Download Translating Research into Practice: Integrating Science with Service

Translating Research into Practice:
Integrating Science with Service through
Comprehensive Cancer Control
Jon F. Kerner, Ph.D.
Deputy Director, Division of Cancer Control
& Population Sciences
Indiana Cancer Consortium Fall Meeting
October 18, 2006
The Central Goals of Healthy People 2010*
Increase quality and years of
healthy life
Eliminate health disparities
* USDHHS Healthy People 2010. Washington D.C. January 2000.
Volume #1: page 2
Carcinogenesis as a Multi-Stage Process*
Initiation
Normal
Cell
Promotion
Initiated
Cell
Conversion
Preneoplastic
Lesion
Progression
Malignant
Tumor
Clinical
Cancer
Metast.
Disease
Cancer Control as a Multi-Stage Process
Prevention
Health
Risk Factor
Behaviors
Early Detection
Surveillance
Diagnosis
& Treatment
Follow-up
*Adapted from Shields PG, Harris CG. Principles of Carcinogenesis: Chemical.
In: Devita VT, Hellman S, Rosenberg SA. Cancer Principles & Practice of Oncology.
J.B. Lippencott Co. Philadelphia :1993.
Terminal
Care
Support
& Follow-up
Support
NCI’s Challenge: Close the Gap Between
Discovery and Delivery
There is a critical disconnect between
research discovery and program delivery
and this disconnect is, in and of itself, a
key determinant of the unequal burden of
cancer in our society.
Barriers that prevent the benefits of
research from reaching all populations,
particularly those who bear the greatest
disease burden, must be identified and
removed.
THE CANCER CONTROL CONTINUUM
Cancer
Control
Continuum
Prevention
Focus
Cross
Cutting
Issues
Detection
Diagnosis
Treatment
Survivorship
• Informed • Health Services • Palliation
• Tobacco Control • Pap Test
• Diet
• Mammography Decision and Outcomes • Coping
Making
• Physical Activity • FOBT
Research
• Health Promotion
• Clinical • Clinical Trials
• Sun Exposure
• Endoscopy
Follow-up
• Virus Exposure • PSA Informed
• Alcohol Use
Decision Making • Imaging
• Chemoprevention
• Communications
• Surveillance
• Social Determinants and Health Disparities
• Genetic Testing
• Decision-Making
• Evidence-Based Health Care
• Quality of Cancer Care
• Epidemiology
Grant Awards by State - Fiscal Year 2005
Total Grants - $ in Thousands
NCI Grants Awarded to the Institutions in the State of
Indiana In (FY 05)
(n= 65, Total Dollars= $21 million)
OD
9 Grants (14%)
$3 m illion
DCTD
21 Grants (32%)
$8 m illion
DCCPS
7 Grants (11%)
$1 m illion
DCB
19 Grants (29%)
$5 m illion
DCP
9 Grants (14%)
$4 m illion
Cancer Centers by State (P30 Core Grants) Year 2005
All Types - All States
Summary Distribution for NCI Grants for state of
Indiana
No. of
Grants
Total NCI
Dollars
%Total
Dollars
Total for Two NCI-designated Cancer Centers
53
$16,841,678
80.2%
Total for Other Nine Institutions
12
$4,162,424
19.8%
Total
65
$21,004,102
100.0%
THE DISCOVERY-DELIVERY CONTINUUM
Discovery
Delivery
Development
Public
Health
Practice
Primary
Care
Practice
Disease
Specialty
Practice
Dynamic Model of Cancer Research &
Diffusion and Dissemination
Intervention
Research
Fundamental
Research
Knowledge
Synthesis
Surveillance
Research
Dissemination
Application and
Program Delivery
Reducing the cancer burden
Adapted from the Advisory Committee on Cancer Control, National Cancer Institute of Canada, 1994.
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).
Original research
18%
Negative
results
variable
Dickersin, 1987
Submission
46%
Koren, 1989
Negative
results
0.5 year
Kumar, 1992
0.6 year
Kumar, 1992
Acceptance
Publication
35%
Lack of
numbers
Balas, 1995
0.3 year
Poyer, 1982
Expert
opinion
Bibliographic databases
50%
Poynard, 1985
Inconsistent
indexing
17:14
6. 0 - 13.0 years Antman, 1992
Reviews, guidelines, textbook
9.3 years
Implementation
It takes 17 years to turn 14 per cent of original research
to the benefit of patient care
E.A. Balas, 2000
Dissemination
Active process through which
target groups are made aware of,
receive, accept and use information
and other interventions.
TRANSLATION
Evidence-based
Knowledge
Clinical
Practice
“The transfer of evidenced-based
knowledge into routine
or representative practice”
Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22:
Disseminating Behavioral Medicine Research: Making the Translational Leap.
What is Evidence…..?
 Surveillance Data
OBJECTIVE
 Systematic Reviews of Multiple
Intervention Research Studies
 An Intervention Research Study
 Program Evaluation
 Word of Mouth/Marketing
 Personal Experience
SUBJECTIVE
INTEGRATION
Explicit EvidenceBased Knowledge
Informed
Application
Tacit Clinical
and
Contextual
Knowledge
“The informed combination of evidence-based
knowledge and local contextual knowledge
into community applications.”
Adapted from Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22:
Disseminating Behavioral Medicine Research: Making the Translational Leap.
Translating Research into Improved Outcomes
(TRIO)
 Use and communicate cancer and behavioral
surveillance data to identify needs, track
progress and motivate action.
 Collaboratively develop tools for accessing, and
promoting adoption of, evidence-based cancer
control interventions.
Support regional and local partnerships to
develop models for identifying infrastructure
barriers, expanding capacity and integrating
science into comprehensive cancer control
planning and implementation.
A Modest Proposal – More Focused Accrual &
Reimbursement by Government?
A Modest Proposal – More Focused Accrual
(when case fatality & disparities are high)?
What % of Diagnosed IN Patients on Protocol?
Protocols within 100 miles for 46260
Protocols within 100 miles for 46260
What else can be done to reduce lung cancer deaths
and to support CCC plan implementation?
"Not everything that can be
counted counts, and not
everything that counts can be
counted."
- Albert Einstein (1879-1955)
Source: Harvard Report on Cancer Prevention, Cancer Causes and Control, November/December, 1996
Research to Practice = Evidence to Action
POLITICAL
WILL
KNOWLEDGE BASE
SOCIAL
STRATEGY
Source: M Peck ScD, UNMC, adapted from J Richmond
Integrating Science with Service: Do We
Have the Right Stuff?
Tacit & Contextual
Knowledge
From Experience
Explicit
Knowledge from
Research Evidence
Our goal is to turn knowledge into
applications that benefit people.
“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