Tim	
  Shaw	
  

Chair	
  Evidence	
  into	
  Prac4ce	
  Working	
  Party	
  
Director	
  Workforce	
  Educa4on	
  and	
  ...
TCRC	
  Program	
  
TCRC	
  Program	
  
•  7	
  Centres	
  and	
  4	
  Units	
  created	
  by	
  Cancer	
  Ins4tute	
  
Second	
  funding	
  r...
What	
  is	
  Catalyst	
  
•  Mul4-­‐disciplinary,	
  mul4-­‐ins4tu4onal	
  Centre	
  
established	
  mid	
  11	
  	
  
• ...
What	
  is	
  Catalyst?	
  
Why	
  Transla4onal	
  Research?	
  
•  Consistent	
  evidence	
  of	
  failure	
  to	
  translate	
  
research	
  findings...
What	
  is	
  Transla4onal	
  Research?	
  

Discovery	
  

Human	
  trials	
  

(basic	
  science	
  
and	
  evidence)	
 ...
CINSW	
  Model	
  of	
  TR	
  
WesFall	
  et	
  al.,	
  (2007)	
  
What	
  has	
  been	
  the	
  challenge?	
  
•  New	
  ‘layer’	
  over	
  exis4ng	
  well	
  established	
  
centres	
  
•...
Progress	
  
•  Established	
  T1	
  and	
  T3	
  commiBees	
  
•  Built	
  strong	
  central	
  management	
  and	
  
com...
Catalyst	
  Working	
  Par4es	
  
T1	
  (Discovery)	
  
•  Liza	
  Horvath	
  (Chair)	
  
•  Andrew	
  Biankin	
  
•  Geoff...
Bench	
  to	
  bedside	
  Working	
  Party	
  
•  Flagship	
  program/s	
  ‘top-­‐down’	
  	
  
a. IMPACT	
  trial	
  	
  ...
IMPaCT
  Individualised Molecular Pancreatic Cancer Therapy
A randomised, open label, phase II trial assessing standard f...
Future	
  Plans	
  
1.  Lead	
  and	
  undertake	
  major	
  ini<a<ves	
  in	
  transla<onal	
  research	
  linking	
  
bi...
Challenges	
  
1. Finding	
  effec4ve	
  ways	
  to	
  improve	
  understanding	
  of	
  
other	
  ac4vity	
  and	
  resear...
Implementa4on	
  Science	
  
Evidence	
  into	
  prac4ce	
  
What’s so special?
Isn’t that what we have all being doing an...
What	
  is	
  T3	
  Research?	
  
Different	
  approaches	
  to	
  Implementa<on	
  Research	
  

Discovery	
  
(basic	
  science	
  and	
  
evidence)	
  

H...
Challenges	
  to	
  implementa4on	
  
Science	
  
•  Rela4vely	
  new	
  discipline	
  
•  Mul4ple	
  overlapping	
  theor...
Our	
  Aim	
  re	
  Implementa4on	
  
Use	
  a	
  rigorous	
  and	
  evidence-­‐based	
  approach	
  to:	
  
• mpact	
  on...
Sydney	
  Catalyst	
  Implementa<on	
  Project	
  	
  
	
  
	
  
	
  	
  	
  	
  	
  	
  	
  	
  –	
  Lung	
  Cancer	
  
L...
Examining	
  the	
  “GAPS”
	
  

A	
  systema4c	
  approach	
  to	
  iden4fying	
  and	
  closing	
  
evidence-­‐prac4ce	
...
Methodology	
  
Examine	
  evidence	
  from	
  a	
  range	
  of	
  sources:	
  
•  Paferns	
  of	
  Care	
  Studies	
  –	
...
Seven	
  Sydney	
  Catalyst	
  Iden<fied	
  Gaps	
  	
  
1.	
  Not	
  all	
  people	
  with	
  lung	
  cancer	
  receive	
 ...
Seven	
  Sydney	
  Catalyst	
  Iden<fied	
  Gaps	
  	
  
3.	
  People	
  with	
  advanced	
  lung	
  cancer	
  who	
  will	...
Seven	
  Sydney	
  Catalyst	
  Iden<fied	
  Gaps	
  	
  
5.	
  People	
  with	
  lung	
  cancer	
  who	
  would	
  benefit	
...
Priority	
  seWng	
  process	
  
1	
  

2	
  

3	
  

4	
  

5	
  

• Gain	
  consensus	
  on	
  gaps	
  -­‐	
  add	
  new...
Priority	
  seWng:	
  Criteria	
  
Relevance

Magnitude

Burden

Amenable

to local setting

of the gap
(size)

of sufferi...
If	
  you	
  had	
  $100	
  to	
  spend	
  on	
  lung	
  cancer	
  
projects	
  to	
  reduce	
  gaps	
  between	
  evidenc...
Results	
  
Sydney	
  Catalyst	
  External	
  Review	
  
•  Expert	
  panel	
  incl.;	
  
–  Emeritus	
  Professor	
  Richard	
  Grol	...
Next	
  steps	
  
•  Looking	
  at	
  themes	
  we	
  can	
  adopt	
  across	
  
spectrum	
  of	
  transla4on	
  
•  Seeki...
Prof Tim Shaw Sydney Catalyst
Prof Tim Shaw Sydney Catalyst
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Prof Tim Shaw Sydney Catalyst

  1. 1. Tim  Shaw   Chair  Evidence  into  Prac4ce  Working  Party   Director  Workforce  Educa4on  and  Development  Group  
  2. 2. TCRC  Program  
  3. 3. TCRC  Program   •  7  Centres  and  4  Units  created  by  Cancer  Ins4tute   Second  funding  round  just  closed   •  •  •  •  Push  research  along  transla4onal  pipeline   Provide  plaForm  for  other  funding  applica4ons   S4mulate  new  collabora4on  and  research   Distribute  funds  
  4. 4. What  is  Catalyst   •  Mul4-­‐disciplinary,  mul4-­‐ins4tu4onal  Centre   established  mid  11     •  Mission;  Taking  breakthrough  discoveries  in  basic   science  swiLly  into  clinical  prac4ce,  and  by  increasing   prac4ce  of  evidence-­‐based  medicine  to  improve  the   quality  and  length  of  life  of  people  living  with  cancer  
  5. 5. What  is  Catalyst?  
  6. 6. Why  Transla4onal  Research?   •  Consistent  evidence  of  failure  to  translate   research  findings  into  clinical  prac4ce     •  30-­‐40%  pa4ents  do  not  get  treatments  of   proven  effec4veness     •  20–25%  pa4ents  get  care  that  is  not  needed   or  poten4ally  harmful     (Runciman  2012;  Grimshaw  2012;  Schuster,  McGlynn,   Brook,  1998;  Grol  2001)  
  7. 7. What  is  Transla4onal  Research?   Discovery   Human  trials   (basic  science   and  evidence)   (evidence  to   bedside)   Implementa<on   (evidence  into   Prac4ce)   Improved   outcomes  
  8. 8. CINSW  Model  of  TR   WesFall  et  al.,  (2007)  
  9. 9. What  has  been  the  challenge?   •  New  ‘layer’  over  exis4ng  well  established   centres   •  Lack  of  profile   •  Lack  of  understanding  about  transla4onal   research  (T3  especially)   •  Working  along  pipeline   •  CI  NSW  feeling  its  way  with  program   •  Compe44on/collabora4on  tension   •  Lack  of  funding  
  10. 10. Progress   •  Established  T1  and  T3  commiBees   •  Built  strong  central  management  and   communica4on  team   •  Funded  flagship  projects  (top  down)   •  Funded  seed  projects  (bofom  up)   •  Funded  scholarships  and  travel   •  Run  series  of  engagement  ac4vi4es   •  Hosted  interna4onal  seminar   •  Commissioned  external  review  
  11. 11. Catalyst  Working  Par4es   T1  (Discovery)   •  Liza  Horvath  (Chair)   •  Andrew  Biankin   •  Geoff  McCaughan   •  Tim  Shaw   •  Georgina  Clark     •  Wendy  Cooper   •  Glen  Reid     •  Sonia  Yip   •  Derek  Hart   •  James  Kench   •  Lorraine  Chantrill   T2  (Implementa4on)   •  Tim  Shaw  (Chair)   •  Jane  Young   •  Philip  Beale   •  Phyllis  Butow   •  Kate  White   •  Sallie-­‐Anne  Pearson   •  Jane  Phillips   •  Nicole  Rankin   •  Deb  McGregor   •  Puma  Sundarasen  
  12. 12. Bench  to  bedside  Working  Party   •  Flagship  program/s  ‘top-­‐down’     a. IMPACT  trial    (personalised  approach  to  tx  of   pancrea4c  cancer)   b. Lung  molecular  MDT  –  mul4centre  (2)  set  up;   part-­‐funding  from  Sydney  Catalyst  biobanking   funding   •  Funded  4  Bofom  up  projects  @$50K   •  Funded  universal  consent  bio-­‐banking  project   •  Run  number  of  workshops  and  seminars   •  Crea4ng  collabora4ve  space  on  website  –  find  a   researcher,  Find  a  Resource   •  Building  partnerships  with  other  organisa4ons  
  13. 13. IMPaCT   Individualised Molecular Pancreatic Cancer Therapy A randomised, open label, phase II trial assessing standard first line treatment with gemcitabine or personalised treatment based on tumour molecular signature in patients with recurrent or metastatic pancreatic cancer to evaluate feasibility and impact on progression free survival    Principal Investigator Dr Lorraine Chantrill,   Contributors Dr Katrin Sjoquist, Dr Chee Lee, Dr Adnan Nagrial, Ms Amber Johns, Dr Venessa Chin, Dr David Chang, Prof John Zalcberg, Dr Sonia Yip, Prof Andrew Biankin, Prof John Simes   Sydney Catalyst Research Manager Ms Danielle Miller   AGITG Project Manager Dr Lucille Sebastian   The IMPACT trial is a collaboration between the AGITG, NHMRC CTC, Sydney Catalyst and the Kinghorn Cancer Center at the Garvan Institute of Medical Research
  14. 14. Future  Plans   1.  Lead  and  undertake  major  ini<a<ves  in  transla<onal  research  linking   biosciences  with  clinical  research  with  the  aim  of  improved  cancer  care   for  individual  pa4ents,  by   a. Linking  basic  science  researchers  with  clinical  researchers  within   Sydney  Catalyst  and  with  clinical  trial  networks,     b. Linking  disciplines  that  do  not  tradi<onally  work  together  in  research   streams   2.  Build  partnerships  within  the  consor<um  that  will  foster  an  increase  in   effec4ve  research  and  implementa4on  programs  with  leveraged  funding   from  government,  NGOs  and  industry.   3.  Seek  and  develop  other  rela4onships  with  interna4onal  Transla4onal   Research  groups  and  networks  
  15. 15. Challenges   1. Finding  effec4ve  ways  to  improve  understanding  of   other  ac4vity  and  research  of  other  disciplines   2. Embedding  research  into  rou4ne  clinical  prac4ce.   Suggested  mechanisms:     •  Invi4ng  basic  science  researchers  to  afend   mul4disciplinary  mee4ngs  at  hospitals     3. Engaging  rural  members  in  SC  and  T1    ac4vi4es   4. Demonstra4ng  impact  of  Sydney  Catalyst  ac4vi4es   on  members’:  research,    understanding  of  new   research  areas  and  output  
  16. 16. Implementa4on  Science   Evidence  into  prac4ce   What’s so special? Isn’t that what we have all being doing anyway?
  17. 17. What  is  T3  Research?  
  18. 18. Different  approaches  to  Implementa<on  Research   Discovery   (basic  science  and   evidence)   Human  trials   (evidence  to   bedside)   Implementa<on   (evidence  into   Prac4ce)   Improved   outcomes   Quality   Improvement   Implementa<on     Science   Change   management  
  19. 19. Challenges  to  implementa4on   Science   •  Rela4vely  new  discipline   •  Mul4ple  overlapping  theories   •  Confusion  around  terminology/applica4on   •  Rela4vely  small  evidence  base   •  Lack  of  funding   •  Difficult  ‘real  world’  research  to  conduct   •  Inherently  mul4-­‐disciplinary  
  20. 20. Our  Aim  re  Implementa4on   Use  a  rigorous  and  evidence-­‐based  approach  to:   • mpact  on  the  transla4on  of  evidence  into  prac4ce  to   I improve  the  outcomes  for  cancer  pa4ents  in  the   Catalyst  catchment   •  ontribute  to  the  science  of  implementa4on   C •  chieve  outcomes  that  would  not  have  been  possible   A without  collabora4on  through  Catalyst   •  um  is  bigger  than  the  parts…..   S
  21. 21. Sydney  Catalyst  Implementa<on  Project                        –  Lung  Cancer   Literature  review   (paferns  of  care   studies  previous   data  linkages   studies  etc)   New  local  data   analyses       eg  MBS  VA  and   ClinCR   Lis4ng  of   poten4al  target   areas   ? Evaluate  impact   Catalyst Prioritisation process Our  chosen   prac4ce  vs   evidence  gaps   ? Interven4on(s)   Implementation studies Gather  baseline   data  
  22. 22. Examining  the  “GAPS”   A  systema4c  approach  to  iden4fying  and  closing   evidence-­‐prac4ce  gaps  
  23. 23. Methodology   Examine  evidence  from  a  range  of  sources:   •  Paferns  of  Care  Studies  –  lung  cancer   •  Data  linkage  studies  –  registry  and  administra4ve   datasets   •  Clinical  prac4ce  guidelines   •  Systema4c  reviews  and  meta-­‐analyses   •  Research  in  peer  reviewed  publica4ons   •  Grey  literature,  including  government  publica4ons   •  Local  sources  of  data:  Clinical  Cancer  Registry  data   for  one  Sydney  Catalyst  member  hospital  
  24. 24. Seven  Sydney  Catalyst  Iden<fied  Gaps     1.  Not  all  people  with  lung  cancer  receive  <mely  diagnosis  and   referral  for  treatment;  unnecessary  delays  at  the  pa4ent,   provider  and  service  levels  have  the  poten4al  to  nega4vely  impact   on  pa4ent  outcomes.   2.  People  with  poten<ally  curable  lung  cancer  who  will  benefit   from  ac<ve  treatment  do  not  always  receive  it;  ac4ve  treatments   including  surgery,  radia4on  therapy  and  chemotherapy  are  under-­‐ u4lised.  
  25. 25. Seven  Sydney  Catalyst  Iden<fied  Gaps     3.  People  with  advanced  lung  cancer  who  will  benefit  from   pallia<ve  treatment  do  not  always  receive  it;  pallia4ve   treatments  including  pallia4ve  radia4on  therapy  and  chemotherapy   are  under-­‐u4lised   4.  People  with  lung  cancer  who  are  of  an  older  age  or  with  co-­‐ morbidi<es  who  may  benefit  from  ac<ve  treatment  do  not   always  receive  treatment;  ac4ve  treatments  including  surgery,   radia4on  therapy  and  chemotherapy  are  under-­‐u4lised  
  26. 26. Seven  Sydney  Catalyst  Iden<fied  Gaps     5.  People  with  lung  cancer  who  would  benefit  from  review  at  a   mul<disciplinary  team  mee<ng  are  not  always  being   reviewed.   6.  People  with  lung  cancer  have  high  levels  of  psychosocial   needs  which  are  not  always  being  met,  resul4ng  in  poorer   outcomes  and  poorer  quality  of  life.   7.  Not  all  people  with  lung  cancer  who  would  benefit  from  early   referral  to  pallia<ve  care  services  are  offered  this  op4on,   which  may  result  in  poorer  symptom  control  and  poorer  quality  of   life  
  27. 27. Priority  seWng  process   1   2   3   4   5   • Gain  consensus  on  gaps  -­‐  add  new  ones  if  agreed   • Priori4se  gaps  individually  against  4  criteria   • Nominate  gold  and  silver  gaps  across  criteria  in  group   • Discuss  reasons  for  distribu4on  of  priori4es  and  look   for  consensus   • Invest  $100  Catalyst  across  priori4es  
  28. 28. Priority  seWng:  Criteria   Relevance Magnitude Burden Amenable to local setting of the gap (size) of suffering (severity) to change •  This  is  part  of   our  strategic   goals.   •  This  is  evident   at  our  local   level.   •  This  is  a  prevalent   •  This  severely   impacts  on  our   issue.   pa4ents.     •  This  is  an  urgent   •  This  impacts  on   issue.   health  services.   Significance •  This  can  be   addressed  in  our   local  area.   •  Poten4al  access  to   resources   •  This  issue  will  have   posi4ve   engagement  of   leaders  and  staff.   •  We  are  ready  for   change.  
  29. 29. If  you  had  $100  to  spend  on  lung  cancer   projects  to  reduce  gaps  between  evidence  and   prac;ce,  how  would  you  spend  your  money?   Gap   Western  NSW  LHD   1  Timely  Diagnosis  and  Referral   2  Cura4ve  treatment   3  Pallia4ve  care  treatment   4  Co  morbid  condi4ons   5  Mul4disciplinary  teams   6  Psycho-­‐social  support   7  Early  referral  to  pallia4ve  care   8  Local  gap   9     -­‐   St  Vincent’s   RPAH  
  30. 30. Results  
  31. 31. Sydney  Catalyst  External  Review   •  Expert  panel  incl.;   –  Emeritus  Professor  Richard  Grol   –  Professor  Stan  Kay   –  Professor  Grant  McArthur   •  Very  posi4ve  feedback  received;  reviewers  no4ng  that   achievements  to  date,  rela4ve  to  rela4vely  modest  funding   and  opportunity,  have  been  significant   •  Considerable  strength  is  the  quality  of  the  people  involved;   enthusiasm  and  experience  is  significant   •  Need  to  develop  further  capacity  in  transla4onal  research   (esp.  T3/implementa4on  research)  and  partnerships  with   Government  and  industry  
  32. 32. Next  steps   •  Looking  at  themes  we  can  adopt  across   spectrum  of  transla4on   •  Seeking  more  substan4al  funding  from  other   sources   •  Looking  at  how  we  can  focus  ac4vity   •  Con4nue  to  build  profile  and  collabora4on   •  Grow  membership  and  par4cipa4on   •  Building  capacity  in  transla4onal  research  

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