The need for knowledge translation in chronic pain

Abstract

One in five Canadians suffers from some form of persistent or chronic pain. The impact on individual lives, families and friends, the health services sector and the economy is huge. Reliable evidence is available that the burden of persistent pain can be markedly reduced when available knowledge is applied. Bridging the quality chasm between chronic pain and the care process will require a unique confluence of opinion from all stakeholders committed within a focused community of practice to address the impact of pain. Various levels of success in this regard have been demonstrated when there is exchange, synthesis and ethically sound application of research findings within a complex set of interactions among researchers and knowledge users. It is now critical to accelerate the capture of the benefits of research for Canadians through improved health, more effective and responsive services and products, and a strengthened health care system to bring about health reform and health care reform across Canada as it pertains to the one in five Canadians living with chronic, disabling pain. The overarching outcome of such an initiative needs to be promoted to sustain a balanced portfolio of curiosity- and needs-based research, which along with existing knowledge, can be mobilized and applied for the benefit of Canadians, the health care system and the economy.

Figure 1)

The burden of chronic diseases is tremendous, and traditional methods of health care delivery are unsuitable for addressing these needs. Chronic disease management has emerged as a new strategy for chronic disease care. Chronic disease management in the clinical setting is defined as an organized, proactive, multicomponent, patient-centred approach to health care delivery that involves all members of a defined population who have a specific disease entity (or a subpopulation with specific risk factors). Care is focused on, and integrated across, the entire spectrum of the disease and its complications, the prevention of comorbid conditions, and relevant aspects of the delivery system. Essential components include identification of the population, implementation of clinical practice guidelines or other decision-making tools, implementation of additional patient-, provider-or health care system-focused interventions, the use of clinical information systems, and the measurement and management of outcomes. It is said that few die from pain, yet many die in pain and even more live in pain

Figure 2)

System change must be designed to address components of chronic disease management principles applied across the care continuum for chronic pain for a system-wide strategic action that draws on existing success stories in Canada and a care continuum perspective on factors impacting on health measures and quality of life. The framework is based on the wide range of health-related disciplines that must join forces if opportunities to reduce disability associated with chronic pain are to be realized. In this respect, it is essential that system-level change is accompanied by and supportive of the empowerment and active participation of individuals, their families and communities. The present project is a first step toward this change as a reality by moving evidence and applying it to the care continuum

Figure 3)

This logic model displays the sequence of actions that describe what the initiative is and will do, and how investments link to results. Five core components of initiative action are inputs (personnel and financial resources; contributions), outputs (engagement, participation, extrinsic knowledge, knowledge synthesis and dissemination), outcomes (creating, capturing, leveraging and retaining knowledge; capacity building through training, recruiting and retaining; changes for individuals, communities, organizations and systems), assumptions (core vision, values, beliefs, aspirations and tacit knowledge of researchers and partners) and external factors (the broader context within which this initiative operates; embedded knowledge)

Figure 4)

Knowledge management applied within an organizational framework ensures growth, continuity and sustainability because action outcomes are measured as life habits and quality of life, and these outcomes are applied to refresh the cycle of knowledge management. The entry point to this organizational framework can be at any point of a green arrow, including new discoveries, such as those from basic science laboratories (eg, the research of the principal investigator and his colleagues and beyond), but also from environmental scans and needs assessments. The organizational framework also maximizes opportunities for partnerships with nongovernmental organizations to participate in applying capacity with process to put evidence into practice