Movement and young minds: Co-designing and integrating physical activity programming into health services for young people experiencing mental health and substance use challenges

In Canada, mental health and substance use (MHSU) disorders affect 25 percent of young people aged 12 to 24 years. Foundry is an organization in British Columbia (BC) made up of a number of centres across the province that offer a variety of services to young people with MHSU disorders. A service not yet offered is physical activity, which can be used to manage mental and physical health. An ideal time to help people develop healthy habits, including being physically active, is while they are still teenagers or young adults.

This study will explore how physical activity programming can be included as a service offered through Foundry centres. This will be done by using photographs to understand youth needs; development of a working group to consider how to add a service; and, co-creation of a physical activity program. This work will be done collaboratively with diverse youth, service providers, and researchers. The long-term goal is to improve the quality of care, and the health of young people with MHSU disorders living in BC, Canada and across the world.

Informing the future of primary care: Virtual care, workforce optimization and the learning health system

Primary care is the foundation of strong health systems, ensuring people stay healthy and get care when needed. However, timely access to high-quality primary care is an ongoing problem in British Columbia and other provinces.

My program of research aims to ensure that all British Columbians can access quality primary care how and when they need it. The central project I lead uses information from interviews with health professionals (physicians, nurse practitioners and nurses) and patients; data from the health system; and provincial policy documents to study access to, experiences with, and outcomes from virtual primary care. Complementary research will inform modernization of the primary care workforce and informing ideal deployment of providers in team-based models in the context of COVID-19 and beyond. Finally, I lead work about implementation of “learning health systems” to support continuous improvement and innovation in primary care and across the health system more broadly.

My work follows an integrated knowledge translation model; I work with a team of researchers, policy makers, clinicians and patient partners to co-produce knowledge and address important and relevant questions that are driven by their combined input.

Transforming adolescent and young adult cancer care in BC in partnership with patients and cancer care allies

In Canada, approximately 7,600 adolescents and young adults (AYAs) aged 15 to 39 are diagnosed with cancer each year, representing 4 percent of annual cancer diagnoses. Currently, cancer care systems have limited capacity to meet the complex needs of AYAs and survival outcomes for AYAs are often worse when compared to children and adults over 40.

This research program will use the principles of participatory action research (PAR) and patient-oriented research (POR) to meaningfully engage AYAs and cancer care allies (healthcare professionals, decision makers, researchers, and community organizations) to better understand AYA cancer care and explore how cancer care systems can respond to the unique, complex needs of AYAs with cancer. Led by a researcher with lived experience of cancer as an AYA and 15 years of experience conducting PAR, the work seeks to inform AYA cancer care research, policy, and practice in BC and beyond. Initial research funding from the Vancouver Foundation, MSFHR, and British Academy is in place, as are collaborators from Royal Roads University, BC Cancer, BC Ministry of Health, Young Adult Cancer Canada, the BC SUPPORT Unit, Callanish Society, InspireHealth, Innovation Support Unit, and AYAs with cancer.

Promoting workplace psychological health and safety of the nursing workforce in the long-term care sector

Every week, at least 500,000 Canadian employees are unable to work due to poor mental health, costing employers upwards of $6 billion in lost productivity. In healthcare, poor employee mental health leads to patient suffering and death and severe rates of staff absenteeism and turnover. Nurses, who constitute the largest human resource in healthcare, experience a disproportionately high rate of depression and posttraumatic stress disorder, and these conditions severely impact patient outcomes. COVID-19 has exacerbated the already numerous workplace risk factors that nurses face, with especially damaging impacts in the long-term care sector (LTC).

COVID-19 has had a devastating impact on workplace psychological health and safety for nurses across healthcare contexts, and especially in LTC. My research responds to this urgent need to improve the quality and safety of resident care provision by improving the workplace conditions for nurses in LTC, driving better systems and patient outcomes. I will work with new and existing partners to identify, implement, and evaluate best practices and policies in this sector. This research will have vast implications for scholarship, policy, and the success of healthcare ecosystems in Canada.

Critical Illness Survivorship: Evidence to Design Patient-Centred Interventions

Over 80% of patients who are treated in the intensive care unit (ICU) for a life-threatening illness face reduced physical health, emotional wellbeing and quality of life. Up to half of patients discharged from the ICU are readmitted to hospital within a year with complex medical conditions. This is a tremendous cost of cure for survivors and their family caregivers. Services for patients with complex medical conditions and/or frail patients is a BC Health System Priority.

This research aims to identify patient- and family-perspectives for designing healthcare services that meet their needs. The primary study will involve interviewing ICU patient survivors, their family members and healthcare providers to map the causes of hospital readmission.

These results will inform the design of services to reduce hospital readmissions. The results of these studies will be shared with national and international researchers and clinicians to benefit patients across Canada.

Adding Quality Years to Later Life via Innovative Health Economics Research Methods

My career goal is to improve the health and quality of life of older Canadians through applying innovative health economic methods to lifestyle interventions among older adults at risk of falls as well as cognitive and functional decline. I propose a multi-disciplinary research program that advances health economic methods for clinical research studies.

Theme 1 of my research program will advance health economic evaluation methodology by answering the question: “Can artificial intelligence combat current methods limitations of economic evaluation?”

Theme 2 will utilize patient outcomes assessed by patients to explore how patient perspectives may optimize adherence to lifestyle interventions to promote quality of life and maintenance of functional dependence. Hence, I plan to advance methods for clinically applied economic evaluation and explore the utility of patient reported outcome measures to efficiently improve health related quality of life.

These methods advancements will provide a new prototypes useful for

  1. clinical trials with concurrent economic evaluations and
  2. patient reported outcome measures that promote adherence and resultantly, health related quality of life — ultimately helping older adults “age in place”.

Optimizing post-procedural pain trajectories through patient-oriented research and artificial intelligence

Our goal is to use smartphones and artificial intelligence to improve pain management for children having surgery. This is needed because many children still have a lot of pain even a year after surgery. The pain affects their daily life, and might cause them to return to hospital. A child’s pain is affected by many things, like their biological sex, anxiety, coping skills, pain level, and type of surgery. Importantly, some of these can be altered.

We will collect data to identify patterns that predict which children

  1. do well after surgery, so we can learn from them or
  2. do not do well/have significant pain, so we can help sooner or even prevent it. We will involve families and children having surgery now, to collect data for a pain risk score to help future children.

We will design a tool to share pain risk data with families and doctors and test these tools in children coming to hospital for spine, tonsil or dental surgery. We hope that using these tools (pain prediction models) will improve the child’s individual care. Identifying children at high pain risk will allow us to intervene before their surgery. This will lead to quicker recovery, less time in hospital, and less chance of addiction to painkillers (opioids).

A Spatial Approach to Exploring Vulnerability in the Context of COVID-19 in British Columbia

Maps are an excellent way of simply communicating complex ideas. We will create maps that use sophisticated analysis techniques and draw on multiple information sources. Our maps will tell decision-makers where in BC they should focus COVID-19 mitigation efforts and other interventions. Drawing on population and location factors, our maps will show where in BC people are vulnerable to developing COVID-19 infections, where people are vulnerable to experiencing challenges to accessing ICU care for complex COVID-19 cases, and where people are vulnerable to experiencing health-related secondary impacts of the pandemic. We will work with officials to identify ways to improve our maps and integrate new evidence. Will also make maps they request to support their decision-making.

Costs and benefits of tumour testing to improve cancer prevention and survival

Women who inherit a BRCA gene mutation are at high risk for breast cancer and the most lethal type of ovarian cancer, high-grade serous ovarian carcinoma (HGSC).

A woman diagnosed with HGSC has a 20% chance of unknowingly carrying a BRCA mutation, and is eligible for genetic testing. Getting a blood sample to do genetic testing in this woman is critical, because if she is found to have a BRCA mutation: 1) her relatives (daughters, sisters) can be tested, and HGSC can be PREVENTED in them, and 2) she herself can be treated with PARP inhibitors that can improve survival.

The problem, however, is that the yield of genetic testing is low, and only 30% of women with HGSC undergo such genetic testing. This excludes 70% from effective treatment and leaves their family members at high risk. How can BRCA mutations be better identified?

One strategy is to begin with testing the HGSC tumour itself. If the tumour has a BRCA mutation, PARP inhibitor treatment can be given. These women can then be targeted for genetic testing, and 2/3 of them will have an inherited BRCA mutation. This improves the efficiency of genetic testing, rather than referring everyone with HGSC.

Tumour testing of HGSC is not routinely done in BC. Hence, I propose to conduct a pilot study of tumour testing for BRCA mutations in HGSC, and a cost-effectiveness analysis of its impact on ovarian cancer survival and future cancer prevention, to justify this testing in this patient population. 

Out-of-hospital-cardiac arrest: Care gaps and opportunities to improve long-term survival

Out-of-hospital-cardiac arrest (OHCA) affects 40,000 Canadians per year. Cardiac arrest is the sudden loss of heart beating, and can occur in people with or without known heart disease. In British Columbia (BC), only 15% of these patients live (50% die before hospital, 35% die in hospital), less than 50% receive bystander cardiopulmonary resuscitation, and only 3% receive bystander automatic external defibrillation. Due to a lack of connected data, little is known about the effect of treatments on long term survival, brain function and quality of life after leaving hospital.

We are closing this knowledge gap by having recently developed a new provincial database linking BC Ambulance records with hospital charts, prescription data, and post-discharge nursing home and home care information. This is the first database of its kind in North America and includes information for over 16,000 OHCA patients. We can now evaluate the complete 'journey' of each patient from 9-1-1 call, to hospital treatments, to survival and functional status long after discharge. We can now determine if current treatments affect length of survival, brain function, and quality of life, and within this framework, eventually test whether new strategies improve patient outcomes.