completing your respective Capstone projects!) TRP students Andrew Wan, Ankita, and Zoey Li and been submitted for publication. Its recommendations toward the numerous physical, psycho-socio-spiritual, financial, and health system challenges faced during care for people with life-limiting illnesses are set to inform policy and practice. Additionally, the Canadian Hospice Palliative Care Association (CHPCA) has championed compassionate visitation protocols in this regard, which will help Canadians to get a chance to say their goodbyes meaningfully and to deal with (impending) loss in a way that both protects the safety of frontline healthcare workers and prevents the transmission of COVID-19.

What the current public health crisis has clearly highlighted across fields is the need for timely (i.e., rapid) evidence to inform (healthcare) decision-making. How to ‘create’ that evidence, though – and how to transfer (i.e., ‘translate’) it to (medical) practice?

Andrea Tricco, Ph.D., Canada Research Chair in Knowledge Synthesis and Director of the Knowledge Synthesis Team in the Knowledge Translation Program of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital in Toronto and her team recently looked at such rapid evidence materials and appropriate steps in a special open-access COVID-19 article in the Journal of Clinical Epidemiology.

Starting with a listing of rapid evidence formats such as inventories, rapid response briefs and rapid reviews, the international group of authors outlined several methodological challenges to evidence generation in a (public health) crisis, such as:

  • urgency of the request from decision-makers,
  • identification of and access to sources of evidence for inclusion,
  • need for potential extrapolation of results from (indirect) evidence, and
  • adequate dissemination channels regarding results.

Focusing on the rapid review approach, defined as ‘‘… a form of knowledge synthesis that accelerates the process of conducting a traditional systematic review through streamlining or omitting specific methods to produce evidence for stakeholders in a resource-efficient manner” by the Cochrane Collaboration as a charitable organisation dedicated to synthesizing medical research findings to facilitate evidence-based decision-making, eight specific steps in the knowledge synthesis process were examined and potential solutions proposed:

  1. Conceptualizing Question and Scope

Conceptualization and scope are ‘moving targets’ in an emergency as the situation is fluent and priorities and implications are rapidly evolving. To maintain (clinical) relevance, the involvement of (frontline) clinicians and patients remains important, as is the coordination of efforts amongst various jurisdictions (e.g., regional, provincial/territorial, federal, international). Entities such as the World Health Organization (WHO) and Cochrane Collaboration are seen as potential clearinghouses – also concerning the registration of studies, reviews, etc. to avoid duplication.

  1. Literature Search

In addition to the classic comprehensive literature searches via multiple databases, grey literature sources (such as inventories/repositories, preprint servers, public health guidelines, websites of stakeholder organizations, etc.) are important to capture emerging evidence. Close collaboration with a librarian/information specialist is suggested – alongside monitoring of sources in multiple languages up to the point of publication.

  1. Citation Screening 4. Data Abstraction and 5.     Methodological Assessment

Screening of large amounts of data in a short period requires a well-versed team and set guidelines for data abstraction. Due to the emerging nature of the situation, evidence may be of lower methodological quality. The utilization of software applications (such as Covidence) and the sharing of screening and abstraction tasks are recommended.

  1. Synthesis and Interpretation of Results

The fluidity of the situation and necessity to include indirect evidence as a proxy make it challenging to extrapolate findings, “… impacting interpretation of results.” The authors propose strict transparency in reporting and close collaboration with decision-makers to ensure contextualization.

  1. Knowledge Dissemination

With regard to the dissemination of results, the Open Science Framework is highlighted alongside targeted outreach approaches including social media platforms, knowledge brokers, and academic detailers. Overall, “… [u]se of evidence-informed dissemination strategies should be considered to ensure wide uptake of results.”

  1. Currency of Results

In order to keep the results of the knowledge synthesis current, strategies for (frequent) updating need to be pursued. The group of authors sees automation in searching and screening as a potential solution, i.e., the creation of a ‘living document’.

Overall, as rapid reviews are being conducted quickly, they must use thoughtful methods approaches, coordinate efforts internationally (to reduce risk of duplication and to effectively use collective evidence), and ensure transparency in reporting. The hope is that the lessons learned today can be carried forward and be used in future times of (global) emergency.

All the very, very best in these challenging times everyone – have a great academic year, and please do stay safe and strong!

Citation: Tricco, A., Garritty, C., Boulos, L., et al. (2020). Rapid review methods more challenging during COVID-19: Commentary with a focus on 8 knowledge synthesis steps. Journal of Clinical Epidemiology, 126, 177-183.

Christopher A. Klinger, Ph.D. is a Sessional Instructor I with the Translational Research Program (TRP) at the University of Toronto’s Faculty of Medicine, Department of Laboratory Medicine and Pathobiology, and Research Scientist with Pallium Canada – a national non-profit evidence-based organization focused on building professional and community capacity to help improve the quality and accessibility of palliative care. His research interests are in health systems and policy, with a focus on hospice palliative/end-of-life care. He also chairs the National Initiative for the Care of the Elderly’s (NICE) End-of-Life Issues Theme Team, a knowledge transfer network dedicated to enhancing the care of older adults both in Canada and abroad, and the Quality End-of-Life Care Coalition of Canada’s (QELCCC) Research and Knowledge Translation Committee, a group of national stakeholder organizations concerned about quality end-of-life care. Furthermore, Christopher is a frequent presenter at aging, hospice palliative care, and public administration conferences.
Raza M. Mirza, Ph.D. is a Sessional Instructor I with the Translational Research Program (TRP) at the University of Toronto’s Faculty of Medicine, Department of Laboratory Medicine and Pathobiology, and Network Manager of the National Initiative for the Care of the Elderly, a knowledge transfer network dedicated to enhancing the care of older adults both in Canada and abroad. He received his MSc and doctoral degrees from the Graduate Department of Pharmaceutical Sciences at the University of Toronto’s Leslie Dan Faculty of Pharmacy. His areas of expertise and teaching interest include research methods, medical decision-making, the socio-behavioral determinants of health in persons aging with a chronic illness, health policy, and factors influencing late-life social, mental, and physical well-being. He has been an invited speaker at national and international gerontology and geriatrics conferences, workshops, and symposiums, and has consulted with various levels of government on diverse issues related to an aging population.