Browsing by Author "Graham, Ian D"
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Item Open Access A review protocol on research partnerships: a Coordinated Multicenter Team approach(2018-11-30) Hoekstra, Femke; Mrklas, Kelly J; Sibley, Kathryn M; Nguyen, Tram; Vis-Dunbar, Mathew; Neilson, Christine J; Crockett, Leah K.; Gainforth, Heather L; Graham, Ian DAbstract Background Research partnership approaches, in which researchers and stakeholders work together collaboratively on a research project, are an important component of research, knowledge translation, and implementation. Despite their growing use, a comprehensive understanding of the principles, strategies, outcomes, and impacts of different types of research partnerships is lacking. Generating high-quality evidence in this area is challenging due to the breadth and diversity of relevant literature. We established a Coordinated Multicenter Team approach to identify and synthesize the partnership literature and better understand the evidence base. This review protocol outlines an innovative approach to locating, reviewing, and synthesizing the literature on research partnerships. Methods Five reviews pertaining to research partnerships are proposed. The Coordinated Multicenter Team developed a consensus-driven conceptual framework to guide the reviews. First, a review of reviews will comparatively describe and synthesize key domains (principles, strategies, outcomes, and impacts) for different research partnership approaches, within and beyond health (e.g., integrated knowledge translation, participatory action research). After identifying commonly used search terminology, three complementary scoping reviews will describe and synthesize these domains in the health research partnership literature. Finally, an umbrella review will amalgamate and reflect on the collective findings and identify research gaps and future directions. We will develop a collaborative review methodology, comprising search strategy efficiencies, terminology standardization, and the division of screening, extraction, and synthesis to optimize feasibility and literature capture. A series of synthesis and scoping manuscripts will emerge from this Coordinated Multicenter Team approach. Discussion Comprehensively describing and differentiating research partnership terminology and its domains will address well-documented gaps in the literature. These efforts will contribute to and improve the quality, conduct, and reporting of research partnership literature. The collaborative review methodology will help identify and establish common terms, leverage efficiencies (e.g., expertise, experience, search and protocol design, resources) and optimize research feasibility and quality. Our approach allows for enhanced scope and inclusivity of all research user groups and domains, thereby contributing uniquely to the literature. This multicenter, efficiency and quality-focused approach may serve to inspire researchers across the globe in addressing similar domain challenges, as exist in this rapidly expanding field.Item Open Access Attributes of context relevant to healthcare professionals’ use of research evidence in clinical practice: a multi-study analysis(2019-05-22) Squires, Janet E; Aloisio, Laura D; Grimshaw, Jeremy M; Bashir, Kainat; Dorrance, Kristin; Coughlin, Mary; Hutchinson, Alison M; Francis, Jill; Michie, Susan; Sales, Anne; Brehaut, Jamie; Curran, Janet; Ivers, Noah; Lavis, John; Noseworthy, Thomas; Vine, Jocelyn; Hillmer, Michael; Graham, Ian DAbstract Background To increase the likelihood of successful implementation of evidence-based practices, researchers, knowledge users, and healthcare professionals must consider aspects of context that promote and hinder implementation in their setting. The purpose of the current study was to identify contextual attributes and their features relevant to implementation by healthcare professionals and compare and contrast these attributes and features across different clinical settings and healthcare professional roles. Methods We conducted a secondary analysis of 145 semi-structured interviews comprising 11 studies (10 from Canada and one from Australia) investigating healthcare professionals’ perceived barriers and enablers to their use of research evidence in clinical practice. The data was collected using semi-structured interview guides informed by the Theoretical Domains Framework across different healthcare professional roles, settings, and practices. We analyzed these data inductively, using constant comparative analysis, to identify attributes of context and their features reported in the interviews. We compared these data by (1) setting (primary care, hospital-medical/surgical, hospital-emergency room, hospital-critical care) and (2) professional role (physicians and residents, nurses and organ donor coordinators). Results We identified 62 unique features of context, which we categorized under 14 broader attributes of context. The 14 attributes were resource access, work structure, patient characteristics, professional role, culture, facility characteristics, system features, healthcare professional characteristics, financial, collaboration, leadership, evaluation, regulatory or legislative standards, and societal influences. We found instances of the majority (n = 12, 86%) of attributes of context across multiple (n = 6 or more) clinical behaviors. We also found little variation in the 14 attributes of context by setting (primary care and hospitals) and professional role (physicians and residents, and nurses and organ donor coordinators). Conclusions There was considerable consistency in the 14 attributes identified irrespective of the clinical behavior, setting, or professional role, supporting broad utility of the attributes of context identified in this study. There was more variation in the finer-grained features of these attributes with the most substantial variation being by setting.Item Open Access Enhancing the uptake of systematic reviews of effects: what is the best format for health care managers and policy-makers? A mixed-methods study(2018-06-22) Marquez, Christine; Johnson, Alekhya M; Jassemi, Sabrina; Park, Jamie; Moore, Julia E; Blaine, Caroline; Bourdon, Gertrude; Chignell, Mark; Ellen, Moriah E; Fortin, Jacques; Graham, Ian D; Hayes, Anne; Hamid, Jemila; Hemmelgarn, Brenda; Hillmer, Michael; Holmes, Bev; Holroyd-Leduc, Jayna; Hubert, Linda; Hutton, Brian; Kastner, Monika; Lavis, John N; Michell, Karen; Moher, David; Ouimet, Mathieu; Perrier, Laure; Proctor, Andrea; Noseworthy, Thomas; Schuckel, Victoria; Stayberg, Sharlene; Tonelli, Marcello; Tricco, Andrea C; Straus, Sharon EAbstract Background Systematic reviews are infrequently used by health care managers (HCMs) and policy-makers (PMs) in decision-making. HCMs and PMs co-developed and tested novel systematic review of effects formats to increase their use. Methods A three-phased approach was used to evaluate the determinants to uptake of systematic reviews of effects and the usability of an innovative and a traditional systematic review of effects format. In phase 1, survey and interviews were conducted with HCMs and PMs in four Canadian provinces to determine perceptions of a traditional systematic review format. In phase 2, systematic review format prototypes were created by HCMs and PMs via Conceptboard©. In phase 3, prototypes underwent usability testing by HCMs and PMs. Results Two hundred two participants (80 HCMs, 122 PMs) completed the phase 1 survey. Respondents reported that inadequate format (Mdn = 4; IQR = 4; range = 1–7) and content (Mdn = 4; IQR = 3; range = 1–7) influenced their use of systematic reviews. Most respondents (76%; n = 136/180) reported they would be more likely to use systematic reviews if the format was modified. Findings from 11 interviews (5 HCMs, 6 PMs) revealed that participants preferred systematic reviews of effects that were easy to access and read and provided more information on intervention effectiveness and less information on review methodology. The mean System Usability Scale (SUS) score was 55.7 (standard deviation [SD] 17.2) for the traditional format; a SUS score < 68 is below average usability. In phase 2, 14 HCMs and 20 PMs co-created prototypes, one for HCMs and one for PMs. HCMs preferred a traditional information order (i.e., methods, study flow diagram, forest plots) whereas PMs preferred an alternative order (i.e., background and key messages on one page; methods and limitations on another). In phase 3, the prototypes underwent usability testing with 5 HCMs and 7 PMs, 11 out of 12 participants co-created the prototypes (mean SUS score 86 [SD 9.3]). Conclusions HCMs and PMs co-created prototypes for systematic review of effects formats based on their needs. The prototypes will be compared to a traditional format in a randomized trial.Item Open Access How does integrated knowledge translation (IKT) compare to other collaborative research approaches to generating and translating knowledge? Learning from experts in the field(2020-03-30) Nguyen, Tram; Graham, Ian D; Mrklas, Kelly J; Bowen, Sarah; Cargo, Margaret; Estabrooks, Carole A; Kothari, Anita; Lavis, John; Macaulay, Ann C; MacLeod, Martha; Phipps, David; Ramsden, Vivian R.; Renfrew, Mary J; Salsberg, Jon; Wallerstein, NinaAbstract Background Research funders in Canada and abroad have made substantial investments in supporting collaborative research approaches to generating and translating knowledge as it is believed to increase knowledge use. Canadian health research funders have advocated for the use of integrated knowledge translation (IKT) in health research, however, there is limited research around how IKT compares to other collaborative research approaches. Our objective was to better understand how IKT compares with engaged scholarship, Mode 2 research, co-production and participatory research by identifying the differences and similarities among them in order to provide conceptual clarity and reduce researcher and knowledge user confusion about these common approaches. Methods We employed a qualitative descriptive method using interview data to better understand experts’ perspectives and experiences on collaborative research approaches. Participants’ responses were analysed through thematic analysis to elicit core themes. The analysis was centred around the concept of IKT, as it is the most recent approach; IKT was then compared and contrasted with engaged scholarship, Mode 2 research, co-production and participatory research. As this was an iterative process, data triangulation and member-checking were conducted with participants to ensure accuracy of the emergent themes and analysis process. Results Differences were noted in the orientation (i.e. original purpose), historical roots (i.e. disciplinary origin) and partnership/engagement (i.e. role of partners etc.). Similarities among the approaches included (1) true partnerships rather than simple engagement, (2) focus on essential components and processes rather than labels, (3) collaborative research orientations rather than research methods, (4) core values and principles, and (5) extensive time and financial investment. Core values and principles among the approaches included co-creation, reciprocity, trust, fostering relationships, respect, co-learning, active participation, and shared decision-making in the generation and application of knowledge. All approaches require extensive time and financial investment to develop and maintain true partnerships. Conclusions This qualitative study is the first to systematically synthesise experts’ perspectives and experiences in a comparison of collaborative research approaches. This work contributes to developing a shared understanding of collaborative research approaches to facilitate conceptual clarity in use, reporting, indexing and communication among researchers, trainees, knowledge users and stakeholders to advance IKT and implementation science.Item Open Access Improving KT tools and products: development and evaluation of a framework for creating optimized, Knowledge-activated Tools (KaT)(2020-05-08) Kastner, Monika; Makarski, Julie; Hayden, Leigh; Lai, Yonda; Chan, Joyce; Treister, Victoria; Harris, Kegan; Munce, Sarah; Holroyd-Leduc, Jayna; Graham, Ian D; Straus, Sharon EAbstract Background Positive impacts of quality improvement initiatives on health care and services have not been substantial. Knowledge translation (KT) strategies (tools, products and interventions) strive to facilitate the uptake of knowledge thereby the potential to improve care, but there is little guidance on how to develop them. Existing KT guidance or planning tools fall short in operationalizing all aspects of KT practice activities conducted by knowledge users (researchers, clinicians, patients, decision-makers), and most do not consider their variable needs or to deliver recommendations that are most relevant and useful for them. Methods We conducted a 3-phase study. In phase 1, we used several sources to develop a conceptual framework for creating optimized Knowledge-activated Tools (KaT) (consultation with our integrated KT team, the use of existing KT models and frameworks, findings of a systematic review of multimorbidity interventions and a literature review and document analysis on existing KT guidance tools). In phase 2, we invited KT experts to participate in a Delphi study to refine and evaluate the conceptual KaT framework. In phase 3, we administered an online survey to knowledge users (researchers, clinicians, decision-makers, trainees) to evaluate the potential usefulness of an online mock-up version of the KaT framework. Results We developed the conceptual KaT framework, and iteratively refined it with 35 KT experts in a 3-round Delphi study. The final framework represents the blueprint for what is needed to create KT strategies. Feedback from 201 researcher, clinician, decision-maker and trainee knowledge users on the potential need and usefulness of an online, interactive version of KaT indicated that they liked the idea of it (mean score 4.36 on a 5-point Likert scale) and its proposed features (mean score range 4.30–4.79). Conclusions Our findings suggest that mostly Canadian KT experts and knowledge users perceived the KaT framework and the future development of an online, interactive version to be important and needed. We anticipate that the KaT framework will provide clarity for knowledge users about how to identify their KT needs and what activities can address these needs, and to help streamline the process of these activities to facilitate efficient uptake of knowledge.Item Open Access Inappropriateness of health care in Canada: a systematic review protocol(2019-02-11) Squires, Janet E; Graham, Ian D; Grinspun, Doris; Lavis, John; Légaré, France; Bell, Robert; Bornstein, Stephen; Brien, Susan E; Dobrow, Mark; Greenough, Megan; Estabrooks, Carole A; Hillmer, Michael; Horsley, Tanya; Katz, Alan; Krause, Christina; Levinson, Wendy; Levy, Adrian; Mancuso, Michelina; Maybee, Alies; Morgan, Steve; Penno, Letitia N; Neuner, Andrew; Rader, Tamara; Roberts, Janet; Teare, Gary; Tepper, Joshua; Vandyk, Amanda; Widmeyer, Denise; Wilson, Michael; Grimshaw, Jeremy MAbstract Background There is increasing recognition in Canada and globally that a substantial proportion of health care delivered is inappropriate as evidenced by (1) harmful and/or ineffective practices being overused, (2) effective clinical practices being underused, and (3) other clinical practices being misused. Inappropriate health care leads to negative patient experiences, poor health outcomes, and inefficient use of scarce health care resources. The purpose of this study is to conduct a systematic review of inappropriate health care in Canada. Our specific objectives are to (1) systematically search and critically review published and grey literature for studies on inappropriate health care in Canada; (2) estimate the nature and magnitude of inappropriate health care in Canada and its provincial and territorial jurisdictions. Methods We will include all quantitative study designs reporting objective or subjective measurements of inappropriate health care in Canada over the last 10 years. We will search the following online databases: MEDLINE, Cochrane Central Register of Controlled Trials, EconLit, and ISI-Web of Knowledge, which contains Web of Science Core Collection-Citation Indexes, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, and Conference Proceedings Citation Index-Social Science & Humanities. We will also search grey literature sources to identify provincial and national audits of inappropriate health care. Two authors will independently screen, assess data quality, and extract data for synthesis. Study findings will be synthesized narratively. We will organize our data into three care categorizations: preventive care, acute care, and chronic care. We will provide a compendium of inappropriate health care for each care category for Canada and each Canadian province and territory, where sufficient data exists, by calculating (1) overall medians of underuse, overuse, and misuse of clinical practices and (2) the range of medians of underuse, overuse, and misuse for each clinical practice investigated. Discussion This review will result in the first-ever evidence-based compendium of inappropriate health care in Canada. We will also develop detailed reports of inappropriate health care for each Canadian province and territory. Systematic review registration PROSPERO CRD42018093495Item Open Access Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation(2020-02-01) Petkovic, Jennifer; Riddle, Alison; Akl, Elie A; Khabsa, Joanne; Lytvyn, Lyubov; Atwere, Pearl; Campbell, Pauline; Chalkidou, Kalipso; Chang, Stephanie M; Crowe, Sally; Dans, Leonila; Jardali, Fadi E; Ghersi, Davina; Graham, Ian D; Grant, Sean; Greer-Smith, Regina; Guise, Jeanne-Marie; Hazlewood, Glen; Jull, Janet; Katikireddi, S. V; Langlois, Etienne V; Lyddiatt, Anne; Maxwell, Lara; Morley, Richard; Mustafa, Reem A; Nonino, Francesco; Pardo, Jordi P; Pollock, Alex; Pottie, Kevin; Riva, John; Schünemann, Holger; Simeon, Rosiane; Smith, Maureen; Stein, Airton T; Synnot, Anneliese; Tufte, Janice; White, Howard; Welch, Vivian; Concannon, Thomas W; Tugwell, PeterAbstract Background Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. Further, there is a lack of guidance on how to equitably and meaningfully engage multiple stakeholders. We aim to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation. Methods This will be a multi-stage project. The first stage is to conduct a series of four systematic reviews. These will (1) describe existing guidance and methods for stakeholder engagement in guideline development and implementation, (2) characterize barriers and facilitators to stakeholder engagement in guideline development and implementation, (3) explore the impact of stakeholder engagement on guideline development and implementation, and (4) identify issues related to conflicts of interest when engaging multiple stakeholders in guideline development and implementation. Discussion We will collaborate with our multiple and diverse stakeholders to develop guidance for multi-stakeholder engagement in guideline development and implementation. We will use the results of the systematic reviews to develop a candidate list of draft guidance recommendations and will seek broad feedback on the draft guidance via an online survey of guideline developers and external stakeholders. An invited group of representatives from all stakeholder groups will discuss the results of the survey at a consensus meeting which will inform the development of the final guidance papers. Our overall goal is to improve the development of guidelines through meaningful and equitable multi-stakeholder engagement, and subsequently to improve health outcomes and reduce inequities in health.Item Open Access Stakeholders’ engagement in co-producing policy-relevant knowledge to facilitate employment for persons with developmental disabilities(2020-04-17) Khayatzadeh-Mahani, Akram; Wittevrongel, Krystle; Petermann, Lisa; Graham, Ian D; Zwicker, Jennifer DAbstract Background Persons with developmental disabilities (PWDD) face a number of individual, environmental and societal barriers when seeking employment. Integrated knowledge translation (IKT) involves ongoing and dynamic interactions between researchers and stakeholders for the purpose of engaging in mutually beneficial research to address these types of multi-faceted barriers. There is a knowledge gap in the IKT literature on effective stakeholder engagement strategies outside of the dissemination stage to inform policy. In this paper, we report on a number of engagement strategies employed over a 2-year period to engage a wide range of stakeholders in different stages of an IKT project that aimed to investigate the ‘wicked’ problem of employment for PWDD. Method Our engagement plan included multiple linked strategies and was designed to ensure the meaningful engagement of, and knowledge co-production with, stakeholders. We held two participatory consensus-building stakeholder policy dialogue events to co-produce knowledge utilising the nominal group technique and the modified Delphi technique. A total of 31 and 49 stakeholders engaged in the first and second events, respectively, from six key stakeholder groups. Focused engagement strategies were employed to build on the stakeholder dialogues for knowledge mobilisation and included a focus group attended only by PWDD, a stakeholder workshop attended only by policy/decision-makers, a webinar attended by human resources professionals and employers, and a current affairs panel attended by the general public. Results Our findings suggest that the level of engagement for each stakeholder group varies depending on the goal and need of the project. Our stakeholder dialogue findings highlight the inherent challenges in co-framing and knowledge co-production through the meaningful engagement of multiple stakeholders who hold different ideas and interests. Focused outreach is needed to foster relationships and trust for meaningful engagement. Conclusions In addition to providing guidance on how to implement adaptable meaningful engagement strategies, these findings contribute to discussions on how IKT projects are planned and funded. More studies to explore effective mechanisms for engaging a wide range of stakeholders in IKT research are needed. More evidence of successful engagement strategies employed by researchers to achieve meaningful knowledge co-production is also key to advancing the discipline.Item Open Access Sustaining knowledge translation interventions for chronic disease management in older adults: protocol for a systematic review and network meta-analysis(2018-09-15) Tricco, Andrea C; Moore, Julia E; Beben, Nicole; Brownson, Ross C; Chambers, David A; Dolovich, Lisa R; Edwards, Annemarie; Fairclough, Lee; Glasziou, Paul P; Graham, Ian D; Hemmelgarn, Brenda R; Holmes, Bev; Isaranuwatchai, Wanrudee; Lachance, Chantelle C; Legare, France; McGowan, Jessie; Majumdar, Sumit R; Presseau, Justin; Squires, Janet E; Stelfox, Henry T; Strifler, Lisa; Thompson, Kristine; Van der Weijden, Trudy; Veroniki, Areti A; Straus, Sharon EAbstract Background Failure to sustain knowledge translation (KT) interventions impacts patients and health systems, diminishing confidence in future implementation. Sustaining KT interventions used to implement chronic disease management (CDM) interventions is of critical importance given the proportion of older adults with chronic diseases and their need for ongoing care. Our objectives are to (1) complete a systematic review and network meta-analysis of the effectiveness and cost-effectiveness of sustainability of KT interventions that target CDM for end-users including older patients, clinicians, public health officials, health services managers and policy-makers on health care outcomes beyond 1 year after implementation or the termination of initial project funding and (2) use the results of this review to complete an economic analysis of the interventions identified to be effective. Methods For objective 1, comprehensive searches of relevant electronic databases (e.g. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials), websites of health care provider organisations and funding agencies will be conducted. We will include randomised controlled trials (RCTs) examining the impact of a KT intervention targeting CDM in adults aged 65 years and older. To examine cost, economic studies (e.g. cost, cost-effectiveness analyses) will be included. Our primary outcome will be the sustainability of the delivery of the KT intervention beyond 1 year after implementation or termination of study funding. Secondary outcomes will include behaviour changes at the level of the patient (e.g. symptom management) and clinician (e.g. physician test ordering) and health system (e.g. cost, hospital admissions). Article screening, data abstraction and risk of bias assessment will be completed independently by two reviewers. Using established methods, if the assumption of transitivity is valid and the evidence forms a connected network, Bayesian random-effects pairwise and network meta-analysis will be conducted. For objective 2, we will build a decision analytic model comparing effective interventions to estimate an incremental cost-effectiveness ratio. Discussion Our results will inform knowledge users (e.g. patients, clinicians, policy-makers) regarding the sustainability of KT interventions for CDM. Dissemination plan of our results will be tailored to end-users and include passive (e.g. publications, website posting) and interactive (e.g. knowledge exchange events with stakeholders) strategies. Systematic review registration PROSPERO CRD42018084810Item Open Access Towards the Development of Valid, Reliable, and Acceptable Tools for Assessing the Outcomes and Impacts of Health Research Partnerships(2022-07-05) Mrklas, Kelly; Hill, Michael D; Graham, Ian D; Raffin Bouchal, Shelley; Tonelli, Marcello; Job McIntosh, Christiane; Lockwood, CraigBackground Researchers and their partners need access to high quality assessment tools to demonstrate the tangible outcomes and impacts of their work. As health research partnership approaches grow in popularity and mandated use, so too will the demand for tools to systematically measure their effects. This thesis surveyed literature spanning partnership traditions to locate and examine the globally available tools for assessing health research partnership outcomes and impacts. It systematically identified and assessed tools and tool characteristics (conceptual, psychometric, pragmatic), terminology, use of theories, models and frameworks, and examined the nature of outcomes and impacts arising from studies using tools with known characteristics. Methods We searched four electronic databases (Ovid MEDLINE, Embase, CINAHL+, PsychINFO) from inception to June 2021 without limits, and guided by an a priori protocol and search strategy. We retained studies involving a health research partnership, the development, use, and/or assessment of tools to evaluate partnership outcomes and impacts as a study aim, studies that reported empirical psychometric evidence (manuscript 2), and those with explicit conceptual foundations, empirical psychometric evidence, and pragmatic characteristics (manuscript 3). Study quality was assessed in both systematic reviews. Results Of 56123 total citations, we screened 36027 de-duplicated records, yielding 2784 full text records, ultimately retaining 169, 49, and 37 eligible studies, respectively. Studies were largely North America-centric, and published in English, after 2010. The tools we located were mostly bespoke (205); few had distinguishing conceptual, psychometric, and pragmatic features (58). The research revealed persistent measurement challenges across partnership traditions, including non-standard terminology, inconsistent reporting and use of term definitions, insufficient psychometric/pragmatic tools and a lack of quantitative methods and deliberate focus on tool development, testing, and use, among others. As compared with other historical reviews, very few of the identified studies and tools overlapped; yet the key messages regarding the need to evolve measurement and tool development were the same. Conclusions Dedicated, collaborative efforts among research partnership traditions are required to coordinate the advancement of partnership measurement and science, and to tackle complex outcomes and impacts measurement challenges in this rapidly expanding research field.Item Open Access Variable participation of knowledge users in cancer health services research: results of a multiple case study(2018-11-22) O’Brien, Mary Ann; Carson, Andrea; Barbera, Lisa; Brouwers, Melissa C; Earle, Craig C; Graham, Ian D; Mittmann, Nicole; Grunfeld, EvaAbstract Background Integrated knowledge translation (IKT) is a research approach in which knowledge users (KUs) co-produce research. The rationale for IKT is that it leads to research that is more relevant and useful to KUs, thereby accelerating uptake of findings. The aim of the current study was to evaluate IKT activities within a cancer health services research network in Ontario, Canada. Methods An embedded multiple case study design was used. The cases were 5 individual studies within an overarching cancer health services research network. These studies focused on one of the following topics: case costing of cancer treatment, lung cancer surgery policy analysis, patient and provider-reported outcomes, colorectal cancer screening, and a team approach to women’s survivorship. We conducted document reviews and held semi-structured interviews with researchers, KUs, and other stakeholders within a cancer system organization. The analysis examined patterns across and within cases. Results Researchers and their respective knowledge users from 4 of the 5 cases agreed to participate. Eighteen individuals from 4 cases were interviewed. In 3 of 4 cases, there were mismatched expectations between researchers and KUs regarding KU role; participants recommended that expectations be made explicit from the beginning of the collaboration. KUs perceived that frequent KU turnover may have affected both KU engagement and the uptake of study results within the organization. Researchers and KUs found that sharing research results was challenging because the organization lacked a framework for knowledge translation. Uptake of research findings appeared to be related to the researcher having an embedded role in the cancer system organization and/or close alignment of the study with organizational priorities. Document reviews found evidence of planned IKT strategies in 3 of 4 cases; however, actual KU role/engagement on research teams was variable. Conclusions Barriers to KU co-production of cancer health services research include mismatched expectations of KU role and frequent KU turnover. When a research study directly aligns with organizational priorities, it appears more likely that results will be considered in programming. Research teams that take an IKT approach should consider specific strategies to address barriers to KU engagement.