CAN-ADAPTT AGM 2010:Population Approaches to Smoking

Cessation in Canada

October 1st, 2010Ottawa, Ontario

Welcome/Bienvenue

While we wait to get started Tell people who you are What ‘hat’ you are wearing What you hope to get out of today Favourite vacation location

Name your table……a Fall theme…..

Introduction: CAN-ADAPTT Team

Jess Rogers – Manager Rosa Dragonetti – Clinic manager Janet Ngo – Coordinator, Western Canada Tamar Meyer – Coordinator, Ontario Katie Hunter – Coordinator, Atlantic Canada Stephanie Elliott – Administrative Secretary Dr. Peter Selby – Principal Investigator Dr. John Garcia –Lead, system level

interventions for cessation

Team Members

Executive Committee Evaluation Committee

• Opportunity to get involved

Guideline Development Group Professional Advisory Committee

• Opportunity to get involved

AGENDA

9:00-9:20 Introduction9:20-10:00 Overview of CAN-ADAPTT

progress10:00-10:15 Setting the Stage - P.Selby10:15-10:45 “Population approaches to

tobacco use cessation programming and current capacity in Canada”- J.Garcia

10:45-11:00 Break11:00-12:00 Small group discussion

AGENDA

12:00-12:30 Report back

12:30-1:30 Networking Lunch

1:30-1:45 Where do we go next? – J.Garcia

1:45-3:45 Small group discussion and report back

3:45-4:00 Closing remarks, Next steps - P.Selby and J. Rogers

4:30-6:00 Networking Reception

Objectives for Today

1. Learn about current status of CAN-ADAPTT project: Engagement/Network Membership Dissemination/Implementation Highlights Version 2.0 Launch/Wiki

2. Contribute to development of

CAN-ADAPTT’s population/systems level standards for tobacco use cessation systems

CAN-ADAPTT

Unique guideline development and dissemination project• Practice informed approach• Practice Based Research Network (PBRN)• Dynamic• Online

Dissemination & Engagement• Stakeholders• Professional

Advisory Groups

National Network• Practitioners• Researchers• Policy-makers

Practice-informedResearch Agenda • Seed grants• Discussion board• AGM

Knowledge Translation

• Seed grants• Discussion board

PRACTICERESEARCHCanadian Clinical Practice Guideline

Health Canada Funding

Funding provided by the Drugs and Tobacco Initiatives Program, Health Canada

3 year funding• March 20, 2008 - March 31, 2011

Overview of CAN-ADAPTT Progress

1. Engagement and Network Membership

2. Dissemination/Implementation Highlights

3. Seed Grants and Research Agenda

4. Version 2.0 Launch

1. Engagement and Network Membership

Timeline/Work Plan

March 2008: Focus on provider and practitioner organizations March, 2009: Ontario coordinator October, 2009: Western and Eastern coordinators Spring, 2010: Engagement beyond providers Fall, 2010: Quebec Coordinator

Network Membership

Multi-sectoral

Multi-disciplinary

National

Network Membership

Multi-sectoral

Multi-disciplinary

National

Psychologist

Physician

OT/PT/Chiropractor

Counselor/Therapist/Social Worker

Respiratory Therapist/Asthma Educator

Pharmacist

Dental professional

Nurse professional

Number of Network Members

>700 members across Canada

Network Membership

Multi-sectoral

Multi-disciplinary

National

Member Survey: Reason for Joining the Network

% of participants who identified this reason as their reason for joining “to a great extent”

(n=141)

To conduct practice-informed research to address gaps

To provide input into identifying knowledge gaps

To contribute to promoting the adoption of the guideline

To build relationships/collaboration with tobacco control professionals

To get updates on tobacco control news and events

To gain access to CAN-ADAPTT’s guideline

Moving forward (targets for next 7 months)

Increase Network Membership• Professional representation• Increase regional reach

Launch Version 2.0 on Wiki Platform Translate Version 2.0 in French and launch Launch Version 3.0 Engage Partners, Stakeholders in dissemination

plan Build sustainability around the Network, guideline

and research agenda

2. Dissemination/ Implementation

Highlights

Dissemination/Implementation

National and provincial conferences• Exhibits, poster and oral presentations, workshops

Stakeholder engagement• Regional teleconferences, meetings,

committee/coalition membership

Communications• Stakeholder articles, e-blasts, journals, listservs

Some sense of numbers…..

26 Oral and poster presentations: To a variety of

practitioner and academic audiences

17 Exhibit tables: At a variety of practitioner

conferences across Canada

5 Workshops: Integrating CAN-ADAPTT

guideline in practice/identifying barriers to

implementationPlus, many upcoming dissemination opportunities

confirmed and in development…

CAN-ADAPTT TRAVELS

Western Canada - Highlights

Successes: College of Registered

Dental Hygienists of Alberta (CRDHA)

University of Alberta Dental Hygiene program

Next steps: engagement on applying

the guideline

Ontario - Highlights

Key Successes Canadian and Ontario

Association of Public Health Dentistry conference keynote, workshop

Ontario Respiratory Care Society keynote, workshop

Atlantic Canada – Highlights

Key successes: Significant increase in Atlantic

Canada representation Numerous collaborations/

connections established• across provinces/disciplines

Next Steps: Pursue workshop opportunities

Benefits of Joining

Individuals & organizations

Access to up-to-date clinical practice guideline Opportunities to contribute to the development of Canada’s

first national CPG Links to a variety of resources including websites, projects,

literature reviews and articles Updates on meetings/conferences A discussion board to connect with colleagues, share

resources and comment on the guideline Disseminate and Implement the guideline

3. Seed Grants and Research Agenda

CAN-ADAPTT Seed Grants

23 applications received from across Canada; 12 funded Applicants: researchers, practitioners, and collaborations of

both.

Topic Themes Proposed Products

• Scientific publications• Academic posters• Grant proposals• Collaborative meetings

• Optometry • Women’s health • Addictions• Mental health/ psychiatry• Health sciences

• Specific populations• Role of HCPs• Counselling• Capacity and theory building

Disciplines

Development of a Practice-Informed Research Agenda

Research Agenda

Existing guidelines*

Comprehensive literature

search*

Organizational reports*

CAN-ADAPTT network

feedback*

March 2009-June 2010

Summer 2010 version

Fall 2010 version

Winter 2011 version

Feedback from stakeholders and

collaborating organizations

Ongoing

CAN-ADAPTT Executive committee

September 2010

February 2011

CAN-ADAPTT Network feedback April 2010 (member survey)

October 2010 (AGM)

Ongoing (discussion board)

June 2010- March 2011

Health Canada

submission March 2011

* Details in following section www.can-adaptt.net Updated: June 30, 2010

4. Version 2.0 Launch

Scope of CAN-ADAPTT

Clinical Practice Guideline

Sections Launched• Counselling• Hospital based populations• Youth (Child and Adolescents)• Pregnant and Breastfeeding Women• Mental Health and Other Addictions • Aboriginal Peoples

Upcoming Launches• Pharmacotherapy

Levels of evidence/grade of recommendation

Guideline Development Group

Gerry Brosky, MD (Counselling) Alice Ordean, MD (Pregnant and Breastfeeding Women) Peter Selby, MBBS/ Charl Els, MBChB (Mental Health and

Addictions) Sheila Cote-Meek, PhD (Aboriginal) Bob Reid, PhD (Hospital-based) Jennifer O’Loughlin, PhD (Youth) Paul McDonald, PhD (Pharmacotherapy)

Guideline Development Process

Guideline Development Process

Applied principles of ADAPTE….. Review existing smoking cessation

CPGs (internationally and across disciplines)

CPGs rated using the AGREE instrument Highest-scoring CPGs were used Sections subject to ongoing input by CAN-

ADAPTT network (PBRN, partners etc.)

Version 2.0

Version 2.0

TODAY

Background and Evidence Overview

Summary Statements

Clinical Considerations

Tools and Resources

Future Research

Structure of the guideline

CAN-ADAPTT Network

Direct input

Direct input

Direct input

Suggestions for Review

Suggestions for Review

Levels of Evidence/Grade of Recommendations

Summary statements are rated based on the GRADE system Required consensus of the Guideline Development Group

Grade of

Recommendation

High

Low

Level of EvidenceWeak Strong

GRADE system of Ratings

1A 1B 1C

2A 2B 2C

Next Steps for the guideline

Integrate outcomes of today’s workshop to create Version 3.0 • Launch date: January 2011

Continue to build clinical considerations• Use of a wiki platform• GDG and network involvement

Continue engagement and dissemination

2.2 Next Steps: Online engagement

Website• New (internal) provider• New website – launching winter 2010

Wiki platform• Launched for AGM (Oct 1)

Twitter• Launching in October

Objective for today….

Inform

CAN-ADAPTT’s guideline on population level approaches for

tobacco use cessation

“Setting the Stage”

Dr. Peter SelbyPrincipal Investigator, CAN-ADAPTT

Setting the Stage…

Opportunity for collaborative approach in developing key principles for an effective smoking cessation system in Canada

Identifying gaps and ways to work together

Society Behaviour and Biology: Making the Case for EBB interventionsT.A. Glass, M.J. McAtee / Social Science & Medicine 62 (2006) 1650–1671

The Smoking Environment in Canada

• About one in five Canadians (5.7 million) 12yrs or older, are daily or occasional smokers*

• Average cigarettes smoked per day = 13.3**

• 37,000 Canadians die from smoking per year

– 100 infants/year• 1 in 5 deaths are due to smoking• 1 in 2 smokers die from smoking-related

diseases

* Canadian Community Health Survey (Statistics Canada), 2010**CTUMS 2009

Burden of Addiction

Smoking rates are higher among:• Young adults• Less than high school education• Blue collar• Mentally ill• Aboriginal• Poor

Never too late to Quit

Quitting smoking at any age may increase life expectancy

Quitting smoking before age 30 = normal life expectancy

Age stop smoking by Life years gained

<30 years 10

<40 years 9

<50 years 6

<60 years 3

“Smoking cessation is a criticalaspect of the management of

many chronic diseases, both interms of treatment outcome,

progression of disease,comorbidities, quality of life, and

survival.”

(Gritz et al., 2007)

“Smoking cessation is a criticalaspect of the management of

many chronic diseases, both interms of treatment outcome,

progression of disease,comorbidities, quality of life, and

survival.”

(Gritz et al., 2007)

Hard things to do….large benefits to doing them….

Providing Smoking Cessation

Many Providers• Physicians, RNs, NPs, Dental Hygenist,

Assistants, Opthalmologists, Chiropractors, Pharmacists, Social Workers, Mental Health Counselors, RTs, etc….

Many Settings• Hospital, Primary Care, Community, Long term

care, Specialty Care, etc.

Opportunities!!!!

Levers and Opportunities

Training of HCPs

Guidelines

Patient/client tools

Provider tools/resources

Incentives

Mass Media

Policy

Priority Setting

Engage community

Research

Clinical Strategies (5A’s, Ottawa Model)

Funding: programs

Funding: pharmacotherapy

Public/Consumers

Existing programmingPartnerships

Opinion leaders/Champions

Need for alignment

Fragmented smoking cessation system across Canada • Information sources (cpg’s, tools etc.)• Settings (clinical, community, hospital, primary

care) • Professionals• Funding• Funding of effective interventions• Educational opportunities in smoking cessation

Provider Approaches

Organizational Level

Population Level Approaches & policy

Importance of alignment and integration of approaches

Intent of the White Paper

Starting point…… Build from evidence, experience and current

capacity to frame the context for smoking cessation guideline

Opportunity today and over Fall 2010 for us to reflect, discuss and revise the White Paper

Today’s Approach

Opportunity to have important conversations in a collaborative way

Helpful hints:• Focus on what matters• Contribute your thinking• Listen to understand• Link and connect ideas• Have FUN! • Be CREATIVE!

Population approaches to tobacco use cessation

programming & current capacity in Canada

60 minutes

John Garcia, PhD

Understand your perspectives on

important components of cessation systems existing challenges and barriers, successes

and where gains can be made emerging opportunities and needs for

smoking cessation system development

What needs to be addressed in a CAN-ADAPTT “System Guideline for Population-based Tobacco Use Cessation”?

Perspectives: Cessation system, What are we talking about?

Clinical Intervention? • Not just a program or intervention

Public Health Approach?• “the organized efforts of society to improve health and well-

being and to reduce inequalities in health” (PHAC)

A goal beyond cessation of tobacco use alone?• Harm reduction – reducing disease, disability and death?

Relationship between tobacco control and cessation?• both a context and the approach?

Exploring Components of Effective Smoking Cessation System(s) Across Canada

CAN-ADAPTT team work to create white paper• Starting place only, stimulate discussion• CDC, IOM, NCI,Ontario (TF, UW, SFO-SAC)

Major components and what we mean:• Goals• Principles• Strategies• Tactics

Tobacco Control – classic goals

1. Preventing tobacco use,

2. Encouraging and motivating quitting tobacco use,

3. Protecting the public from exposure to tobacco smoke, and

4. Denormalization of tobacco and tobacco industry

Tobacco control is not equivalent to cessation Some are questioning this orientation

Cessation System Goals – 6 identified on page 3

Reduce the health consequences (i.e. harm) of the use of tobacco products

Motivate attempts to quit tobacco use Support tobacco users in their efforts to quit

tobacco use

Cessation System Goals (continued)

Facilitate tobacco users stopping use at an earliest age possible

Address the needs of high priority populations to eliminate or reduce inequities in burden of diseases caused by tobacco products (e.g. Aboriginal People, occupational, SES groups), • including those who may be at elevated risk due to

other health conditions (e.g. mentally ill, poly-drug users)

Cessation System Goals (continued)

Encourage repeated sustained quitting and reduction of long-term use in order to reduce health burden among those who have difficulty quitting

Cessation System Goals

Do these goals make sense/resonate?

Alternative goals – for the population-based system?

Key Guiding Principles – page 4 & 5

Tobacco Use Cessation System should be: Continuous – range of interventions,

integrated Goal and Objective Directed Evidence-based Comprehensive and integrated Aligned – across disciplines,

interventions/strategies, decision-makers (across levels)

Key Principles

Build from/include: Strong relationships with smokers

• Not just “one offs”: family members, friends, colleagues

SDOH/Equity and concern for vulnerable populations

Continuous learning cycle• Evidence-inspired, tailoring, continuous improvement

Commitment to invest in research Roles for a range of health care providers, range of

capacities and roles

Proposed structure of a tobacco use cessation system

Strategies

Approaches to achieving the goal(s)

Goals and PrinciplesKey concepts informing the organization and management of the

system

TacticsHow would you go about executing the strategy?

What activities are required? Where would resources be spent?

ActionsPragmatic, action-oriented and implementable tactics necessary to

move toward goals and objectives

This morning

This afternoon

This afternoon

After the break…..Let’s Discuss

1. What is the current status of tobacco use (smoking) cessation systems in Canada?

What’s working well? What are the emerging opportunities for system

development? What are some of the major challenges for

cessation system development?

Evidence and Experience

Focus on areas where there is some degree of evidence around impact, effectiveness and/or trends in practice.

Acknowledge continuous learning cycle and opportunity to build from best practice and experience

BREAK

Small Group Discussion Questions

1. What is the current status of tobacco use (smoking) cessation systems in Canada?

What’s working well? What are the emerging opportunities for system

development? What are some of the major challenges for

cessation system development?

25 minutes

Building from your conversation…..

2. What are the key principles that should be considered in the design of tobacco use cessation systems in Canada?

Please use the White Paper as a starting point only.

Go beyond it and generate new principles.

25 Minutes

Large Group Report Back

Focus your report back on: What were the emerging opportunities? Was there general agreement with the

Principles in the White Paper? What changes/additions did your group

discuss making to the Key Principles?

40 Minutes

Networking Lunch 12:30-1:30

• Visit display tables at the back of the room

• Network with colleagues and meet new people

• Explore CAN-ADAPTT Wiki

• Introduce yourself to the CAN-ADAPTT team!

Welcome Back….

Review discussion from this morning…..

Proposed structure of a tobacco use cessation system

Strategies

Approaches to achieving the goal(s)

Goals and PrinciplesKey concepts informing the organization and management of the

system

TacticsHow would you go about executing the strategy?

What activities are required? Where would resources be spent?

ActionsPragmatic, action-oriented and implementable tactics necessary to

move toward goals and objectives

This morning

This afternoon

This afternoon

Strategies

#1 Planning and Priority Setting

#2 Policy Interventions

#3 Health Communication and Media Interventions for Population Level Tobacco Cessation

#4 Healthcare Setting/Organization and Community Interventions

#5 Population-level Cessation Interventions

Strategies

#6 Training or Building Capacity Among HCP’s in the Provision of Smoking Cessation Interventions

#7 Investment

#8 Evaluation

#9 Surveillance and Monitoring

#10 Alignment and Coordination

White paper….drilling down

World Café Format Opportunity to have important conversations

in a collaborative way

1:40 – 3:45

How does it work?

Discuss specific strategies Round 1: stay at your current table

Quick Report Back Round 2: travel to a new table Round 3: travel to a new table Round 4: return to your original table

Group Discussion

Round #1: Table Talk

Explore the strategy your table has been assigned

Have the important aspects been captured?

Are there additional tactics that could be considered/included?

20 minutes

Report Back

5 minutes/table Introduce the strategy Was there general agreement that the

strategy is important/should be included? What revisions/additions would you

suggest?

40 minutes total

Travel Time

Travel to a NEW table for Round 2 of small group discussion

Table Leads STAY at your first table

5 minutes

Round #2: Table Talk

Have the important and relevant strategies been captured?

What is missing? What needs to be added?

15 minutes

Travel Time

Travel to a NEW table for Round 3 of small group discussion

Table Leads STAY at your first table

5 minutes

Round #3: Table Talk

Table leads take 5 minutes describing what was discussed in Round #2

If there was one thing that hasn’t been said but is needed what is it?

20 minutes

Travel Time

Travel ‘Home’

5 minutes

Large Group Report Back

What key themes emerged?

20 minutes

“Where do we go next?”

Think about….

1. Explore opportunities for collaboration, importance of alignment and how to move forward

2. How might we learn from the experience of different jurisdictions as they implement tobacco use cessation systems across Canada and abroad?

Moving Forward

What needs to happen next week, next month, this year……..beyond?

10 minutes

Wrapping Up

Reflection and Next Steps Evaluation Acknowledgements Thank you Reception

For more information

CAN-ADAPTT

175 College Street

T: 416-535-8501 ext 7427

E: can_adaptt@camh.net

www.CAN-ADAPTT.net