Translating Research to Practice: Taking the Next Step to get Children Diagnosed with Cancer Moving

Introduction

An accumulating body of evidence suggests that research-based physical activity (PA) interventions can offer children diagnosed with cancer benefits [1, 2, 3, 4]. Despite this, efforts to translate PA interventions to practice are rarely described [see 5, for a notable exception] potentially contributing to a growing knowledge-to-practice gap in pediatric oncology. Researchers may be able to lead translation efforts, yet, whether researchers are translating their PA interventions into practice remains unknown. Therefore, we sought to ascertain if/how PA interventions are translated into practice in an effort to offer practical insights and guidance for those seeking to translate their research.

Methods

As part of a larger environmental scan [6], we conducted a systematic literature review following established guidelines [7]. Citations were identified through searching five electronic databases, and screening was conducted according to established eligibility criteria [6]. Upon confirming inclusion, the corresponding author(s) of the identified citations were contacted and asked whether their intervention was translated into practice. Based on authors’ response, one of two sets of open- and closed-ended follow-up questions were sent. These questions either asked for more information about the translation process or reasons for not translating, as appropriate. PA intervention information was extracted from the citation. A standardized data charting document was used to collate information from the identified citation and from authors’ responses. Qualitative content analysis was used to analyze authors’ responses to the open-ended questions [8]. Brief quotes to illustrate key findings were selected and are presented in Figure 1.

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Results

Sixty-five authors were identified and 49 were contacted. Sixteen authors could not be contacted. Of the 49 authors contacted, 41 responded to the emails. Based on author responses, six programs were included as PA interventions that were translated and 20 were included as PA interventions that were not translated. Fifteen authors did not receive the second email because they did not respond to the first email (n=2) or were unable to provide the required information (i.e., research was ongoing n=2; author was no longer in charge of the PA program n=4; program was developed prior to research n=7).

Discussion

In an effort to understand if/how research interventions are translated into practice, we reviewed the current literature. Findings suggest that only a small proportion of interventions were translated. The authors who intended to translate and were successful in their efforts offered brief insights into practical ways to overcome some barriers to translating research, while those who were unsuccessful underscored challenges that need to be considered. Financing constraints and low adherence rates were common barriers identified. Bolstering funding via concerted efforts and modifying the design of the intervention were necessary to overcome these barriers.

A main finding from this study was that most authors did not translate their research because it was never their intention to do so. They conducted an intervention to examine a specific outcome, and thus the research was not designed with factors to address external validity and generalizability (including implementation into practice). This raises important questions about (a) the design of research without consideration of knowledge translation, (b) current research funding paradigms, and (c) whose responsibility it is to translate PA interventions. On the one hand, researchers may be ideally suited to translate their interventions as they are up-to-date on the best available evidence and designed/conducted the intervention. As such, they have insight into what aspects, if any, should be modified to ensure participant engagement. On the other hand, translating research to practice is often time- and resource-intensive. One possible strategy to mitigate this burden is to provide the minimal PA prescriptions needed for change [16]. Indeed, less frequent PA interventions (e.g., 1-3 days/week) have not only been shown to be effective [3], but have even been reported as a key to the ongoing sustainability of PA programs for children diagnosed with cancer [3].

Moreover, the importance of collaborative and coordinated approaches was highlighted [17]. Those researchers who were successful in translating their intervention described concerted and ongoing engagement with key stakeholders. It may be prudent for researchers to establish and foster relationships with individuals in the local healthcare system (e.g., healthcare providers, administrators) and in the community (e.g., organizations) from study inception onward. As healthcare systems, particularly healthcare providers, have been shown to play a key role in PA promotion [18]. fostering productive healthcare and allied healthcare providers’ relationships might be ongoing education and systems that enable them to easily and efficiently refer to PA interventions/programs [19]. Among older adult cancer survivors, similar ideas have been suggested. Notwithstanding the importance of fostering relationships, it is likely that many researchers may have limited experience engaging stakeholders and translating knowledge. Thus, to move research to practice, it may be important to encourage interdisciplinary collaborations between pediatric oncology/exercise researchers and specialists in knowledge translation and implementation science. This may enhance the likelihood of knowledge translation upon study cessation and could serve to spread out or share the load/effort required to translate research [16]. Moving forward, more efforts to identify how researchers and stakeholders can effectively share responsibility for moving evidence to practice is necessary.

Notably, all authors who successfully translated their research noted that modifications to their PA intervention were necessary, underscoring that highly-controlled trial, which are necessary to establish efficacy, may not be conducive to translational efforts. Thus, more practical/pragmatic trials that consider the complexity of the real world are necessary [16, 17]. Within the context of pediatric oncology, including more heterogeneous samples at different stages of the cancer trajectory would increase generalizability and the pool of potential participants. Further, highly-controlled PA interventions are often costly, which could further hinder effective translation and sustainability efforts [17]. In this regard, researchers may wish to keep the resources in mind that will be required to maintain their intervention and include translation budgets when applying for funding [20, 15].

Finally, it should be noted that translating PA interventions is only one strategy to bridge the knowledge-to-practice gap, as practice does not need to always be translated directly from research. Indeed, the results from the larger environmental scan suggest that some sustainable PA programs offered to children diagnosed with cancer were not translated from research [6]. It would be insightful to determine the way in which these programs were developed and if/how the coordinators ensure evidence-informed practice.

Taken together, findings confirm that only few research-based PA interventions are translated into practice underscoring that once research-based PA interventions end, children diagnosed with cancer are tasked with finding alternatives. Results underscore the barriers faced when engaging in knowledge translation of these and offer insights into strategies to overcome some barriers. As well, results raise important questions that need to be discussed about whose responsibility it is to translate evidence to practice. Moving forward, researchers are urged to consider translating their interventions to sustainable programs to enhance PA participation opportunities for this population. Collaborating and developing practical interventions are likely crucial steps needed in order to get more children diagnosed with cancer moving.

Acknowledgment

The authors would like to thank all of the corresponding authors of the research-based PA interventions for their interest and participation in this project. As well, the authors would like to thank Liam Kronlund and Jena Shank who assisted with the larger environmental scan.

Funding

Amanda Wurz was supported by a Vanier Canada Graduate Scholarship.

Declaration of Interest Statement

The authors declare no conflict of interests.