title: How does context influence collaborative decision-making for health services planning, delivery and evaluation?
abstract: BACKGROUND
  Collaboration among researchers (clinician, non-clinician) and decision makers (managers, policy-makers, clinicians), referred to as integrated knowledge translation (IKT), enhances the relevance and use of research, leading to improved decision-making, policies, practice, and health care outcomes. However IKT is not widely practiced due to numerous challenges. This research explored how context influenced IKT as a means of identifying how IKT could be strengthened.
  
  
  METHODS
  This research investigated IKT in three health services programs for colon cancer screening, prostate cancer diagnosis, and the treatment of pancreatic cancer. Qualitative methods were used to explore contextual factors that influenced how IKT occurred, and its impact. Data were collected between September 1, 2012 and May 15, 2013 from relevant documents, observation of meetings, and interviews with researchers and decision-makers, analyzed using qualitative methods, and integrated.
  
  
  RESULTS
  Data were analyzed from 39 documents, observation of 6 meetings, and 36 interviews. IKT included interaction at meetings, joint undertaking of research, and development of guidelines. IKT was most prevalent in one program with leadership, clear goals, dedicated funding and other infrastructural resources, and an embedded researcher responsible for, and actively engaged in IKT. This program achieved a variety of social, research and health service outcomes despite mixed individual views about the value of IKT and the absence of a programmatic culture of IKT. Participants noted numerous challenges including lack of time and incentives, and recommendations to support IKT. A conceptual framework of factors that influence IKT and associated outcomes was generated, and can be used by others to plan or evaluate IKT.
  
  
  CONCLUSIONS
  The findings can be applied by researchers, clinicians, managers or policy-makers to plan or improve collaborative decision-making for health services planning, delivery, evaluation or quality improvement. Further research is needed to explore whether these findings are widespread, and further understand how IKT can be optimized.
authors.affiliation: University Health Network, Toronto, Canada. anna.gagliardi@uhnresearch.ca.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Gagliardi
authors.forename: Fiona
authors.initials: F
authors.lastname: Webster
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Brouwers
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Baxter
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
mesh_terms: D000328:Adult; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003299:Cooperative Behavior; D003657:Decision Making; D005260:Female; D006282:Health Personnel; D006285:Health Planning; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009864:Ontario; D010190:Pancreatic Neoplasms / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D036301:Qualitative Research; D012108:Research Personnel; D057170:Translational Research, Biomedical