Knowledge translation tools in preventive health care

Kip’s case and KT tools in action

“I need to know my prostate cancer number,” says Kip as he walks into your office. Kip is a 55-year-old man with no relevant family history of prostate cancer. He has heard from a friend, a survivor of prostate cancer, that all men older than age 40 should have the prostate-specific antigen (PSA) test. Kip has visited numerous prostate cancer–related websites and watched online videos about PSA screening shared by his friends.

For men like Kip, who are between the ages of 55 and 69, with no relevant family history of prostate cancer, the CTFPHC provides a weak recommendation against screening for prostate cancer with the PSA test based on moderate-quality evidence. Various tools developed by the CTFPHC can help Kip to make a decision that is right for him.

Diversity of available KT tools

Knowledge translation tools can be broadly organized into 3 areas: implementation tools (eg, point-of-care tools), resource planning tools (eg, equipment or technology needed to support implementation), and evaluation tools (eg, quality indicators).³ Most CTFPHC KT tools are implementation tools. The most common types of implementation tools are printed educational materials and decision aids, which can have a range of uses, target audiences, delivery channels, formats, and components (Table 1).⁴ Printed educational materials typically refer to printed guidelines, recommendations for clinical care, and peer-reviewed publications,⁵ but can also include frequently asked questions and other formats. Although traditionally delivered on paper, printed educational materials are increasingly available via electronic applications. They are typically considered passive implementation tools. Decision aids, on the other hand, translate evidence into user-friendly formats in order to actively inform conversations with patients about their decision options, help clarify their values related to possible benefits and harms of options, and guide them through the decision-making process.⁶ However, Gagliardi and colleagues’ classification of KT tools does not separate passive dissemination and active implementation tools.³ Thus, the term implementation tool as used here, and shown in Table 1,⁴ refers to a tool (or its components) that can be used for either a passive or an active implementation process. For example, Figure 1⁴ shows an infographic on screening, a popular component of decision aids, which provides visual representation of information that can actively guide a decision-making process or be distributed passively, such as through mass mailings to clinicians or patients.

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Figure 1.

A 1000-person diagram illustrating the results of screening 1000 men with a PSA test

PSA—prostate-specific antigen.

Reprinted from the Canadian Task Force on Preventive Health Care with permission.⁴

Working with the 1000-person diagram

As the CTFPHC 1000-person diagram shows (Figure 1),⁴ for men like Kip the risk of dying from prostate cancer is 5 per 1000 men screened compared with 6 per 1000 men not screened.

While considering Kip’s request for PSA testing, you recall that the CTFPHC website has KT tools that can help facilitate shared decision making. You refer Kip to the short video by Canadian physician Mike Evans on PSA testing,⁷ provide him with the CTFPHC tool entitled PSA Screening: Patient FAQ,⁸ and book a follow-up appointment to discuss further.

Before Kip’s next visit, you review the CTFPHC clinician-directed KT tools. You refresh your knowledge on the CTFPHC guideline, using the CTFPHC tool Prostate Cancer—Clinician Summary.⁹ You also watch the CTFPHC screening video for clinicians.¹⁰ Your question about screening for different age groups is answered in the Primary Care Practitioner FAQ tool.¹¹ You also review the metrics of the CTFPHC 1000-person diagram (Figure 1).⁴

Figure 1⁴ shows that screening 1000 men for prostate cancer with the PSA test would save 1 life over 13 years. The overall reduction in prostate cancer mortality is 1 per 1000; although not shown in the infographic, there is no reduction in all-cause mortality.¹² The infographic also shows possible harms from screening. It shows that among 1000 men screened, 178 men with positive PSA test results will have follow-up testing that does not identify prostate cancer (false-positive findings) and 4 of those 178 men will experience biopsy complications.

Furthermore, the infographic shows that 33 per 1000 men screened will be diagnosed with prostate cancer that would not have caused illness or death (overdiagnosis) and will be potentially exposed to treatments and their adverse effects, as well as experience anxiety from knowing this overdiagnosis of prostate cancer.

Use and development of KT tools

Back to Kip

Kip is back in your office, and you check if he understands his decision options, which include getting a PSA test or not getting a PSA test. To guide your conversation, you use the CTFPHC 1000-person diagram (Figure 1)⁴ for men aged 55 to 69 years of age. You help Kip understand the risks of benefits and harms of PSA testing using natural frequencies, which are more understandable than probabilities (eg, 1 less man per 1000 screened over 13 years will die from prostate cancer compared with men who are not screened).

While reviewing portions of the tool with Kip, you seek to understand how much the potential benefits and harms matter to him. He is not impressed with the modestly reduced risk of dying from prostate cancer as a result of PSA screening. He is not that concerned about a prostate biopsy if his PSA is elevated; he has been through worse. On the other hand, Kip is concerned about getting a prostate cancer diagnosis if that cancer was not destined to become a problem in his lifetime.

You then review whether Kip has enough information to make a decision. Kip is confident he has enough information to choose. He decides not to have the PSA test. Kip thanks you and takes a hard copy of the CTFPHC 1000-person diagram to show to friends.