Knowledge translation in challenging healthcare environments: The PIOPPO experience at the National Centre of Oncological Hadrontherapy (CNAO Foundation).

Knowledge translation is the ability to translate concepts and ideas effectively among different stakeholders, leading to innovation and new knowledge. Translating knowledge is particularly challenging in the healthcare sector, which has been experiencing a shift from a centralized and sequential model of value creation to a more distributed and open model, where various stakeholders (including patients) act as co-creators of the outcome. According to management as well as the medical literature, knowledge translation in healthcare has been mainly seen as the translation of scientific research into clinical practice. However, different types of knowledge translation emerge, such as when multidisciplinary teams need to work together on a joint medical project. In this situation, multiple backgrounds, competencies, skills, and emotional feelings of the different stakeholders are a compelling barrier that prevents the effective transfer and sharing of knowledge. This is why knowledge translation needs a set of enablers to facilitate the transfer, sharing, and creation of new knowledge, innovation, and ideas. This paper investigates such a perspective by analyzing the PIOPPO project from the National Centre of Oncological Hadrontherapy (CNAO Foundation) in Pavia, Italy. The CNAO is one of the few dual-beam Hadrontherapy centres in the world that provides a beam that is able to irradiate patients with protons or carbon ions to treat radioresistant tumours. The PIOPPO project is an experimental phase 2 trial involving preoperative chemotherapy and carbon ion therapy to treat resectable and borderline-resectable pancreatic adenocarcinoma. The stakeholders involved in the PIOPPO trial have different characteristics, both in terms of competencies and emotions. The PIOPPO multidisciplinary team includes highly skilled professionals from several disciplines, which are not all related to medicine (from oncologists to physicists, from biologists to surgeons). Pancreatic cancer patients are also involved while experiencing a challenging personal time. The paper analyses the knowledge translation flows, instruments, and issues among such different stakeholders.