Translating implementation science

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Published: 8 May 2019
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Dr Margaret Barton-Burke - Memorial Sloan Ketting Cancer Center, New York, USA

Dr Margaret Barton-Burke speaks to ecancer at ONS 2019 about how implementation science is bridging the gap between research and clinical practice to improve patient care.

She explains how her own research with long-term breast cancer survivors - specifically with black women, where there is a disparity in survivorship when compared to white women - has been applied. She urges oncology nurses to read the literature closely as well critically, so to determine whether it is a practice change suitable to their institution.

Dr Barton-Burke concludes by explaining the importance of not only translating science into practice, but also translating it in to terms that the patient can understand. 

What we presented, what I presented, today was in a session called Implementation Science. Implementation science, for me, is a very interesting perspective where you take science and you actually take it to the clinical area, to the practice area. So what you learn from a research study needs to then get hardwired or connected in some way and that’s the way you’re going to change practice.

Why is implementation science important?

From my perspective, 17 years or even five years is too long to wait from study findings to implementation to a clinical practice if it’s a valuable finding and if it’s a finding that’s going to help patient care. So it’s important to focus on implementation, not just on the research but on taking that research another step further. Whether you call it hardwiring, my phrase that I use at work is ‘Making it stick,’ and I use that term because many times we have findings and nurses need to understand the political situation or navigate areas that they never thought about before so that they can take those research findings and make sure that they’re implemented in the right way and hardwired into the institution so that they can make change.

What are the challenges facing implementation science?

I think part of that is in nursing, I will only use nursing as an example, sometimes we are getting better at finding the evidence through research projects and then implementing it. However, there is still an old guard or an old way of thinking which is, ‘This is the way we’ve always done it, therefore we’re going to not change practice because it worked before,’ even if something is newer or more streamlined, maybe possibly more cost-effective. Any of those areas and many more there’s a lot of opportunity in implementation science, we just have to push nursing to realise that.

How has your own work been translated into practice?

My original work was with breast cancer survivors. Over time my work extended to long-term breast cancer survivors but really worked with the population of black women breast cancer survivors. Now, why is that important? It’s important because that population needs to understand what the disease of cancer is, the treatments as well as the long-term sequelae or side effects of treatment and how to handle them. From my research what we actually found was there is a difference in survivorship of black women compared to white women. Those are the only two populations I’ve studied but there is a disparity. It’s trying to improve or break down, making people aware of the disparities, which is one of the goals that I have with my implementation science.

The other thing that came out of my work had to do with the framework that I used for my study actually was a multidimensional framework. What we developed was an annual conference about knowledge and knowledge transfer about breast cancer to the population of colour in St Louis, Missouri when I worked there.

What is on the horizon for nursing science?

There is a challenge in nursing science. The Future of Nursing report that came out several years ago, we’re now at the third iteration of that Future of Nursing report, but the first one actually suggested that more nurses need to have terminal degrees. That terminal degree seems to be more focussed on a doctor of nursing practice, which is a clinical doctorate as opposed to a research doctorate, therefore what we see in statistics is that there are less nurses going for PhDs than going for DNPs. That means that the research will potentially not be conducted because DNPs are practice driven, their work would be in evidence-based practice and quality, not necessarily in research; PhD is a research doctorate.

The reason I’m saying that is because in my institution we have 46 nurses who either have their PhDs and EDDs, or an academic doctorate, or they’re in school for it. That’s a large number, a critical mass I finally feel like we have in the institution and I think we can make science around that critical mass and using the work of those nurses.

What is your take home message for oncology nurses?

Read the literature, know what’s in the literature. Read the studies in the literature critically so that you’re not just taking. Because it’s a published article many times what happens is nurses are asked to go to the literature to investigate a certain problem when they want to make an evidence base or a change in practice. But they’re not always critically looking at the literature so they need to learn how to critically appraise the literature. So read the literature, appraise the literature and then determine whether this is a practice change that you want to implement within your institution because not all practice changes fit every institution, is what I would say, although we want everybody focussed on good practice.

Do you have anything to add?

Implementation science, many times, is called implementation to translation science and for many years, especially with the community that I work with in St Louis, Missouri, but I also did that work in Boston, Texas, St Louis and I do global work. I think many times we take for granted that we have our own healthcare language, our own nurse language and when I say translational science I really talk about taking science and translating it into words that people will understand. If we can start to think not just about translating science into practice but really taking and translating it in a way that a patient can understand then they can be an informed consumer of the healthcare system.