Minutes - Strategic Priority Planning Workshop

Date: May 8, 2008

Place: Hilton Montréal Bonaventure

Present:

IAB Members

1. Ron Barr
2. Angela Brooks-Wilson
3. Heather Bryant (Chair)
4. Jacques Corbeil
5. Richard Doll
6. Elizabeth Eisenhauer
7. Margaret Fitch
8. Scott Leatherdale
9. William Mackillop
10. Les Mery
11. Anne-Marie Mes-Masson
12. Mark Nachtigal
13. Morag Park
14. Steve Pillipow
15. Cheryl Robertson
16. Michael Tyers

Guests

17. Kimberly Badovinac, CCRA
18. Neil Berman, BCCA
19. Alan Bernstein, GHVE
20. Sharon Buehler, MemorialU
21. Roy Cameron, UWaterloo
22. Pierre Chartrand, CIHR
23. Mario Chevrette, CRS
24. Abraham Fuks, McGill
25. Pamela Goodwin, SLRI
26. Jessica Hill, CPAC
27. Gerald Johnston, Dalhousie
28. Cyril Kay, UAlberta
29. Anne Leis, USaskatchewan
30. Nicola Lewis, CBCRA
31. Victor Ling, TFRI
32. Joan Loveridge
33. Neil MacDonald, McGill University
34. Timothy Murphy, MSFHR
35. Christopher Paige, UHN-OCI
36. Joseph Pater, Cancer Care Ontario
37. Robert Phillips, OICR
38. Brent Schacter, CAPCA
39. Peter Scholefield
40. Sylvie Stachenko, PHAC
41. Jeanette Ward, University of Ottawa
42. Barbara Whylie, CCS/NCIC
43. James Woodgett, SLRI
44. Michael Wosnick, NCIC
45. Joy Yorath, CNIB

CIHR and ICR Staff

46. Kimberly Banks Hart
47. Erik Blache
48. Philip Branton, SD
49. Judy Bray
50. Diane Christin
51. Dale Dempsey
52. Isabel Faustin
53. Ian Graham
54. David Hartell
55. Benoît Lussier
56. Gwendoline Malo
57. Claudia Mongeon
58. Stephanie Pineda
59. Diana Sarai
60. Andrea Smith

Regrets

• J. Brisson
• D. Butler-Jones
• C. Cass
• L. Dionne
• M. Farmer
• D. Fox
• T. Hudson
• A. Laupacis
• J. Lozon
• J. Magnan
• B. Neel
• E. Phillipson
• D. P.-Guerrera
• I. Smith
• T. Sullivan
• S. Sutcliffe
• J. Till
• J.-Michel Turc
• S. Wood

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Call to order

The meeting was called to order at 9 a.m. by Judy Bray.

Strategic Priority Planning Workshop

Background:

• A strategic priority planning workshop was hosted by the CIHR Institute of Cancer Research (ICR) on May 8, 2008 in Montreal, Quebec. The purpose of the workshop was to solicit input from members of the Canadian cancer research community on potential future strategic priorities for ICR. The participants included representatives from the major Canadian cancer research funders, cancer researchers, current and past ICR Institute Advisory Board (IAB) members, as well as representatives from different CIHR Branches and Portfolios. The workshop also provided an opportunity to reflect on how the Canadian cancer research community has changed since ICR’s inception in 2000, and examine ICR’s role in advancing the Canadian cancer research agenda.

The workshop began with a series of presentations to set the context of the day’s discussion. The presentations were followed by two participant breakout sessions. The day concluded with a presentation on knowledge translation (KT) and the importance of an effective KT strategy for ICR.

Current Canadian Strategic Initiatives in Cancer Research

Philip Branton, Scientific Director, ICR

The Canadian landscape of cancer research funding, particularly in the area of targeted research, has changed significantly in the eight years since the Canadian Institutes of Health Research (CIHR) and the CIHR Institute of Cancer Research (ICR) were created. Prior to 2000, most of the strategically funded research was supported by the National Cancer Institute of Canada (NCIC), through its Clinical Trials Group and Centre for Behavioural Research and Program Evaluation, and through NCIC partnerships in the areas of breast cancer, prostate cancer and tobacco control research. The launch of CIHR provided a new source of funds to support strategic research and sparked a priority setting process that led to the development of the original slate of ICR research priorities. During the last few years, several additional sources of strategic research funding have emerged on the scene, including the Terry Fox Research Institute, the Ontario Institute of Cancer Research (OICR) and the Canadian Partnership Against Cancer (CPAC). This proliferation of research funding agencies has spurred the need for communication and collaboration between parties in order to build strategic partnerships and avoid duplication of effort. A survey of Canadian cancer research funding organizations reveals several areas of significant overlap, including cancer prevention, translational research, health services research and tumour banking. As ICR moves forward in identifying future research priorities it will be important to consider the “whole picture” and seek partnerships and/or alignment with other existing or planned initiatives in order to ensure minimal overlap and maximum impact of the research dollars invested.

Past Priorities and ICR Achievements, 2001-2008

Judith Bray, Assistant Director, ICR

Through a broad-based consultation process in the initial year of ICR’s operation, seven research priorities were identified, including the overarching priority of research training and capacity building. In 2004/2005, an eighth strategic research priority was identified, Access to Quality Cancer Care. Since 2002, ICR has supported major strategic research initiatives in each of the eight priority areas listed below.

1. Strategic Training in Health Research (STIHR)
2. Palliative and End of Life Care
3. Molecular Profiling of Tumours
4. Clinical Trials
5. Early Detection of Cancer
6. Risk Behaviour and Prevention
7. Molecular and Functional Imaging
8. Access to Quality Cancer Care

ICR has also provided one-year bridging funding to members of the cancer research community whose grants fell just below the funding cut off in the CIHR open grants competition. This funding enabled researchers to re-apply to the next competition in which many were subsequently successful.

Overview documents were recently produced for each of these priority areas and are available on the ICR website (coming soon!). These documents outline the planning process, the funding results and some of the early outcomes of the research. Many of the priorities were addressed through partnerships, e.g. Clinical Trials and Risk Behaviour and Prevention, but for others such as Palliative and End of Life Care and Access to Quality Cancer Care, ICR led the process of strategic planning and as a result launched major initiatives, supported by multiple partners. The largest initiative in terms of funding, and perhaps also impact, was the Palliative and End of Life Care initiative in which ICR and partners have invested more than $17 million. As a result, there has been a tremendous impact on research capacity in Canada, both in terms of the number of funded projects and also the number of researchers working in the field. A recent survey of ICR funded researchers intended to capture some of the early research outcomes yielded a series of success stories and outcomes that included publications, increased research funding, important clinical data, patents, commercial spin-off activities and the production of educational materials. All of these outcomes will have a positive impact on cancer control. ICR is now in the process of developing an evaluation strategy for all ICR-funded programs.

Discussion centered around the need to work collaboratively when identifying priorities, something that ICR has a history of doing well, and to involve partners in all aspects of the process from initial planning, through launch and funding, and ending with evaluation. The need to be strategic was also stressed in that ICR-supported initiatives should have well defined objectives that would be unlikely to be achieved through the open competitions, i.e. a demonstrable value-added component. As ICR moves forward, it was recommended that initiatives should be determined by the research questions rather than research area or the availability of funds and program tools. With the creation of CCRA, it is likely that at least some of ICR’s future strategic planning will occur in collaboration with other CCRA members. A strategy will have to be developed by which CCRA members can collectively address research questions of common interest while still retaining their unique organizational profiles. In the case of ICR, the Institute is the champion for all cancer research funded by CIHR and so the focus, in the future, should be on identifying the pressing research issues and specific questions in cancer research and defining a role for the Canadian cancer research community in addressing these questions. In other words, ICR should not be restrained by its limited strategic research budget but should think in terms of what is needed in Canadian cancer research as a whole. ICR’s potential impact can be maximized through partnership and broad-based consultation with the research community.

Participant Poll on Cancer Research Priorities

Prior to the workshop, participants were asked to provide their top two research priorities, with one of them being in the basic/biomedical area. The results covered a wide range of topics (See Appendix 1) with the following five priorities receiving the most votes:

1. Prevention, including Risk Behaviour and Early Detection (11 responses)
2. Translational Research (8 responses)
3. Survivorship (5 responses)
4. Cancer Stem Cells (3 responses)
5. Cohort studies (3 responses)

Additional topics mentioned included regulation of tumour metastases, alternative medicine approaches, health economics and the effects of host factors on cancer development and progression from prevention to palliation, e.g. vitamin D, hyperinsulinemia, chronic inflammation, infectious agents, innate microbial flora.

The discussion re-emphasized the need to use CCRA as the vehicle to discuss priority setting and through which initiatives could be launched. There are plans for CCRA to recruit a scientific Chair, who will have much the same role as an Institute Scientific Director, and also a Project Director. This will provide the necessary resources for CCRA to function as originally envisioned - as a coordinating body for Canadian cancer research. Many different organizations have conducted their own priority setting exercises and so we should not be duplicating their efforts but rather working together to identify the priorities for Canadian cancer research. ICR was again encouraged to think in terms of the global CIHR cancer research budget rather than just the Institute budget when planning priorities. Other factors raised included the need to involve key decision and policy makers at the planning stage to encourage implementation of change and also to consider opportunities for international partnerships.

CCRA 2006 Survey Data

Kimberly Badovinac, Manager, Canadian Cancer Research Survey, CCRA

The 2006 CCRA Cancer Research Survey will be released in the summer of 2008. There has been an increase in participation compared to the previous year with the inclusion of data from the Canada Research Chair and Canadian Foundation for Innovation programs and also some specific Networks of Centres of Excellence projects. The survey has yet to be expanded to include university sponsored research, many of the cancer research foundations, and private sector investments. The survey provides a comprehensive summary of Canadian cancer research funding by sector, including Federal Government programs, provincial cancer agencies, provincial health research organizations and the voluntary sector. The survey also shows the distribution of funding by tumour site and type of research (e.g. biology, etiology, prevention etc.). Data is also included on trainee awards by research area and tumour site. As a result of Canada’s membership in the ICRP, our data is entered onto their website along with the UK and US data allowing comparisons between the three countries. In fact the funding distribution is very similar between the UK and Canada in terms of site specific research. Analysis of the Canadian data suggests that research funding on prostate, lung and colorectal cancer is low relative to the high mortality rates with these cancers. Data collection for the 2007 survey is now underway and a further increase in participation is anticipated.

Breakout Sessions

Participants were divided into six groups for the breakout sessions and each group was provided with a designated facilitator and a recorder. Groups were asked, over the course of two breakout sessions, to discuss and make recommendations on two broad questions; they were also provided with suggested criteria and ‘sub questions’ to guide their discussions (Appendix 2). The following represents a summary of the collective responses to Questions A and B.

Question A

Discuss the list of criteria used for selecting cancer research priorities in 2001 and reduce the list to a maximum of six criteria.

Collectively the six groups proposed the following criteria, some of which were retained from the 2001 list, plus some new ones.

• Impact of research on disease burden – included short, medium and long term impacts
• Ability to address identified research gaps – focus on research questions; address gaps; identify potential niche areas
• Potential for national and international partnerships – opportunities to leverage new funds
• Cost benefit and economic impact
• Alignment with a national research strategy – working within CCRA
• Continuity and alignment with current and past efforts and initiatives led by ICR and others build on past achievements
• Potential for global excellence
• Competitive advantage in Canada
• Sustainability of research
• Ability to easily translate research results into improvements in clinical outcomes.

Overall, participants agreed that the setting of cancer research priorities should be done as a consultative process in the context of a national strategy. CCRA provides the ideal platform for these discussions. Priorities should be built around pressing research questions related to the impact and burden of disease and in areas where Canada already has existing strengths and so is likely to be able to contribute in the global arena. One possible role for ICR, specifically, would be to bring issues to the CCRA table and provide leadership, where appropriate, in moving the Canadian cancer research agenda forward.

Given the limited ICR funds ($8 million per year), should the Institute continue to support a broad range of priorities or narrow its focus to on or two specific themes?

All of the groups advocated for a smaller number of priorities than the eight originally selected by ICR for 2001 to 2008. Suggestions ranged from supporting one to five priority areas with a mechanism to respond quickly to emerging opportunities. One group suggested that rather than set a definite number of priorities, all potential priorities should be ranked, and funded from the top down as money became available. This approach would most probably result in a small number of priority areas targeted by ICR. A convener role could also be taken up by ICR by bringing forward the proposed priorities to CCRA for discussion and collaboration thus encouraging the uptake, by other stakeholders, of priorities not immediately addressed by ICR.

The following benefits were identified by the groups for adopting a more limited number of priorities (one to five):

• The potential for greater impact
• Maximized return on investment
• An increased leadership role for ICR
• Partnership could play an important role
• Attract new researchers into an area
• Responsive to arising opportunities

The following drawbacks were identified by the groups:

• Missed opportunities for impact in multiple areas
• The research community’s expectations for ICR may not be met
• Impact of failure is more broad reaching

An alternative approach would be for ICR to expand its horizons beyond the $8 million currently in its strategic research budget to include the total CIHR cancer research funding. Through consultation with the research community, large initiatives could be identified that are beyond the scope of individual operating grants or small team grants but would have the potential to move Canadian cancer research forward at an accelerated pace. ICR could bring ideas to the CCRA table and assume the lead in soliciting the additional external funding required to launch and support innovative initiatives that might, for example, include large, multidisciplinary consortia.

Question B

How should ICR-led research initiatives be evaluated and by whom?

Participants recommended that a systemic approach to evaluation be established perhaps using a logic model as part of the evaluation framework. The importance of establishing objectives, milestones and expected deliverables at the RFA stage was stressed repeatedly. It was also felt that evaluation should be a continuous process throughout the life of a grant rather than just at the end of the funding period.

In terms of the evaluation process, external experts were advocated by several of the groups as this may allow for a more objective, arms length evaluation of the initiatives. External reviews could be conducted by CCRA, NGOs, Canadian or international experts, and potential end users of the research. On the other hand, several groups also recommended making use of the existing CIHR evaluation resources available to ICR. This approach would be less costly and could potentially be done with a shorter turn around time. It was noted that based on Treasury Board guidelines, an internally conducted evaluation is acceptable for government practice. It was also suggested that CIHR staff could work with the IAB who may be able to provide content expertise or with the cancer operating grant review panel chairs when conducting internal evaluations. It was proposed to develop a phased approach to evaluation.

When determining continued or renewed funding for existing ICR initiatives, several groups felt that the evaluation questions would be dependent on the initiatives’ objectives as identified at the RFA stage. They suggested that the list of criteria set out in funding opportunities should be used as milestones for the evaluation of progress for the initiative. Participants also felt that the following would be important factors in determining continued support for an initiative: the continued relevance of the initiative to ICR; the ability of the research community to secure funding through other sources; and the costs of continuing to support the initiative. One group also felt that in fact “success” may result in the end of strategic funding as the objectives of the initiative e.g. capacity building, had been achieved and the community was now self sufficient, conversely perceived “failures” in strategic initiatives may need to be nurtured and turned into successes.

The breakout groups were also asked for their feedback regarding realistic expectations for outcomes of three to five year projects. Suggestions by the group included evaluating the outcomes based on the initial objectives identified at the RFA stage and the impact of the initiative on the broader institutional environment. It was also suggest that projects should be evaluated throughout their tenure, and not just at their conclusion, with an incorporated mechanism to affect change to the project if needed.

How can ICR best take advantage of partnership opportunities?

Participants recommended that partnerships should be encouraged between ICR and national and international organizations, as long as the partnerships were strategic and were the best way to address a priority area. International partnerships were encouraged to facilitate inter-country comparisons, in the context of shared funding for international initiatives, and as a means to learn from other organizations with similar mandates.

CCRA was again identified as the primary strategic planning body for cancer research and the most appropriate vehicle for fostering international partnerships and engaging with policy decision makers and other cancer research stakeholders. Within CCRA, ICR was encouraged to stimulate discussion about large initiatives that may attract new funding.

In addition to ICR’s relationship with CCRA, other federal departments, such as Foreign Affairs and International Trade Canada, and industry, through training programs, were identified as potential partnership opportunities.

Participants were also asked about the potential for ICR to partner with site-specific organizations. There was no consensus reached by participants to support potential partnerships between ICR and site-specific organizations. It was suggested that ICR may partner with site-specific organizations when it was appropriate to the priority area, something that could be established at the CCRA table.

Participants were asked to provide feedback on how ICR can promote partnership opportunities with the Canadian Partnership Against Cancer (CPAC) and specifically with the cancer cohort. ICR was encouraged to stay up to date on the cohort’s progress and opportunities through CCRA. It was suggested that ICR-supported initiatives, such as the Canadian Tumour Repository Network (CTRNet), should be considered as future resources for the cohort. It was further recommended by the breakout groups that CIHR may be able to contribute advice on systems issues, such as ethics, privacy, and resources. ICR may also identify gaps in terms of sub-populations, such as aboriginal populations.

Participants were asked to list examples of potential research questions for the cohort. The groups suggested the following:

• Prevention
• Etiology – environment, diet, geographic
• Biomarkers
• Interface with geriatric cohort
• In the short term, less than 10 years, could develop questions on population health status related to cancer
• In the longer term, ICR could sponsor nested case control studies

What would a KT strategy for ICR look like?

Ian Graham, Vice-President, Knowledge Translation, CIHR

The workshop ended with a presentation and discussion on knowledge translation that included an explanation of how KT fits within CIHR’s mandate and the various KT funding opportunities available to researchers. KT is something that researchers traditionally accomplish by publishing their research findings or presenting them at conferences, usually to other researchers. Institute KT activities may include publishing the results of funded research; sharing information with partners and interested knowledge users; and engaging knowledge user when setting Institute priorities. KT can be described as including the following four components:

Knowledge Synthesis

• The contextualization and integration of research findings of individual research studies within the larger body of knowledge on the topic.
• Synthesis is a family of methodologies for determining what is known in a given area or field and what the knowledge gaps are.

Dissemination

• Involves identifying the appropriate audience for the research findings, and tailoring the message and medium to the audience.

Knowledge Exchange

• Refers to the interaction between the knowledge user and the researcher resulting in mutual learning, it encompasses the concept of collaborative or participatory, action-oriented research where researchers and knowledge users work together as partners to conduct research to solve knowledge users’ problems (Integrated KT).

Ethically Sound Application of Knowledge

• The iterative process, by which knowledge is actually considered, put into practice or used to improve health and the health system.
• KT activities must be consistent with ethical principles and norms, social values as well as legal and other regulatory frameworks

Ideally, researchers and knowledge users should work together to shape research questions, interpret the study findings and move the research results into practice. The term “knowledge users” encompasses many groups such as policy/decision makers, research funders, the public, industry, clinicians, the media and other researchers.

Currently, CIHR offers many opportunities for support of KT activities along the trajectory from research to application (see Table 1).

Table 1 – KT Funding Opportunities at CIHR

KT Focus	Funding mechanisms
Synthesis	CIHR funds the Canadian Cochrane Network and Centre Knowledge Synthesis competition Operating grants competition
Integrated KT	Partnerships in Health System Improvement (PHSI) Knowledge Synthesis competition Knowledge to Action competition Strategic research funded through institutes Proof of Principal (POP) Meeting, Planning and Dissemination grants to develop collaborative relationships and grant proposals
End of Grant KT	Allowable expense as part of a grant application Knowledge to Action competition KT Supplement Grants (up to $25,000 for end of grant KT) Proof of Principal (POP) Meeting, Planning and Dissemination grants to disseminate results
Science of KT	Operating grants competition- KT Panel, Strategic calls from the KSE Branch on theories and methods of KT

Tools are currently in development to offer guidance to peer reviewers in assessing KT strategies within an application and a KT case book will be published shortly.

In terms of ICR KT activities, the mid-term international review of CIHR highlighted what was perceived as a lack of ICR support for KT. Although ICR had clearly outlined KT within its original strategic plan in 2002, the Institute had somehow failed to communicate the KT activities that it had in fact undertaken since that time. ICR has particular strength in working with other cancer organizations with a KT mandate (e.g. the Canadian Cancer Society and CPAC) and has supported projects with integrated KT components through the Partnerships for Health Systems Improvements (PHSI) program. ICR was encouraged to include a KT section within a new strategic plan and to promote the CIHR KT funding opportunities to the cancer research community. ICR was also encouraged to take advantage of opportunities and projects currently underway within the CIHR KT branch to assist in developing a KT strategy for the future.

Wrap-up and closing remarks

Heather Bryant thanked Judy Bray for facilitating the planning day, as well as the ICR staff, current and former IAB members and partners. Dr. Bryant was surprised by today’s comments and what ICR has been able to accomplish in the past 7-8 years. ICR now has a better understanding of the cancer research landscape in its aim to improve cancer control. She addressed a few words about tomorrow’s IAB meeting and decisions that will be taken based on today’s strategic planning session.

Meeting was adjourned at 16:00.

Prepared by Judy Bray