Dr. Collins Helps UW-CTRI Optimize Treatments

Dr. Linda Collins
Dr. Linda Collins

Installment five of our series on BREATHE 2 collaborators

Dr. Linda Collins isn’t just an international expert at optimizing healthcare treatments that save lives.

She’s also an expert at the very important task of helping her granddaughter optimize desserts. Together, they make one heck of an ice cream sandwich cake. (Pro tip: layer ice cream sandwiches and chocolate sauce; frost with Cool Whip; freeze, slice, and voila).

One might say that she has taken UW-CTRI research to tasty new levels through her multiphase optimization strategy (MOST). And the partnership with UW-CTRI Research Director Dr. Tim Baker, Director Dr. Michael Fiore and colleagues gave MOST a platform.

“I feel like meeting Mike and Tim was one of the best things that ever happened to me professionally,” Collins said.

She remembers getting an e-mail from them in 2007. Baker and Fiore explained they had wanted better tools to test the variables in their treatments, and experts at the National Institute on Drug Abuse recommended they talk to Collins.

“At that time, MOST was a bit of a concept,” Collins said, “hadn’t really been tried.”
They had lunch at a hotel in Washington, DC, and agreed to collaborate.

“They were the first people willing to take it out for a spin, to do a serious application of MOST,” Collins said. “It was a huge break for what I wanted to do.”

MOST helps researchers to engineer effective treatment packages. Collins helped UW-CTRI implement MOST in the UW-Partnership to Assist Smokers (UW-PASS), funded by a P50 grant from the National Cancer Institute set in healthcare systems. MOST helped illuminate the effects of various intervention components, and how they can best be combined. It emphasized efficiency and careful management of resources to move the intervention science forward steadily and incrementally. MOST helped to guide the evaluation of UW-PASS data.

It was such a success they incorporated what they had learned from MOST into the Breaking Addiction to Tobacco for Health (BREATHE) Study, completing the MOST cycle between the two studies. “It was the first to do so,” Collins said.

They had created an optimized treatment and, like a fresh dessert, it was rewarding.

“It was so great to do the randomized controlled trial of the optimized intervention and have the results be significant,” Collins said.

“We have benefitted enormously because of Linda,” said UW-CTRI Associate Director of Research Dr. Megan Piper. “We do what we do the way we do it because of her methodology.”

In the new P01 center grant known as BREATHE 2, researchers will complete a full cycle of MOST within a single funding period—a first at UW-CTRI. Here’s how:

BREATHE 2 Road Map

  1. Cessation Optimization Trial: The BREATHE 2 Cessation project will implement MOST to identify the most promising treatments to use with primary care patients who smoke and are ready to quit. This project will produce two optimized treatments—one using a combination of nicotine-replacement medications and one with varenicline-based treatments.
  2. Reach Optimization Trial: In the BREATHE 2 Reach project, researchers will contact smokers. They’ll use MOST to help identify an optimized package of interventions that will encourage smokers not willing to quit to engage in evidence-based treatment when they are ready to quit.
  3. Evaluation: Researchers will evaluate these optimized treatment packages from the first two projects in a third BREATHE 2 project as a randomized clinical trial.

In addition, fellow BREATHE 2 Collaborator Dr. Russ Glasgow will use his RE-AIM approach to help BREATHE 2 adjust the treatments and the way they are implemented in primary care clinics in real time while maintaining the integrity of the research, essentially combining RE-AIM with MOST and other tactics to form an all-star group of statistical methods.

Collins has been a force-multiplier, sharing her approach with researchers across the globe on various public health issues. For example, she received a Fulbright Specialist Award and spent three weeks in Ireland, where she gave a workshop at the National University of Ireland Galway and a presentation at the Royal College of Surgeons in Ireland.

Dr. Linda Collins, second from left, presented on MOST at the Royal College of Surgeons in Ireland.
Dr. Linda Collins, second from left, presented on MOST at the Royal College of Surgeons in Ireland.

“That was really great,” she said. “They’re interested in MOST there.” As are the researchers she has trained in places like Norway, England, Netherlands, Germany, and New Zealand. She said it’s common for people to attend her talks and then post on social media, thanking her for revolutionizing the way they think about intervention research with memes of cartoon minds blowing up.

All along, she knew MOST was like a mattress coversheet that can be easily folded—if she created it, it would be something many people could use.

She’s grateful for UW-CTRI’s role in getting it all started. “They took a big risk in partnering because MOST hadn’t been done, and it was possible the review committee would think the ideas were from outer space or would not work,” when actually MOST is based on solid engineering principles.

“You would not believe how many people say to me ‘it won’t get through review’ or ‘it won’t work,’ even now. I’m grateful Mike and Tim had integrity and knew how to run an experiment. They had 80 experimental conditions in the field at one time and did so with very few protocol deviations.”

“Our working with Dr. Collins was a watershed moment for our center,” Baker said. “She introduced us to innovative and powerful ways of developing new and more effective treatments. Her guidance with regard to using these methods was, no doubt, a key determinant in our getting our last several major center grants and making substantial progress in our work. Besides these tangible achievements, working with Dr. Collins brought a new level of intellectual excitement to our work and we benefited repeatedly from her ability to penetrate complex issues, providing us insights and actionable options.”

Collins and UW-CTRI have collaborated on 19 published research papers.

“Linda is brilliant, gracious, and committed to advancing research methodologies,” Piper said. “I have always found her to be very supportive. We co-wrote a chapter in a textbook that focused on how to implement MOST in real-world treatment settings. I have participated in her week-long trainings, sharing our MOST work here at UW-CTRI. I’ve always enjoyed working with her.”

“I want to express great appreciation to Dr. Collins for all her guidance,” Baker said, “and to express my great hope that our partnership continues.”

After years working at Penn State University, Collins is establishing a new hub for application and advancement of intervention optimization in the School of Global Public Health at NYU. “I’m really excited,” she said.

At NYU, she’ll be closer to her home state of Connecticut, where she enjoys vacationing and running the annual Manchester Road Race, which is 4.75 miles. “I’m not fast, but I do finish,” she said.

It revitalizes her for more research and creates room for dessert.

For more on BREATHE 2, click here.