Implementation to Impact (i2i)

Investigators: A/Prof Natalie Taylor (UNSW), Prof David Thomas (UNSW), AO Conjoint A/Prof Katherine Tucker (POWH), Dr Mandy Ballinger (UNSW), Dr Milita Zaheed (POWH), Dr Frank Lin (Garvan), Prof David Goldstein (POWH), Dr April Morrow (UNSW), Ms Kathryn Leaney (Cancer Voices NSW), Ms Magaret Gough (Consumer), A/Prof Bonny Parkinson (Macquarie University), Prof Phyllis Butow (University of Sydney), Prof Sandy Middleton (Australian Catholic University).

Funder: Medical Research Future Fund - Rapid Applied Research Translation Initiative
Funding Period: 2022-2027

Scientific advances continue to revolutionise our understanding of cancer biology, and optimise the way phase 1 and 2 oncology trials are conducted, significantly enriching basic research (T0), translation to humans (T1), and initial translation to patients through clinical trials (T2). However, many innovations become stuck at T2, and struggle to penetrate T3 – “translation to practice” – at scale (T4), generating masses of research waste and missed opportunities for patients – particularly those with hard-to-treat cancers, to engage with potentially lifesaving therapies or risk prevention strategies, due to lack of system support.  

Propelling precision medicine into routine cancer care through scalable research-led clinical models can address this bottleneck, by a) strategically matching the "right patient" to the "right trial/treatment", b) harmonising research and clinical care priorities and practices across Australian healthcare contexts, and c) using clinical informatics – i.e., capturing data at the clinical encounter and using those data to embed and support knowledge generation processes for rapid adoption of research and continuous care improvement. Recognising the magnitude of this problem, in partnership with the Prince of Wales Hospital Sydney (POWH), we have launch a precision medicine clinic to drive integration of research into routine healthcare. This will be the first of its kind in Australia, and a prototype for the integration of precision oncology into clinical programs generally. 

Investigators: A/Prof Natalie Taylor (UNSW), Dr Jacobus Ungerer (Pathology Queensland), Prof Claire Wakefield (UNSW), Dr Denis Bauer  (CSIRO), Dr Bennett Shum (UNSW), Dr Bonny Parkinson (Macquarie University), Dr Carolyn Mazariego (UNSW), Prof Gerald Watts (University of Western Australia), Amy Peterson (University of Wisconsin-Madison), Ms Brittany McGill (UNSW), Dr Varinder Jeet (Macquarie University), A/Prof Timothy Dobbins (UNSW), Dr Jing Pang (University of Western Australia).

Funder:  Medical Research Future Fund (MRFF) Clinical Trials Activity Initiative 
Funding Period: 2023-2026

Every year thousands of Australians suffer unnecessary death or disability from treatable genetic conditions because effective screening is unavailable. Newborn Bloodspot Screening (NBS) of pre-symptomatic infants for treatable genetic conditions is highly effective in reducing death and disability and is one of the top ten public health innovations of the 21st century. Despite recent advances in whole genome and whole exome sequencing, research on these methods suggest clinical, technical, cost, and ethical barriers to their use in expanding NBS. To address these challenges, our team developed, and validated a targeted, adaptive genomic sequencing test for NBS expansion (TAG-NBS), which has been accredited by the National Association of Testing Authorities, Australia for newborn screening. The test sequences a selection of genes, currently 53, for genetic variations that cause treatable genetic conditions. The number of genes in the test can be increased over time, providing a platform for ongoing NBS expansion.

We bring together an internationally recognised, multi-state, multidisciplinary team of experts in translational genomics, newborn screening, clinical genetics, data science, health economics, health policy, clinical psychology, and implementation science, alongside consumer representatives (e.g., Rare Voices Australia), to introduce TAGNBS to the clinical setting. Through a world first clinical effectiveness-implementation trial, our goal is to embed this technology for the early diagnosis of treatable genetic diseases in Australian NBS programs to improve health outcomes.

Investigators: Prof David Goldstein (UNSW), A/Prof Susanna Park (University of Sydney), Dr April Morrow (UNSW), A/Prof Peter Grimison (Chris O'Brien Lifehouse), Prof F Boyle (University of Sydney), Dr Tracy King (University of Sydney), Prof Bogda Koczwara (Flinders University), Dr Carole Harris (UNSW), Louisa Robinson, Philip Mendoza-Jones (UNSW), Dr David Mizrahi (University of Sydney), A/Prof William Huynh (Brain and Mind Research), Prof Matthew Kiernan (University of Sydney), A/Prof Natalie Taylor (UNSW) (AI)

Funder: MRFF - 2023 Clinician Researchers: Applied Research

Funding Period: 2024-2028

Chemotherapy-induced nerve damage or peripheral neuropathy (CIPN) is a key toxicity of chemotherapy treatment, producing sensory dysfunction, functional disability, falls risk and reduced quality of life. Although CIPN affects up to 70% of patients treated with neurotoxic chemotherapy, there remains no effective prevention or treatment. Over the past 15 years, we have built a successful translational research program to improve the assessment and management of CIPN. This has culminated in the development of a clinical pathway to guide best practice in CIPN assessment and management, guided by a multidisciplinary and clinician-led research team. This project will provide the necessary evidence base to improve effectiveness of health services and health care outcomes for patients by designing strategies to evaluate the benefits of the clinical pathway and to understanding how best to introduce it into practice, via a process mapping and implementation study of the pathway and its accompanying enhanced screening program. The project will examine the feasibility of implementation in a real-world setting from clinician and patient perspectives and the impact on patient outcomes, to evaluate our implementation framework. Our translational research team includes researchers, clinicians, patient-advocates, implementation scientists and policymakers to address key barriers to optimize translation.

Investigators: Dr Erin Turbitt (University of Technology Sydney), Prof David Amor (Murdoch Children's Research Institute), Ms Elizabeth Callinan (University of Technology Sydney), Prof Elise van den Hoven (University of Technology Sydney), Prof Bronwyn Hemsley (University of Technology Sydney), Dr Elizabeth Palmer (UNSW), A/Prof Alison McEwen (University of Technology Sydney), Dr April Morrow (UNSW), A/Prof Helen Heussler (University of Queensland), A/Prof Natalie Taylor (UNSW) (AI)

Funder: MRFF 2023 Consumer Led
Funding Period: 2024-2026

Neurodevelopmental conditions impact the brain and become evident during childhood. These conditions variably affect cognition and behaviour and may lead to intellectual disability and autism. With the wider use of genetic testing, the diagnosis of neurodevelopmental conditions with a genetic basis is expected to increase. Parents often experience fear and uncertainty when a child is diagnosed. Emotional distress can be exacerbated by the medicalised prognosis, focusing on a child’s deficits, from doctors and online resources. We aim to facilitate a “strengths-based” approach that emphasises a child’s existing qualities and strengths, and their positive possibilities for the future.

To accomplish this, we will create “NurtureNextGen” a consumer-led, evidence-based digital tool. Its primary goal is to enhance health self-efficacy and improve quality of life for the whole family. This can best be achieved through a balanced perspective that embraces strengths, acknowledges complexity and fosters agency. The aim is to support families at the stage of genetic diagnosis, while also empowering them by nurturing realistic hopes and expectations.

To develop the tool, we will hold workshops and use arts-and design-based research methods to iteratively codesign NurtureNextGen in partnership with two cohorts of consumers: parents of children with genetic neurodevelopmental conditions and paediatric specialists. We will explore implementation and feasibility through an implementation science approach. Our multidisciplinary team of consumers and academics has the expertise to create and deliver this intervention that will make a meaningful difference to the lives of children and their families. Key outcomes will be: (1) a digital tool, NurtureNextGen; (2) an implementation plan; and (3) new knowledge about strength-based approaches to genetic neurodevelopmental conditions.

Investigators: Dr Ursula Sansom-Daly (UNSW), Dr Kate Hetherington (UNSW), Dr Joanna Fardell (UNSW), A/Prof Natalie Taylor (UNSW), A/Prof Reema Harrison (Macquarie University), Prof David Ziegler (UNSW), A/Prof Anthony Herbert (Queensland University of Technology), Dr Natalie Bradford (Queensland University of Technology), A/Prof Antoinette Anazodo (Sydney Children's Hospital), Dr Lori Wiener, Dr Abby Rosenberg (Dana-Farber Cancer Institute), Joseph Thomas (University of Technology Sydney), Dr Jessica Ryan (Children's Hospital at Westmead, Jenny Hynson (Royal Children's Hospital Melbourne), Dr Ruwanthie Fernando (Liverpool Hospital)

Funder: MRFF 2023 MRFF Clinician Researchers - Applied Research in Health
Funding Period: 2024-2028

The new ‘precision era’ of cancer medicine, with its rapid expansion of novel therapies, has meant that people with previously incurable cancers can live for years with unpredictable prognosis and quality of life. In 2023, precision therapies are now available for all young Australians with cancer. Evidence shows that patient-centred palliative care (PC) ensures young people (<30 years) receive care aligned with their wishes, that maximises quality of life, and improves clinical outcomes (eg, less pain/suffering), particularly when integrated early alongside active cancer treatments. Contrary to being all about death, PC enables young people to live their best lives, for as long as possible. Yet PC is not routinely integrated early for young cancer patients, including in early-phase clinical trials. No studies have tested a model of care (MoC), inclusive of evidence-based interventions, to guide healthprofessionals as to when and how PC should be integrated along the cancer care trajectory. Our team has shown that Australian health-professionals feel under-equipped to facilitate PC communication with young people with cancer. We have identified key timepoints along the care trajectory when PC is needed, and codesigned evidence-based communication tools that – applied at scale – will support health-professionals to integrate early, best-practice PC for young cancer patients in this MoC. In partnership with health-system stakeholders, will test and embed a MoC of early patient-centred PC integration, supported by our communication tools. We will validate (in a Delphi study), adapt (via local multidisciplinary workshops) and test (in a feasibility stepped-wedge trial) our MoC. This study will develop the evidence base to implement our MoC, which offers systems efficiencies through more and earlier PC interventions concurrent to active cancer treatments, that improves patient/family quality of life, and reduces distress of the healthprofessionals who care for them.

Investigators: Prof Paul James (Peter MacCallum Cancer Centre), Ms Mary-Anne Young (Garvan Institute of Medical Research), Dr Tatiane Yanes (University of Queensland), Prof Georgia Chenevix-Trench (Council of the Queensland Institute of Medical Research), Prof Stephen Fox (Peter MacCallum Cancer Centre), A/Prof Natalie Taylor (UNSW), Dr Victoria Jackson (Walter and Eliza Hall Institute of Medical Research), Helen Mar Fan (Genetic Health Queensland), Dr James Blackburn (Garvan Institute of Medical Research), Dr Amanda Willis (Garvan Institute of Medical Research), A/Prof IIias Goranitis (University of Melbourne), Ms Bronwyn Terrill (Australian Genomics), Dr Mia McLanders (Metro North Hospital and Health Service), Prof Melissa Southey (Monash University)

Funder: Genomics Health Futures Mission – 2022 MRFF Genomics Health Futures Mission
Funding Period: 2024-2027

Polygenic scores (PGS) describe a large component of the distribution of risk for common cancers in the population. Some, including colorectal, breast, ovarian and prostate cancers, have been validated in large cohorts making them ready for translational studies. This project builds on the investigators decade of experience with cancer PGS to perform a comprehensive trial of introducing PGS alongside existing genetic testing for cancer predisposition in the Australian healthcare system.

The first stage of the trial will leverage GSA array data for 16,000 Australians to deliver optimal solutions too remaining barriers to implementation, including: a clinical grade imputation pathway, an accurate non-categorised adjustment for genetic ancestry, and a technical benchmarking of whole genome versus array genotyping approaches. The outcomes of these tasks will be consolidated into non-specialist applications for use in general diagnostic labs. The team will prepare the clinics through: structured guideline development to align PGS-personalised risk with existing risk assessment and management guidelines, developing and evaluating a clinical training program for clinicians ordering the PGS-based testing (Task 6), generating a model of community and consumer expectations for the use of polygenic data. High-quality standard data on the clinical and psychosocial outcomes of current panel genetic testing for cancer predisposition will be collected (1000 controls).

In the second stage of the trial multi-cancer PGS will be combined with personal risk factors to provide a comprehensive risk assessment for the intervention cohort of 1000 individuals and the impact on the assessed risks, uptake of risk management strategies and psychosocial outcomes compared to the control data. The data from all tasks will be used to evaluate the effectiveness of the program in an Implementation Research framework.

Investigators: Prof Jackie Curtis (UNSW), Prof David Castle (University of Toronto), A/Prof Simon Rosenbaum (UNSW), Prof Philip Ward (UNSW), A/Prof Grant Sara (University of Sydney), A/Prof Natalie Taylor (UNSW), Prof Mark Harris (UNSW), Dr Scott Teasdale (UNSW), Dr Peri O'Shea (UNSW), Prof Kim Delbaere (NeuRA).

Funder: NHMRC TCR Improving Physical Health of People with a Mental Illness
Funding Period: 2024-2028

People living with Severe Mental Illness (SMI) die up to 20 years earlier than other Australians. This gap is widening despite health policies, clinical guidelines and some attempts to modify modes of service delivery. This project aims to better understand and address personal and system barriers to engaging with evidence-based physical health clinical interventions for Australians with SMI. It will develop innovative models of care that partner peer workers with nurse practitioners embedded in mental health services with outreach to GPs. This project aims to address barriers in integrating with primary care and other services to support long-term consumer participation and motivation. Using evidence-based interventions the project will work with consumers to develop individualised physical health assessment and care plans. We will deploy a customised digital mHealth application for self-monitoring and self-management and will use co-production, including consumers, carers, peer workers, clinicians, health service managers and researchers to develop and test solutions for metropolitan, regional and rural settings in two Australian states. Scalability and sustainability will be achieved by identifying core requirements for each setting and using cost-effective electronic self-monitoring tools. The project will: i) identify barriers to access physical health supports and maintain long-term health-enhancing behaviours, ii) co-produce individualised models of care through participatory design, iii) use type 1 effectiveness-implementation hybrid design to test and evaluate impact and implementation of the intervention, iv) allow development of models of care for national adoption. Leveraging current evidence this project will deliver cost-effective empowerment-based interventions shifting the paradigm on how to improve physical health challenges experienced by Australians living with SMI.

Investigators: Prof Elgene Lim (Garvan Institute of Medical Research), Dr Jeremy Mo (Garvan Institute of Medical Research), Katherine Saw (Garvan Institute of Medical Research), Dr Carolyn Mazariego (UNSW), Dr Minh Tranh (UNSW), A/Prof Jo River (University of Technology Sydney), A/Prof Ann Dadich (Western Sydney University), Peta Brydon (St Vincent's Hospital Sydney), Dr Emma-Kate Carson (Campbelltown Hospital), Dr Rachel Dear (St Vincent's Hospital Sydney), Dr Oksana Zdanska (St Vincent's Hospital Sydney).

Funder: Pfizer Research Grant
Funding Period: 2024

The Eva clinical trials navigator aims to improve healthoutcomes by improving patient awareness of clinical trials,increasing patient enrolment, facilitating informed decision-making, enhancing engagement, providing ongoing support,and generating valuable data for research and healthcareadvancements.

This co-design project focuses on supporting equity in accessand outcomes of care. It aims to improve equity in clinical trials participation forconsumers by addressing barriers and enhancing experiences of patients and clinicians. This project involves developing a clinical trials navigator tool, a digitally enabled model-of-care.

Investigators: Prof Jason Grebley (UNSW), Prof Greg Dore (UNSW), Prof Andrew Lloyd (UNSW), Dr Susan Matthews (Flinders University), Dr Melanie Kingsland (University of Newcastle), A/Prof Natalie Taylor (UNSW), Dr Alison Marshall (UNSW), Dr Sophy Shih (UNSW), Dr Richard Gray (UNSW), Dr Evan Cunningham (UNSW), Prof Carla Treloar (UNSW), Dr Lise Lafferty (UNSW), Dr Louise Causer (UNSW), Mr Charles Henderson (NUAA), A/Prof Philip Cunningham (UNSW).

Funder: MRFF Rapid Applied Research Translation
Funding Period: 2024-2028

Progress towards hepatitis C virus (HCV) elimination is impeded by low testing/treatment due to the current diagnostic pathway requiring multiple visits leading to loss to follow-up. We evaluated new point-of-care HCV tests enabling same-visit testing/treatment to improve treatment uptake and developed a national program for test implementation. The next step is delivering them at scale. Implementation science methods will be used to understand barriers/facilitators for implementing point-of-care testing and develop strategies for rapid translation into practice. We will evaluate the effectiveness, cost-effectiveness, epidemiological impact, and acceptability of models to enhance and scale-up point-of-care HCV testing in community/prison.

Investigators: A/Prof Ju Lee Oei (University of Sydney), Dr Mark Tracy (University of Sydney), Prof Jane Pillo (University of Western Australia), Prof Dominic Fitzgerald (Sydney CHildren's Hospitals Network), Prof Alistair McEwan (University of Sydney), Dr Sankalp Khanna (CSIRO), Robert Halliday (Children's Hospital at Westmead), Kylie Pussell (Miracle Babies Foundation), A/Prof Donna Hartz (University of Newcastle), Dr Himanshu Popat (University of Sydney), Dr Evelyn Lee (Macquarie University), A/Prof Shannon Simpson (Telethon Kids Institute), Dr Andrew Wilson (Perth Children's Hospital), Dr Carolyn Mazariego (UNSW).

Funder: 2021 MRFF Chronic Respiratory Conditions
Funding Period: 2023-2027

Every year, more than 1000 Australian infants are diagnosed with Bronchopulmonary dysplasia (BPD), the most common and debilitating complication of prematurity. They are at risk of hypoxemia for months. Hypoxemic spells cause serious organ injury, even death and are mostly clinically undetectable until a crisis occurs. In the NICU, oxygenation is monitored and treated vigilantly based on 24 hour pulse oximetry but this is not possible at home. Current Australian guidance cannot recommend oximetry for infants at risk of hypoxia at home because there is no data to inform on best use.

We propose a 4 year randomised clinical trial with wearable oximetry embedded in a digital care pathway that was extensively used in the COVID pandemic for adults, to improve oxygen management and health in BPD.

Our primary outcome is hospitalisation within 1 year. We aim to decrease hospitalization from 55% (rate now) to 35%. Secondary outcomes are feasibility, acceptability and compliance to care plans. Intervention infants will have oximetry at home with notifications sent via phone app to adjust oxygen or present for medical evaluation by telehealth/with a clinician. Oximetry data will be sent by bluetooth to the app, then the cloud to a clinician for intervention. 224 infants (112 per arm) will be randomised to intervention or usual care from every Australian state and territory. Algorithms will be developed by CSIRO to predict and prevent acute hypoxemic crises.

Expected outputs that will inform on future research and practice will include the first evidence of high level oximetery data post hospital discharge, development of consumer led guidance for home care of preterm infants, and scaling up for use in other infants at risk of hypoxemia e.g. heart and neuromuscular diseases.

Investigators: Dr Marianne Gale (SELSHD), A/Prof Patrick Bolton (SELSHD), Dr Ryan Courtney (UNSW), Prof Nick Lintzeris (SELSHD), Kathryn Thorburn (UNSW), Prof Anthony Shakeshaft (UNSW), A/Prof Jackie Curtis (Mindgardens), A/Prof Natalie Taylor (UNSW), A/Prof Freddy Sitas (UNSW), Prof Phil Ward (SWSLHD), Nicola Kerr (MNCsws), Melinda Ricketts (MNCLHD), Dr Hamish Fibbins (Mindgardens), Tim Croff (SELSHD), A/Prof Ju Lee Oei (Royal Hospital Women), Dr Anh Dam Tran (UNSW), Dr Stella Settumba Stolk (UNSW), A/Prof Ben Kwan (SELSHD), Myna Hua (SELSHD), Dr Catherine Spooner (UNSW), Amy Murray (SELSHD)

Funder: NSW Health Translational Research Grants Scheme
Funding Period: 2022-2024

Tobacco smoking is a leading cause of death and illness. This project implements and evaluates a program to support smokers in hospital to stop. It aims to increase the rate at which health workers offer smoking cessation strategies to smokers admitted to hospital. These strategies include nicotine replacement therapy and a phone-based app. We will measure the rate at which staff offer these techniques to smokers, and the number who stop smoking as a result. We will also talk to staff, and to patients from disadvantaged groups, about how they found participating in this intervention and how it might be improved. We will use this information to improve the interventions and argue for their widespread use.

Investigators: Dr Eleonora Feletto (University of Sydney), A/Prof Natalie Taylor (UNSW), Prof Karen Canfell (University of Sydney), Dr Jie-Bin Lew (University of Sydney), Prof Lyndal Trevena (University of Sydney), Prof Sarah Durkin (Cancer Council Victoria), Dr Emily He (University of Sydney), Dr Belinda Goodwin (Cancer Council Queensland), Prof Mark Jenkins (University of Melbourne), Prof Jane Young (University of Sydney).

Funder: NHMRC Targeted Call for Research - Participation in Cancer Screening Programs
Funding Period: 2022-2025

The Mobilising the National Bowel Cancer Screening Program through combining individual, health service, and population level interventions (MAIL, GP, and SCALE) project will design and evaluate innovative approaches to increasing participation in the National Bowel Cancer Screening Program (NBCSP). The NBCSP has now been fully rolled out but national participation remains at <45%. Research shows that the NBCSP has the potential to save 84,000 lives by 2040 if participation could reach and be sustained at 60%. The project will explore the application of proven evidence-based interventions in Australia, particularly for under-screened or inappropriately screened people. Primary care, especially through general practitioners (GPs), play a critical role in advocating for cancer screening. The project will leverage our experience, growing knowledge and stakeholder consultation to design and evaluate an innovative primary care based “advocate” intervention alongside a planned mass-media campaign and emerging interventions to determine the optimal combination of interventions to increase NBCSP participation.

Investigators: Prof David Ziegler (Children's Cancer Institute), A/Prof Paul Ekert (Children's Cancer Institute), Prof Maria Kavallaris (UNSW), Prof Tracey O’Brien (Cancer Institute NSW), A/Prof Mark Cowley (Children's Cancer Institute), Prof Claire Wakefield (UNSW), A/Prof Natalie Taylor (UNSW), Sarah-Jane Dawon, A/Prof Orazio Vittorio (Children's Cancer Institute), R Davies.

Funder: Cancer Institute NSW Translational Program Grants
Funding Period: 2020-2025

Implementing novel therapeutic strategies for childhood brain cancer patients - Brain cancers represent the second most common childhood cancer and the leading cause of disease-related death in childhood. Standard treatments utilise 40-year-old cytotoxics and radiation therapy, resulting in devastating late effects.1 Many brain tumours still have no effective treatments, such as Diffuse Intrinsic Pontine Gliomas (DIPG) - the most common childhood high grade glioma (HGG). Due to their location within the brainstem they cannot be removed surgically, and until recently could not even be biopsied. They represent one the most aggressive of all cancers, with no active systemic therapies, and almost all children dying within twelve months.

Our team are national leaders in childhood brain cancer research. The Brain Tumour Group at CCI is the largest Australian program dedicated to developing new treatments for childhood brain cancer. We have made ground-breaking progress in targeted agents, nano-medicine, liquid biopsies, and immunotherapy that are ripe for clinical translation. With our expertise in translational and implementation research we will bring these discoveries to the clinic. Our team has developed the internationally recognised Zero Childhood Cancer (ZCC) paediatric precision medicine program that has enrolled >300 children nationally, 40% with malignant brain tumours. ZCC provides in-depth, personalised tumour analysis rivalling the most advanced programs globally. The genomic analyses, in vitro drug screening and in vivo personalised xenograft (PDX) brain tumour models provide a unique opportunity to accelerate discoveries to clinical application.

Investigators: Prof Claire Wakefield (UNSW), Dr Jordana McLoone (UNSW), Dr Christina Signorelli (UNSW), Prof Richard Cohn (SCH), Dr Thomas Walwyn (PCH), A/Prof Natalie Taylor (UNSW), Ms Karen Johnston (SCH), Dr Elysia Thornton-Benko, Prof Stewart Kellie (CHW), Dr Kate Webber (Monash Health)

Funder: MRFF Brain Cancer Survivorship Grant
Funding Period: 2020-2023

Almost all childhood brain cancer survivors have health problems after they finish cancer treatment. Unfortunately, most Australian survivors are not receiving the care they need to manage these problems. We developed the Re-engage program to help childhood brain cancer survivors improve their confidence to manage their health and to improve their quality of life. Re-engage offers survivors two telehealth nurse consults and careful case review by an expert team. Our nurses create a care package for survivors which includes a summary of their care needs, a letter for their GP, referrals to specialists and education about healthy lifestyles. This trial will test the impact of Re-engage and will help us to roll-out Re-engage across Australia