title: Knowledge translation at the macro level: legal and ethical considerations.
abstract: Macro-level legal and ethical issues play a significant role in the successful translation of knowledge into practice. The medicolegal milieu, in particular, can promote clinical inertia and stifle innovation. Embracing new clinical practice guidelines and best practice models has not protected physicians from superfluous torts; in some cases, emerging evidence has been used as the dagger of trial lawyers rather than the scalpel of physicians. Beyond the legal challenges are overarching justice issues that frame the broad goals of knowledge translation (KT) and technology diffusion. Optimal implementation of the latest evidence requires attention to be paid to the context of the candidate community and the key opinion leaders therein, characterized by the "8Ps" (public, patients, press, physicians, policy makers, private sector, payers, and public health). Ethical and equitable KT also accounts for the global burdens and benefits of implementing innovation such that disparities and gaps in health experienced by the least advantaged are prioritized. Researchers and thought leaders must attend to questions of fairness, economics, and legal risk when investigating ways to promote equity-oriented KT.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA. gluke.larkin@yale.edu
authors.forename: Gregory Luke
authors.initials: GL
authors.lastname: Larkin
authors.forename: Cara J
authors.initials: CJ
authors.lastname: Hamann
authors.forename: Edward P
authors.initials: EP
authors.lastname: Monico
authors.forename: Linda
authors.initials: L
authors.lastname: Degutis
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Schuur
authors.forename: Walter
authors.initials: W
authors.lastname: Kantor
authors.forename: Charles S
authors.initials: CS
authors.lastname: Graffeo
mesh_terms: D003695:Delivery of Health Care; D004059:Diffusion of Innovation; D004635:Emergency Medicine / Q000941:ethics / Q000331:legislation & jurisprudence; D004992:Ethics, Medical; D019317:Evidence-Based Medicine; D006302:Health Services Research; D006801:Humans; D033181:Information Dissemination; D019359:Knowledge; D014481:United States