1. Translating Research into Policy and Practice: Whos 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?

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

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

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

6. Promising molecule or gene target Candidate protein biomarker Basic epidemiologic finding 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 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 (of new drug, assay, device, behavioral intervention, educational materials, training) Basic Science Discovery Late Translation Early Translation Dissemination Adoption The Translation Continuum Data collection to support outcomes research, intervention refinement, health services and other research; and to inform provider practices Translating Research to Reduce the Burden of Cancer Source: Reuben SH. 2005

7. THE DISCOVERY-DELIVERY CONTINUUM DiscoveryDevelopment Delivery Public Health Practice Primary Care Practice Disease Specialty Practice

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. Bridging theGap: A Synergistic Model Getting Evidence-BasedCancer Control InterventionsInto Practice Science Push Documenting, improving, and communicating the intervention for wide population use Delivery Capacity Building the capacity of relevant systems to deliver the intervention GOAL: To increase the adoption, reach and impact of evidence-basedcancer control ULTIMATE GOAL: Improve population health and well being Market Pull/ Demand Building a market and demand for the intervention -basedIncrease the number of systems providing evidencecancer control -Increase the number of practitioners providing evidencebasedcancer control -Increasethe number of individuals receiving evidencebasedcancer control 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.

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

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

15. What is Evidence…..? 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 OBJECTIVE SUBJECTIVE

16. INTEGRATION Explicit Evidence- Based Knowledge Informed Application Tacit Clinical and Contextual Knowledge The informed combination of evidence-based knowledge and local contextual knowledge into policy & practice applications. Adapted from Glasgow, R SBM (2005) 26 th 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.

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

20. Does the impact of research on policy application depend on the relationship between research and application agencies? Executive Branch Research (NIH, NSF) Research & Application (e.g. AHRQ) Application & Research (e.g. CDC) Application (e.g. CMS, HRSA) Regulatory (e.g. FDA, EPA)

21. 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 Our goal is to turn knowledge into applications that benefit people.