In 2021, the Canadian Government expanded access to medical assistance in dying (MAiD) to persons whose death is not reasonably foreseeable (Track-2 MAiD) with the introduction of Bill C-7. Island Health has consistently had the highest yearly provisions of MAiD in Canada since its legalization in 2016. However, the number of Island Health physicians and nurse practitioners willing to assess and provide Track-2 MAiD is low. Recent media reports and public discussions about Track-2 MAiD have increased the spread of misinformation and mistrust. Our overall goal is to improve experiences with and access to Track-2 MAiD for patients and their families, and to support clinicians assessing and providing this service. To achieve this goal, we will establish a network that consists of patient-partners, multidisciplinary clinicians, researchers, and trainees. Using a transparent, collaborative approach to share knowledge and identify gaps, we will seek to minimize mistrust towards Track-2 MAiD and inform meaningful developments and safeguards in clinical practice. The activities proposed will also help build a research program and the capacity for further meaningful changes that support safe access to and experiences with Track-2 MAiD.
Research Location: Vancouver Island University
A translational research network to study and improve the clinical care of brain injury in intimate partner violence (IPV) on Vancouver Island
IPV is a serious societal and medical challenge worldwide that has severe impacts on the lives of survivors. In Canada, >40 percent of women over the age of 15 who have been in an intimate partner relationship (~6.2 million women) have experienced IPV. The prevalence of IPV is particularly high in the Nanaimo and Duncan regions of Vancouver Island. Among many challenges faced by IPV survivors, the physical assaults often result in brain injuries that have short- and long-term consequences. Brain injury occurs in the vast majority of IPV survivors, yet the nature, identification, and treatment of this brain damage has been remarkably understudied. Consequently, care pathways to improve patient outcomes are extremely limited. To address this issue, the proposed activities will bring together a diverse and balanced group of scientists, clinical practitioners, trainees, patients, and community leaders on Vancouver Island, as well as other national and international experts on the topic. Specifically, the primary goal of this application is to apply a patient-oriented approach to identify key knowledge gaps and establish a research network capable of investigating these issues and translating the findings into meaningful clinical outcomes.
Team members: Aimee Falkenberg (Island Health); Kix Citton (Nanaimo Brain Injury Association); Uta Sbotofrankenstein (BC SUPPORT); Jodie Gawryluk (University of Victoria); Paul Van Donkelaar (UBC – Okanagan); Karen Mason (Supporting Survivors of Abuse and Brain Injury through Research); Taylor Snowden (University of Victoria); Justin Brand (Vancouver Island University); Naz Saadat (University of Victoria); Jackie Demmy (Island Health; nursing students; Vancouver Island University); Janet Hildebrand (Island Health); Sasha Dallaire (Island Health); Coral Taylor (Island Health); Janet Calnan (Island Health); Charlotte Breakey (Island Health); Carrie Esopenko (Icahn School of Medicine Mount Sinai); Cheryl Wellington (UBC); Stuart McDonald (Monash University); Josh Allen (Vancouver Island University).
Foot-Ankle Stability (FASt) solutions for lifelong mobility
“You need to improve your stability” is one of the most common pieces of advice offered by clinicians after an individual experiences a fall resulting in an injury. Despite this common advice, researchers are still trying to determine how to best keep a person stable as they age. Recent work has shown that foot and ankle structures may play a critical role in maintaining stability, but how this is accomplished varies from person to person, and may change as people age. In the game “Jenga”, players are required to remove blocks from within the stack and place them on the top of the structure; the blocks at the bottom are more difficult to remove than those closer to the top, as smaller movements at the base can cause the structure to collapse. Feet and ankles are much the same: If there are foot and ankle issues, the lack of stability at a person’s base can create small movement that ultimately contribute to a fall. My research will help researchers and clinicians fundamentally understand the importance of the foot and ankle to movements that are important for mobility (e.g. walking) and use this knowledge to create digital health solutions and assistive technologies aimed at maintaining mobility throughout the lifecycle.
Biomarkers and interventions for mild traumatic brain injury and intimate partner violence
Mild traumatic brain injury (mTBI; e.g. concussion) results in a range of symptoms that disrupt daily life, and many mTBI patients go on to suffer persistent post-concussion symptoms (PPCS) that last for months to years. There are no reliable biomarkers for mTBI and PPCS, or interventions known to improve recovery.
This project will therefore assess the use of blood biomarkers as diagnostic and prognostic methods for mTBI and PPCS, and also investigate whether exercise intervention early after mTBI improves recovery. This project will also examine a grossly understudied cause of brain injury — intimate partner violence (IPV). Despite evidence of mTBI in approximately 90 percent of IPV survivors, the nature of this brain damage and how it contributes to their lived experience is poorly understood. Therefore, another goal of this project is to investigate the neurological health and a range biomarkers reflective of brain injury in women with a history of IPV.
In partnership with knowledge users (e.g. clinicians, nurses, patients, scientists), the findings from this project will facilitate the development of evidence-based interventions, education programs, and changes in practice and policy that improve the care of those who have suffered mTBIs.
A patient-oriented mental health recovery effort: Working across sectors to alleviate suffering related to burnout, post-traumatic stress disorder, or treatment resistant depression
The mental health of healthcare providers is understudied and inadequately supported, especially given the current pandemic. Workplace stress can lead to burnout, Post-Traumatic Stress Disorder (PTSD), and Treatment Resistant Depression (TRD), which affects morale, absenteeism, retention, and patient care. The focus of this application is to address PTSD and TRD with a combination therapy involving Roots to Thrive (RTT) Communities of Practice (CoP) with Ketamine-Assisted Psychotherapy (KAP). The RTT CoP have documented enhanced efficacy for resilience, mental wellness and cognition. Ketamine is described as the single most important advancement in the treatment of depression in over 50 years.
My program of research innovatively examines the synergy of these two interventions, an evidence-based treatment known as RTT CoP-KAP. My research aims to lead the development and implementation of a more inclusive mental health model that continues to prescribe connection to self, spirit, and community as the primary healing modality, and further supporting with medicine-assisted healing modalities (beginning with ketamine and then expanding to include MDMA).
Developing a curriculum that promotes self-compassion among healthcare providers
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Healthcare workers experience high rates of stress leave and attrition due to unaddressed mental health needs. While some providers leave the workplace because of burnout, many stay, which compounds the issue and contributes to toxic workplaces and higher patient mortality rates.
New research shows that self-compassion — defined as unconditional positive regard turned inward — is a significant contributor to healthy communities of practice, and promotes the ability to manage workplace stressors (Dames, 2018). The project team will:
- Co-develop an evidence-based curriculum and tools that will inform and improve practice by promoting self-compassion among healthcare providers within Island Health and Vancouver Island University.
- Build capacity for knowledge translation and future research to study curriculum outcomes.
The curriculum will help providers develop an ability to learn of, articulate, and digest emotions in a safe environment of unconditional positive regard for self. When providers lack self-compassion, they are at a higher risk of mental and physical ailments, emotional exhaustion, and burnout. Rather than turning to substances/activities that lead to dissociation or avoidance, this curriculum will enable participants to cultivate a habit of self-soothing by nurturing themselves with loving kindness.
At the end of the Reach award, the research team will have completed a literature review, curriculum, and submitted a grant application to fund a pilot study on Vancouver Island. The curriculum is expected to improve stress resilience among providers, decrease the use of substances to cope with stress or distress, reduce attrition rates due to burnout, and promote relationally healthy communities of practice (CoP, defined by Wenger as a “group of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly”). The proposed curriculum will enhance the mental health and well-being of providers; instilling self-compassion in providers is shown to improve experience and outcomes for patients. Those who direct compassion inwardly naturally extend compassion to others.
This Reach award will cover the costs of bringing stakeholders together to develop the curriculum and to draft an application for the pilot study. This project's potential impact on patient and provider outcomes is enormous and well aligned with health authority and provincial priorities.