The Surviving Opioid Overdose with Naloxone Education and Resuscitation (SOON-ER) Trial

THE SURVIVING OPIOID OVERDOSE WITH NALOXONE EDUCATION AND RESUSCITATION (SOON-ER) TRIAL: THE CO-DESIGN OF A TOOLKIT FOR OPIATE OVERDOSE CULMINATING IN A RANDOMIZED STUDY OF AN OPIOD OVERDOSE EDUCATION AND NALOXONE DISTRIBUTION INTERVENTION FOR LAYPEOPLE IN AMBULATORY AND INPATIENT SETTINGS

The SOON-ER project aims to generate an evidence-based Overdose Education and Naloxone Distribution (OEND) toolkit, to be offered in clinical settings, that allows for brief patient training with a new nasal naloxone delivery service. The SOON-ER project includes simulation testing to determine if offering OEND programs in clinical settings can improve bystander resuscitative performance in overdose situations. It will measure the effect of a brief OEND training on overdose knowledge and attitudes in patients at risk for opioid overdose.

The ultimate goal of this ongoing project is to transform care for the thousands of Canadians affected by opiod overdose and to integrate overdose prevention into routine clinical practice in Canada.

Overdose from opioids such as oxycodone, fentanyl, and heroin are now responsible for over 100,000 deaths per year worldwide. Overdoses in Ontario result in more years of life lost than HIV, pneumonia, or influenza.

Overdose education and naloxone distribution (OEND) could be an effective method of combatting the overdose epidemic. Typically, OEND programs are offered in non-clinical settings, such as community harm reduction centers, and involve lengthy patient training. Consequently they do not reach many patients at risk of overdose. 

Having OEND in clinical settings (such as hospitals and emergency departments) could increase the number of at-risk patients reached by OEND programs.The SOON-ER project seeks to compare the efficacy of OEND programs in clinical vs. non-clinical settings to maximize the impact of OEND in emergency departments, family practices, inpatient settings, and opiod substitution clinics by creating a toolkit for overdose first aid by lay responders.

OCAD University led the design phase of the SOON-ER project, addressing the need for an integrated design approach to the opiate crisis. The design process included extensive community and stakeholder engagement in iterative workshops over 9 months. The result was the development of an ultra-brief first aid training animation and the creation of a toolkit with nasal naloxone, for lay response to overdose. Key aspects of the design process addressed the context of overdose, stigma, and marginalisation. 

To test the effectiveness of the new system, SOON-ER will recruit patients at risk of opioid overdose in the emergency department, family practices, opioid substitution clinics and inpatient settings. These patients will be trained using the new toolkit or were referred to a conventional community OEND program. The success of patient responses to opioid overdose situations will be evaluated and compared in simulated overdose situations.

Project results from SOON-ER will be disseminated in Canada and abroad.

For more information, please visit http://www.soonerproject.org/ and http://stmichaelshospitalresearch.ca/research-programs/rescu/our-research/sooner/

Creator: 
Photograph of Narcan nasal spray
Friday, April 13, 2018 - 11:00am
Lab Member: 
Kate Sellen

Synthesis Maps | Gigamaps | The CanIMPACT Project

Strategic Innovation Lab has developed a repertoire of systems mapping methods and outputs to help understand and guide complex service design, social system design, and knowledge translation for complex systems research. Synthesis maps  are typically designed as communicative artifacts that translate multiple knowledge perspectives about social systems to illustrate the dilemmas and challenges within a complex system scenario. Synthesis maps are particularly effective in representing multi-level social systems such as are common in healthcare – indicating an outer boundary (e.g., national or provincial system), the service networks, agencies and specialized providers within a care context, for example.

The Gigamap technique was developed by Birger Sevaldson of the Oslo School of Architecture and Design, who sLab has collaborated with since 2011 in the development of systemic design methods and the RSD conference series. This process develops a strong architectural and descriptive approach to complex projects, which is pursued through studio work using a research through design (RTD) process

Gigamaps and synthesis maps look very similar as finished products. However they differ in their developmental processes. Both are rich images that visualize complex system problems, and both are used as design artifacts in similar domains (from health to public policy, from service experiences to social change). Both are used with stakeholders for advising, planning, and designing for social and systemic challenges (wicked problems).

  • Gigamaps are more "direct engagement in the relations of a system." Gigamaps employ a research through design (RTD) practice of engaging directly with a system problem and following the contours of the complexity as expressed in a design space.
  • Synthesis maps evolved from the SFI pedagogy necessary to train students in systems thinking and to learn both system formalisms and systemic design for complex multistakeholder problems. Synthesis maps are typically designed as communicative artifacts that translate multiple knowledge perspectives about social systems to illustrate the dilemmas and challenges within a complex system scenario.

The SFI maps have been developed in half-term courses guided by design-led field research and extensive secondary source references to build descriptive system maps as a mapping of territory for systemic design of the social systems of concern. sLab also develops a core systems theory or methodology within the SFI maps as a means of pattern and leverage. Because the process sLab teaches is developed more as a synthesis of evidence and is informed by theory, their process is better considered as a Synthesis Map.

The typical synthesis map process requires a small team of graduate research assistants trained in the method, directed by a faculty advisor in a collaborative design process. Working through a series of drafts on paper and electronic modes, the team starts with a preliminary map, often sketched using graphic recording and rough free skecthes, followed by an integration of core concepts. Iterative refinements are made with sponsors/stakeholders to interactively integrate their insights and proposals with the design team's system maps. The move toward final synthesis and visualization progresses through studio workshops and team design and critique. 

The CanIMPACT Project (Canadian Team to Improve Community-Based Cancer Care Along the Continuum) is a multidisciplinary pan-Canadian program studying how to improve cancer care to patients in the primary care setting. Funded by the Canadian Institutes of Health Research for 5 years (2013–2018, Grant no. 128272) the project was led by Dr. Eva Grunfeld, Director of Research at U Toronto's Dept of Family and Community Medicine.  For the CanIMPACT synthesis map project, the sLab team (Jones, Smriti Shakdher, Prateeksha Singh) prepared two synthesis maps to reflect the discovered insights from the multi-year investigation: a clinical system map and a patient-centred map informed by the CanIMPACT Patient Advisory Council. The resulting maps were published (a first for a system map method) in Current Oncology and presented at the first Canadian Partnership Against Cancer (CPAC) conference, and MedicineX 2017.

The CanIMPACT Project included:

  • A domain and literature review: A scoping review of the CanIMPACT study and its references was conducted. Continuous searches informed emergent questions for representing mapping decisions.
  • Expert interviews and content analysis, with Visual Notetaking: The CanIMPACT qualitative study, the Casebook survey of cancer initiatives, and administrative data substudy reports were analyzed, guided by interviews with study area leads.
  • Knowledge Synthesis to design Maps in stages: In collaborative sessions, maps were hand-sketched to represent salient findings drawn from content analyses.
  • Peer critique of electronic and print Maps: Structured critiques of the maps were held with the CanIMPACT and PAC experts at key stages of map development.
  • Iterative Map Design: The clinical map was developed first, in stages that adhered to the method. The necessity for a patient-centred map was discovered during the peer critique step.

This project exemplifies well how the synthesis mapping approach can lead to high-quality representations of insights from complex research, how deeply deliberated discourses within a clinical or social research team can be articulated as systemic models, and how new knowledge production can be further developed toward strategic design outcomes such as program strategies and policy interventions. 

For further information on synthesis mapping and the CanIMPACT Project, please visit http://slab.ocadu.ca/project/synthesis-maps-gigamaps.

Creator: 
CanImpact Synthesis Map: Patient Experience of Primary Care in the Cancer Continuum A Relationship-Centred View of Breast and Co
CanImpact Synthesis Map: Canadian Clinical System of Primary Care in the Cancer Continuum
Monday, October 23, 2017 - 2:15pm
Lab Member: 
Peter Jones