The healthcare system is undergoing a paradigm shift toward person- and family-centred care. While this is a critical priority, it will be challenging to put into practice. One strategy to implement this change is shared decision-making (SDM), a process that supports patients and providers to discuss the risks and benefits of options, clarify preferences, and make choices based on their informed values. Knowledge translation and implementation science (KT/IS) are key approaches for accelerating this system change.
To advance the science of implementing evidence into policy and practice, I will implement and assess evidence-based SDM tools in routine primary care, focusing on maternal health.
Key objectives include to:
- Investigate factors contributing to successful implementation of SDM tools in routine care,
- Adapt, implement, and assess health care professional training to support uptake of SDM,
- Investigate how documentary film can work as a method of knowledge translation to support patients’ informed choices, and
- Evaluate partnerships between researchers and policy makers to catalyze the implementation of SDM.
This research will be used to advance person- and family-centred care in maternal health and in primary care more broadly.
Primary care includes the day-to-day services provided by family doctors, nurse practitioners, and other health care providers. High quality primary care that follows patients over time and coordinates specialist and hospital care is key to an effective and efficient health care system. Unfortunately, many Canadians struggle to get primary care where and when they need it, despite there being more family doctors per person than ever before.
My research program seeks to answer the following questions:
- How can we make sure we have the right number of health care providers to meet the needs of Canadians now and in the future?
- How can we efficiently organize delivery of primary care to meet the needs of patients? How do we improve access to effective care for underserved groups, including people managing both mental and physical health conditions and recent immigrants and refugees?
I analyse routinely collected data from health care delivery and look at the impact of policy changes using statistical models. I work in partnership with researchers who have complementary skills collecting information through interviews and focus groups. My research teams include patients, care providers, and people who plan health services. This helps make sure we ask questions that matter and that research results will help change our health care system.
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer related deaths mostly due to the absence of symptoms as the cancer develops. This leads to diagnosis after the tumor has already become widely invasive and cannot be surgically removed. Unfortunately, surgical removal of early stage tumors is the most effective treatment option and other treatments, such as chemotherapy, are woefully ineffective.
Thus, there are two major fronts where research could improve the outcomes of pancreatic cancer patients:
- early detection and
- more effective treatments. Early detection requires knowledge of the events associated with tumor development, while improving treatments requires a thorough understanding of pancreatic cancer. It is clear that a 'one-size-fits-all' strategy has largely been ineffective for pancreatic cancer. We hypothesize that this is partly because PDAC is a 'catch-all' diagnosis for tumors that look the same, but may have different properties due to differences during their development. Our research program seeks to identify these differences and ultimately leverage the differences to improve patient outcomes through the development of personalized treatments.
Personal identity–one's psychological sense of personal continuity–is an important aspect of mental health, informing one's motivations, behaviours, and social relations. Disruptions in identity can contribute to prevalent conditions such as personality disorders. Indeed, distorted identity is a core aspect of personality dysfunction and disorder, contributing to considerable negative health and social outcomes–and a prominent challenge for health care providers and systems. Interventions that strengthen identity during young adulthood may be a potent way to mitigate personality dysfunction, preventing entrenched impairment and setting a course for positive mental health.
This proposal features a novel psychosocial intervention aimed at strengthening identity and reducing personality-related dysfunction among vulnerable young adults–tested in a randomized controlled trial. The intervention is designed for use by non-specialists to maximize transferability and impact on access and quality of care. Building on the applicant's work in maladaptive personality and identity, the project is set within a broader program of research on identity-focused intervention, including within early psychosis and recovery from alcohol misuse.
Anemia is a condition in which there is a decrease or destruction of red blood cells causing inadequate transport of oxygen throughout the body. It is a major public health problem affecting ~25% of the global population, or ~9 million Canadians of all ages.
In infants and children, anemia can impair brain development and decrease learning ability. In adults, it can cause fatigue, lower work capacity and increase the risk of adverse pregnancy outcomes (e.g. low birthweight). Causes of anemia can include micronutrient deficiencies (e.g. iron or folic acid), infection and disease, and genetic hemoglobin disorders (e.g. thalassemia). Understanding the causes of anemia is critical to inform appropriate strategies to prevent and treat anemia, and to reduce the risk and burden of disease.
Dr. Karakochuk's research program will seek to improve diagnostic methods and investigate novel biomarkers for anemia and iron deficiency, and assess the risk-benefit of iron and folic acid supplementation programs designed to treat anemia and other chronic diseases. The ultimate goals are to reduce the burden of anemia and to inform safe and effective nutrition policy, programs and interventions for individuals and populations in Canada and globally.
Mental health and substance use (MHSU) challenges are leading health issues facing youth globally. In Canada, 20% of the youth population experiences mental health disorders, and youth aged 15-24 have the highest rates of past year substance use and related harms. To address these concerns, MHSU researchers and advocates argue for a population health approach incorporating promotion, prevention, and treatment within a 'healthy public policy' framework. Yet while much research has focused on the prevention and treatment of youths' MHSU challenges, there has been limited focus on mental health promotion.
Further, while there is growing recognition of the importance of engaging youth in matters that affect their lives, there is a paucity of evidence-based guidance on how to do this effectively. This study contributes to addressing these substantial gaps by exploring how to meaningfully engage youth in the policymaking process to promote MHSU outcomes. Participatory approaches and mixed methods are being used to generate knowledge and inform a framework to guide youth-engaged research and action to better tackle the MHSU needs of Canadian youth.
Infectious diseases remain a serious and constant threat despite the high standards of sanitation and health care enjoyed by the British Columbians. Moreover, British Columbians, living in a major port of entry to Canada, face an increased risk of contact with emerging infectious diseases as exemplified by SARS. An effective disease surveillance system requires multiple health organizations to work together and share information with each other. Advances in genomic technology have improved the detection and characterization of disease-causing microbes and provide public health practitioners a better surveillance tool. Yet, genomic data is voluminous and complex, creating a challenge for our health care system and practitioners. Moreover, contextual data needed to interpret genomic data often contain sensitive and private information making sharing of contextual data across jurisdictions a challenge.
Dr. Hsiao's research program builds innovative technology solutions to improve organizational efficiency, trust, and capacity of BC's public health surveillance network. Our work will stop the spread of diseases, reduce the overall disease burden and health care cost, and ultimately improve the health and well-being of British Columbians.
This program of research will seek to understand how youth and young adults (YYA) with mental health (MH) disorders make decisions about seeking MH services at YYA centres such as Foundry BC. Foundry BC provides health and wellness services to YYAs through integrated service care in communities across BC. Nearly 75% of MH disorders develop before the age of 25, yet less than 20 percent of Canadian YYAs receive appropriate treatment. This can cause serious problems such as relapse, rehospitalisation, increased suicide risk, and can interrupt critical identity development. Currently, there is little to no research that understands how Canadian YYAs making decision about accessing and staying engaged MH services.
This program of research will work closely with Foundry BC to:
- To develop a theoretical framework of service use decision-making and engagement among Canadian YYAs living with MH disorders using mixed-method approaches; and
- Explore barriers that marginalized YYAs with MH disorders face when accessing digital information using mixed method approaches. Ultimately, this research will lead to the development of a YYA MH service use lab in BC that uses mixed-method approaches and an innovative decision-making framework to develop interventions to increase service use among this vulnerable group in BC. This research will work closely with YYAs and parent knowledge users as part of the research team, and mentor highly qualified students to become MH leaders.
One million Canadian women are affected by endometriosis annually. There is little investment in research, and socioeconomic cost, >$4 billion annually in Canada, continue to climb owing to lost productivity, sick days, treatments for frequent pain, infertility and depression. Most critically, affected women may have up to a 10-fold increased risk of developing specific types of ovarian cancer. There are no biological features that predict if endometriosis will result in severe or chronic pain, infertility, or cancer.
In 2017, my work identified cancer mutations in the DNA of endometriosis, a feature seen only in cancer.
Since then, I have established a research program with two goals:
- to examine association between specific mutations and types of endometriosis.
- to understand how other biological features, such as the immune-system, may be affected by mutations and contribute to the establishment of endometriosis, and progression to cancer. Cancer mutations are present in all types of endometriosis, including those with no risk of cancer. Additional work is needed to understand how these mutations influence the biology and symptoms of both endometriosis and their associated cancers, as well as establish management strategies.
Metastasis, which is the spread of cancer cells from a primary tumor to other areas in the body, remains the main cause of cancer related death. Awareness of the clinical importance of metastasis and our basic scientific understanding of the metastatic process has improved substantially over the past few decades. However, many aspects of metastasis are still not well defined and our ability to identify patients at high risk for cancer spread is limited. In addition, cancer treatments are not metastatic-specific, so despite aggressive treatments many patients still progress to a metastatic disease state. Dr. Williams' research aims to address these issues by identifying aggressive disease early and uncovering key regulators of metastasis for inhibitor development.
Cancer cells are constantly shedding small fragments, which can be readily detected in the blood. This project will develop a test that analyzes these fragments, identifying cancer patients and determining the aggressive nature of their disease. It also aims to uncover how cancer cells move and grow within the body by forming tiny 'feet-like' structures called invadopodia. Understanding their role in cancer progression will shed light on how cancer cells move and grow within the body, validating them as targets for metastatic inhibitor development. Overall, this research program will make powerful strides towards ending metastasis, the most significant cause of cancer mortality.
