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CAN-ADAPTT. Peter Selby MBBS, CCFP, MHSc, FASAM Associate Professor, Family and Community Medicine, Psychiatry, Public Health Sciences, University of Toronto Clinical Director, Addictions Program PI, Ontario Tobacco Research Unit Executive Director, TEACH PI, CAN-ADAPTT, STOP STUDY

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can adaptt



Associate Professor,

Family and Community Medicine, Psychiatry, Public Health Sciences,

University of Toronto

Clinical Director, Addictions Program

PI, Ontario Tobacco Research Unit

Executive Director, TEACH


CAN-ADAPTT Team: Rosa Dragonetti, Jess Rogers, Katie Hunter, Denise Koubanioudakis, Tamar Meyer, Janet Ngo, Stephanie Elliott

    • Rationale
    • Methodology
    • Results
    • Challenges & Lessons Learned
  • Seed Grant Presentations
  • Discussion and Next Steps
can adaptt team
  • Rosa Dragonetti, Manager
  • Jess Rogers, Project Manager
  • Katie Hunter, Atlantic Canada Coordinator
  • Denise Koubanioudakis, Quebec Coordinator
  • Tamar Meyer, Ontario Coordinator
  • Janet Ngo, Western Canada Coordinator
  • Stephanie Elliott, Administrative Secretary
guideline development group
Guideline Development Group
  • Gerry Brosky, MD, MSc, CCFP
  • Paul McDonald, PhD, FRSPH
  • Jennifer O'Loughlin, PhD
  • Sheila Cote-Meek, BScN, MBA, PhD
  • Alice Ordene, MD, CCFP, MHSc
  • Robert Reid, PhD, MBA
  • Charl Els M.B. ChB., F.C. Psych, M.Med Psych, A.S.A.M., M.R.O.
  • Peter Selby, MBBS, CCFP, MHSc, FASAM
executive committee
Executive Committee
  • Peter Selby
  • Cameron Norman
  • Roberta Ferrence
  • Charl Els
  • Michèle Tremblay
  • John Garcia
  • Paul McDonald
  • Tupper Bean
  • Laurie Zawertalio
  • Virginia Chow
  • Louise Walker
professional advisory group
Professional Advisory Group

Health Canada

Asthma Society of Canada

Canadian Chiropractic Association

Canadian Dental Hygienists Association

Canadian Dental Association

Dieticians of Canada

Director, Primary Care Lung clinic

Canadian Nurses' Association

Canadian Association of Optometrists

Canadian Pharmacists Association

Canadian Physiotherapy Association

Todd Evans

Meridene Haynes

John Tucker

Judy Lux

Dr. Euan Swan

Jayne Thirsk

Tony D'Urzo

Tracy Vanderwoude

Dr. Kirsten North

Kristine Petrasko

Dr. Maura Ricketts

professional advisory group1
Professional Advisory Group

Carol Miller

Dr. Sonu Gaind

Dr. Karen Cohen

Chritiane Menard

Donna Czukar

Doug Brothwell

Brenda McGibbon Lammi

Karen Poole

Bob Reid

Millicent Toombs

Canadian Physiotherapy Association


Canadian Psychological Association

Canadian Society of Respiratory Therapists

Canadian Cancer Society

Canadian Association of Public Health Dentists

Canadian Association of Occupational Therapists (CAOT)

Royal Ottawa Care Group & Ontario Assoc. of Social Worker

University of Ottawa Heart Institute

Canadian Medical Association

health canada
Health Canada
  • 3 year Project Funding
  • Drugs and Tobacco Initiatives Program, Health Canada

“There are therefore 2 major disconnects between research and practice: research may not translate expeditiously to everyday practice, and clinical problems encountered in everyday practice are often under-investigated.” (Tierney et al., 2007)


Barriers and the Care Gap

Structure of Care

System Level



Process of Care

Organization/Setting Level






Content of Care

Provider/Patient Level


  • National Network:To create a national network of smoking cessation researchers, policy/decision- makers and practitioners/providers to inform smoking cessation research and practice.
  • Clinical Practice Guideline: build from existing guidelines identify and adapt evidence to the Canadian context through a practice-informed approach
  • Research Agenda:To develop a practice-informed research agenda in key areas of smoking cessation that bridges the gaps between clinical practice, research and theoretical frameworks.
  • Knowledge Translation:To translate research findings into a dynamic set of evidence-based guidelines on smoking cessation.
  • Dissemination and Engagement:To disseminate findings and engage stakeholders from national and professional organizations to promote the adoption of the Wiki-guidelines. 
  • Collaboration:To collaborate with other projects in smoking cessation.
  • Evaluation:To evaluate the system and population impacts of the proposed practice-based research network.

Clinical Practice Guideline

Research Agenda



National Network


& Engagement

Seed Grants

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

* ADAPTE. (2007)


Pregnant and Breastfeeding Women/ Femmes enceintes et qui allaitent

Youth (Children and Adolescents)/ Jeunes (enfants et adolescents)

Mental Health and/or Other Addictions/ Santé mentale et/ou autres dépendances

Aboriginal Peoples/ Autochtones

Hospital-based populations/ Populations des hôpitaux

practice informed approach
Practice-informed Approach

Best available evidence filtered through end-users

Practitioner input is collected via:

  • Annual General Meetings (n=2 with 50-60 participants)
  • Stakeholder meetings (n=118)
  • Presentations/Workshops (n=39)
  • Teleconferences/Webcasts (n=15)
  • Online discussion board (posts, n=221)
  • Member surveys (n=3)
  • 800 members
    • National
    • Interprofessional
    • Multidisciplinary
  • 800 members
    • National
    • Interprofessional
    • Multidisciplinary
  • 800 members
    • National
    • Interprofessional
    • Multidisciplinary
Connected with 100+ organizations

Promoted CAN-ADAPTT at 50+ conferences and events

Workshops, poster presentations, key note address

Website visitors from 66 countries

Engagement and Dissemination

  • Regional coordinators
    • Provide outreach
      • Overall: Jess Rogers and Stephanie Elliott
      • Western Canada: Janet Ngo
      • Ontario: Tamar Meyer
      • Quebec: Denise Koubanioudakis
      • Atlantic Canada: Katie Hunter
can adaptt s monthly transdisciplinary tobacco rounds
CAN-ADAPTT’s MonthlyTransdisciplinary Tobacco Rounds:

6 Online/In-person Transdisciplinary Tobacco Rounds (TTR) held in the past year

CAN-ADAPTT held monthly tobacco rounds, inviting speakers to share their knowledge in smoking cessation treatment and approaches, helping to promote best practices and share experiences with network members.

Audience: practitioners, researchers, students and decision makers.

Attendees from across Canada

can adaptt s monthly transdisciplinary tobacco rounds1
CAN-ADAPTT’s MonthlyTransdisciplinary Tobacco Rounds:

Special Transdisciplinary Tobacco Rounds Symposiums:

January 2011:"Exploring Law as a Tool in Canadian Tobacco Control and Public Health Policy."  

Presenters: Eric LeGresley M.Sc., LL.M., Barbara Russell, PhD, and David Sweanor, B.A., J.D. 

April 2010: “Neuroscience and Tobacco” (presented in conjunction with the CAMH Neuroscience department);

Presenters: Dorothy Hatsukami, PhD, Fang Liu, PhD,

MarykaQuik, PhD

can adaptt s monthly transdisciplinary tobacco rounds for 2010 2011
CAN-ADAPTT’s MonthlyTransdisciplinary Tobacco Rounds for 2010/2011:

February 2010: Martin Stampfli, PhD: “How cigarette smoke skews immune responses to promote infection.”

June 2010: Dr. Milan Khara MBChB, CCFP, cert. ASAM: “Smoking Cessation in Patients with Substance Use Disorders: The Vancouver Coastal Health Tobacco Dependence Clinic”. 


November 2010: Heather Manson, MD MHSc FRCPC. "Evidence to Guide Action: Comprehensive Tobacco Control in Ontario." 

can adaptt s webinar lunch and learn series
CAN-ADAPTT’s Webinar “Lunch and Learn series”

CAN-ADAPTT has held 5 Lunch and Learn webinar series to date;

Aboriginal Peoples: Sheila Cote-Meek, BScN, MBA, PhD

Pregnant and Breastfeeding Women: Alice Ordean, MD, CCFP, MHSc

Youth (Children and Adolesecents): Jennifer O’Loughlin, PhD

Hospital Based Populations: Robert Reid, PhD, MBA

Pharmacotherapy: Peter Selby,

These webinars are being held to discuss and explore each of the guideline sections. Webinars are hosted by the lead developer of their respective section from the Guideline Development Group.

qu bec highlights
Québec- Highlights
  • Project in Québec began mid-December 2010
  • Established an Advisory Committee composed of policy makers, researchers, professors, public health practitioners and clinicians
  • Held a first Advisory Committee meeting in February 2011
  • Revising the translation of the documentation and the Website
western canada highlights
Western Canada - Highlights

Key Successes:

  • Collaborations with dental hygiene organizations in Alberta (CRDHA & Univ. of Alberta Dental Hygiene program)
  • Resource-sharing with Partnership to Assist with Cessation of Tobacco (PACT) in Saskatchewan
atlantic canada highlights
Atlantic Canada – Highlights
  • Regional Smokers Helpline & Advocacy Groups
    • Smoke Free Nova Scotia
    • SHL Newfoundland & Labrador
  • New Brunswick Respiratory Therapists
    • Conference presentation
    • Collaborative manuscript
ontario highlights
Ontario - Highlights
  • Canadian and Ontario Association of Public Health Dentistry conference keynote/workshop
  • Ontario Dental Assistants Association Affiliate workshops
  • Ontario Dental Hygienists Association
Ontario Tobacco Research Unit is conducting a mixed method evaluation.

1. On-line survey of CAN-ADAPTT members:

Initial/baseline survey (February-March 2010)

Follow-up survey (February-March 2011)

2. Case-studies of health professions (interviews):

(1) dentists/dental hygienist; (2) family physicians; (3) pharmacists; (4) nurses

3. Semi-structured interviews with CAN-ADAPTT team

Interviews aim to examine progress in establishing CAN-ADAPTT network, promotion activities to recruit network members, management of the network, processes of revision, update and dissemination of the guidelines


OTRU Evaluation

learning and next steps
Learning and

Next Steps

challenges guideline development
Challenges: Guideline Development
  • New, experimental process
    • learning curve for team and network members
  • Pharmacotherapy section
  • Applying LOE/GR
    • building from existing LOE
    • GRADE limitations
  • ‘Clinical Practice Guideline’ vs ‘Implementation Guide’
  • Balancing evidence, expert opinion, and network feedback
challenges engaging a network
Challenges: Engaging a Network
  • Challenges with encouraging use of online platform
    • Learning curve for network members
  • Lack of ‘final’ guideline for providers
  • Support and relationship building
  • Coordinated dissemination & engagement
next steps
Next Steps
  • Funding beyond March 31/11 not secured
  • CAMH will maintain CAN-ADAPTT website
  • Open to new opportunities to collaborate for funding
  • Next steps for the project could include
      • Wiki platform
      • Revisit traditional methodology for application to a practice-informed guideline
      • Consistent integration of network members in the process
      • Sharing Best Practices (tools/resources etc.)
lessons learned
Lessons Learned
  • Timing is everything
    • Aligning launch of guideline with other efforts
    • It takes time to build a self-sustaining network
    • Huge need to continue small grant funding to continue momentum and sustain great research work in Canada
    • Knowledge Attitudes Practice

This is just the beginning…..

Purpose: To make research more responsive to practice by addressing gap in current practice guidelines, research question of importance to Health Care Providers (HCPs)

Mechanism to support practice-informed approach of PBRN – collaborative, Canadian researcher-practitioner teams (must include >1 HCP)

Awards of up to $5,000 to facilitate preparation of a scientific product in smoking cessation research (e.g.: lit review, pilot study, publication, grant proposal)

Seed Grants

can adaptt seed grants
CAN-ADAPTT Seed Grants
  • 23 applications received from across Canada; 12 funded
  • Applicants: researchers, practitioners, and collaborations of both.

Topic Themes


Proposed Products

  • Optometry
  • Women’s
  • health
  • Addictions
  • Mental health/
  • psychiatry
  • Health
  • sciences
  • Specific
  • populations
  • Role of HCPs
  • Counselling
  • Capacity and
  • theory building
  • Scientific publications
  • Academic posters
  • Grant proposals
  • Collaborative
  • meetings
  • Reports were completed from each Seed Grant team
  • CAN-ADAPTT Team teleconference with each Seed Grant Team
    • Feedback
    • Status update
    • Reflections on the Process
  • Outstanding Achievements and overwhelming support for CAN-ADAPTT process
  • Full Seed Grant Report available April 2011