Indicators of harmful use of non-prescribed addictive substances—reflected in healthcare visits, hospitalizations, and deaths—are rising in Canada, signaling an urgent crisis. Addressing this issue requires a focus on identifying and supporting demographic groups that are disproportionately impacted. One notably vulnerable group is individuals with psychosis, who show alarmingly high rates of substance use disorders (SUD). Substance use relapse in this population is associated with increased hospitalization, incarceration, and a heightened risk of early death due to opioid overdoses, suicide, or infectious and cardiovascular diseases. However, individuals with SUD and psychotic illnesses are often excluded from clinical research, resulting in a lack of evidence to guide best practices for prescribing antipsychotics, SUD treatments, and other psychotropic medications. This project aims to develop guidance by analyzing real-world clinical evaluations, diagnostic data, and prescribing patterns and linking them to outcomes such as substance use relapse, medication side-effects, and healthcare utilization using electronic medical records along post-discharge data from two provincial centers in BC.
Program: Health Professional-Investigator
The role of acquired brain injury in amplifying dementia risk through modifiable factors
Acquired brain injuries (ABIs) like traumatic brain injury or stroke can cause long-term issues with thinking, mood, and daily life. They also increase dementia risk, but we still do not fully understand how or how best to prevent it. This research fills that gap by exploring how ABIs worsen known dementia risks (e.g., high blood pressure, depression, inactivity) and by studying blood markers of early brain damage and inflammation.
I will use large Canadian health studies to track how ABIs affect dementia risk over time and identify unique risk factors. We will also follow people recovering from a recent ABI, measuring these biomarkers and lifestyle factors to learn how they speed—or slow—brain changes linked to dementia.
I will share our findings through plain-language briefs, workshops, and online resources with healthcare providers, policymakers, and people living with ABIs. Ultimately, this project will guide new prevention strategies and create a clinical decision-support tool to help doctors spot those at highest risk. Tailored interventions based on these results could lower dementia rates and improve long-term care for ABI survivors.
BC Familial Pancreatic Cancer Program-Improving access to germline testing at time of diagnosis
Hereditary factors are identified in 10-15% of patients with pancreatic ductal adenocarcinoma (PDAC). Of the estimated 800 new diagnoses of pancreatic cancer in BC each year, only 20% are referred for a consultation to the provincial hereditary cancer program (HCP). Mainstream testing holds promise for personalized oncologic care and may reduce the significant variability in testing rates based on patient geography and ethnicity.
We will conduct surveys to gain understanding of why providers choose not to refer patients or offer mainstream testing. We will provide targeted training to provider and patients on the benefits and uses of genetic testing. We will compare new pathology diagnoses to testing rates over the study period and explore novel care delivery pathways, including a direct patient contact model that informs patients about test availability.
This research program will foster greater collaborations with health care providers and increase knowledge and use of genetic testing in BC. We envision through this research program, a provincial framework/registry for genetic assessment of PDAC at point of diagnosis.
Understanding and Overcoming Disparity in Care of Breast Cancer Patients in Rural British Columbia
Patients living in rural BC face geographical inequalities in cancer care delivery and research. We have recently demonstrated a worse breast cancer survival for patients in rural BC. A gap exists in understanding, from patients and the health care system, the disparities in the care of breast cancer patients in rural BC.
The plan is to establish a research and training program with collaborative research in partnership with patients, health care practitioners, research scientists and program leaders involved in cancer care in the North. The program will involve patient informed research methodologies and prospective clinical trials. The plan is to also work collaboratively with the Indigenous breast cancer population in rural BC to develop a respectful and integrated holistic treatment strategy. KT activities will include patient education forums, CME events and updates to the BC Cancer policies.
Anticipated outcome include involvement of breast cancer trainees in the program. Novel and effective models of cancer survivorship care. Increased enrollment of rural patients into clinical research and trials. The impact would be a systemic approach to improve equitable delivery of BrCa care leading to improved outcomes in rural BC.
Developing equity-centered language with First Nations, Inuit, and Métis peoples to reduce anti-Indigenous discrimination in healthcare
Anti-Indigenous discrimination and racism are pervasive in healthcare across BC. One contributing factor is the language that is used to describe First Nations, Inuit, and Métis (FNIM) peoples. Language is powerful, and the words we read, hear, and use can change the way we think and behave. Unfortunately, many of these words about FNIM peoples are negatively biased. With continued exposure to this negative language, particularly in the published health literature, healthcare providers can develop negative feelings and thoughts about FNIM peoples, which can lead to biased action, and ultimately culturally unsafe care. Our goal is to develop equity-centered language to reduce anti-Indigenous racism in healthcare. In collaboration from the outset with FNIM researchers, healthcare providers, patients, caregivers, and community members, we will use Indigenous research methods to co-develop tools that provide specific and concrete guidance to identify and prevent the use of negative, deficit-based language, while providing and promoting positive language, starting with cancer care. Adapting how we communicate in healthcare and research will bring us one step closer to culturally safe care for FNIM peoples in BC and nation-wide.
Administrative-based case-finding algorithms to evaluate health inequities: a methodological framework and an application in progressive pulmonary fibrosis
The ability to study disease at the population level is required to understand the causes for delays in diagnosing a disease. Administrative data are collected when patients have an encounter with the healthcare system and are commonly used to identify individuals with disease. However, there is no way to specifically identify patients whose disease is getting worse over time and would benefit the most from treatment. My proposed research program will create a framework to develop algorithms that identify patients with worsening disease using administrative data. My research will start with people who have progressive pulmonary fibrosis (lung scarring conditions) and then extend to other common lung diseases. Using these algorithms to identify people with progressive lung diseases, I will then study health inequities that prevent people from receiving treatment. I will use these findings to inform health system and policy changes by working with patients, researchers, clinicians, and policymakers.
Preventing the Next Fracture: Expanding Access to Fracture Liaison Services across British Columbia
Broken bones (fractures) occurring in older adults after minor injury are a frequent result of osteoporosis and can negatively affect quality of life, independence and even result in death. One fracture often leads to more fractures. Treatment can prevent future fractures but less than 20% of Canadians receive these treatments after a fracture. Our research aims for all older adults in British Columbia (BC) to receive prevention treatments after a fracture. Research shows that Fracture Liaison Services (FLS) is the best way to achieve this aim. In FLS, a health provider educates patients and starts prevention treatments while the orthopedic team cares for the fracture. Our research answered: How to develop FLS in BC and adapt it in different situations? What policies ensure everyone can benefit, recognizing factors such as language, culture, geography and gender? We developed and tested FLS at one BC hospital and then spread this successful FLS model to two new hospitals. We are now studying how to spread FLS in BC. Our goal is to ensure that older adults have equal access to FLS to reduce repeat fractures, to improve quality of life and maintain independence and decrease related health costs.
Co-designing the implementation of an injury prevention program in girls community soccer
Sport has many physical and mental health benefits. But it is also the leading cause of injury in Canadian youth. Soccer is one of the most popular sports for girls, but 1 in 20 will suffer a serious injury every year. These injuries reduce quality of life, lower physical activity levels, and can have long-term impacts. For example, half of girls who have a knee injury will develop osteoarthritis, a painful, disabling joint disease with no cure. Convincing research shows that injury prevention programs can prevent two-thirds of injuries. Yet, in the real-world regular use of these programs by teams is low. This is partly due to a lack of sustainability planning and input from relevant stakeholders. This project will first address these issues in design and then will test an injury prevention program. We will involve soccer players, coaches, physiotherapists, and administration in all research. First, we will combine and consider research findings and learnings from world experts. Second, we will understand stakeholder needs and settings. Third, we will co-design a plan to implement and sustain the program in the long-term. Last, we will test if the program is feasible and acceptable for sustained use in community girls soccer.
Seeking Rural Equity by Increasing Rural Engagement in Clinical Trials: An East Kootenay Clinical Research Program
Clinical trials play a key role in medical advances, helping to identify new treatments or improved ways to treat illnesses. Clinical trials generate information that can guide treatment decisions. By participating in clinical trials, individuals may have access to new treatment options for serious conditions. However, when clinical trials do not include people from rural areas, the knowledge generated may not be useful in rural settings. This program of research aims to help people in rural communities in the East Kootenay area have access to clinical trials. Partnerships with universities, major urban hospitals, and researchers across Canada (the Accelerating Clinical Trials Canada Consortium) will help East Kootenay Regional Hospital to build a program of research for people living in rural communities. This will enable people in the East Kootenay region to participate in certain clinical trials. Successes and lessons learned from this program will help other rural areas to build their own clinical research capacity with the goal of making clinical research in Canada more inclusive of rural populations.
The Better Outcomes for the Sickest & Tiniest (BOOST) Program – Rigorous clinical trials in babies born extremely preterm to improve patient and family important clinical outcomes
In Canada, many babies are born early, at less than full term of pregnancy (40 weeks). Some of them, about 900 a year including 80-95 here in BC, are born very, very early (<26 weeks) and have a high chance of dying or having serious brain injury. These babies are cared for in a neonatal intensive care unit (NICU), where critical medical decisions are often based on research that has not included newborns who are as small and fragile like them and rarely asks families what actually matters to them. Our BOOST (Better Outcomes for the Sickest & Tiniest) program will do studies called clinical trials to find better ways to help these babies. We will test treatments that vary widely across Canadian NICUs (for example, use of a medicine called indomethacin given intravenously immediately after birth). These treatments may lower the risk of two things parents say are important: severe bleeding in the baby’s brain and death. Our research will put the new evidence in the context of values and preferences of families of diverse backgrounds and I will work with national groups in Canada to update the current evidence and develop medical guidelines that improves care of these tiny babies.