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Department of Family Medicine and Department of Medicine

Division of Palliative Care

Research

Strategic Research Plan

In 2020, the division developed a research strategic plan to recognize previous and ongoing scholarship, and articulate overarching themes of interest that align to its vision and mission going forward. The division’s main overarching theme of research and quality improvement (QI) excellence will be on primary-level palliative care across different settings of care and its relationship with specialist-level palliative care. The goal is to understand the role of primary-level palliative care in creating health system capacity to address all the palliative needs of a community and population in a way that ensures equity of care. The strategy was launched with the initiation of several research studies in 2020 and 2021.

This strategic plan recognizes that research – and its various approaches and methods – is only one part of scholarship. Scholarship also includes education and teaching, quality improvement, and health systems design.

We have four inter-linking research streams that will contribute to this overarching theme:

  1. Primary-level palliative care and the palliative approach across care setting (Major stream)
    • This includes models of care, impact of primary-level palliative care supported by specialist-level palliative care, and factors that enhance or impede it.
  2. A Public Health approach to Palliative Care (Major stream)
    • This includes understanding the concept and study factors that enhance or impede access to palliative care for all citizens and health systems design.
  3. Palliative Care Education
    • Areas include interprofessional learning, learning methods that advance primary-level palliative care across the learning cycle, from undergraduate and postgraduate education to continuing professional learning.
  4. Palliative care for Structurally Vulnerable Populations and Long-Term Care
    • The strategic plan acknowledges the need for flexibility to adapt to changing needs, environments and funding, while still retaining focus and vision. It provides short-term and long-term goals and broad strategies to achieve these.

Dr. Joshua Shadd Pallium Canada Research Hub

The Joshua Shadd Pallium Research Hub, named after Dr. Joshua Shadd, represents a close collaboration between the Division of Palliative Care in the Department of Family Medicine at McMaster University and Pallium Canada, a non-profit foundation founded in 2000.

The Hub was formally established in early 2019 by interim division directors Dr. Denise Marshall and Dr. Anne Boyle on behalf of the division. The foundational work had been laid by Dr. Shadd himself prior to his death in December 2018.

The Hub is an opportunity to undertake scholarship in several areas of mutual interest to the Division of Palliative Care and Pallium Canada. Both, for example, champion the role of primary- or generalist-level palliative care (also known as the palliative care approach) across different settings. Both champion interprofessional learning and collaboration and support a public health approach to palliative care.

Through the Hub, educators and researchers in the division, the Department of Family Medicine, and Pallium Canada are finding opportunities to study various aspects of palliative care including continuing interprofessional education and teaching methods and the spread of the palliative care approach across different settings such as the community, home care, hospitals and long-term care, among others. It also provides opportunities to collaborate with scholars and researchers across Canada and internationally through Pallium’s and the division’s respective networks.

Most recently, the Hub developed a new evaluation and research plan for Pallium Canada’s Learning Essential Approaches to Palliative Care (LEAP) program and its new Canadian Palliative Care ECHO program. It has also undertaken a study to explore the impact of LEAP learning in Long-term care.

Work continues on the Canadian Atlas of Palliative Care (https://www.youtube.com/watch?v=Om0Trf-X9EA) as a graphical (using maps and graphs) and verbal (text) representation and description of the current state of palliative care in a jurisdiction.

Research Team

Christopher Klinger PhD: Division Research Lead

Christopher A. Klinger, PhD is a Research Scientist with Pallium Canada and Assistant Professor (Part-Time) through the Dr. Joshua Shadd – Pallium Canada Research Hub within the Department of Family Medicine, Division of Palliative Care at McMaster University. As a health services researcher, his main interests are mixed-methods health systems and policy research alongside education and training, with a focus on hospice palliative care. He co-chairs the Quality End-of-Life Care Coalition of Canada’s (QELCCC) Research and Knowledge Translation Committee, a group of 35+ national stakeholder organizations dedicated to achieving quality end-of-life care for all residents of Canada.

Ashlinder Gill PhD: Division Research Coordinator

Ashlinder Gill is a Research Coordinator for the Division of Palliative Care, and Department of Family Medicine. She will be facilitating the implementation of projects for our faculty, palliative care residents, and the Dr. Joshua Shadd Pallium Canada Research Hub. Ashlinder has worked in health research since 2010, where her initial interest in palliative care began while completing her undergraduate studies at the University of Waterloo and co-operative education placements with the Palliative Care Consult Team at Sunnybrook Health Sciences Centre. To advance her research training, she completed her graduate studies at the Institute of Health Policy, Management and Evaluation (University of Toronto) and was a trainee with the Health System Performance Research Network. During this time, Ashlinder conducted patient and caregiver interviews as well as focus groups for multiple team grants and ministry-funded projects. The primary aim of these projects were to better understand the challenges experienced by community-dwelling older adults with multimorbidity and how to best deliver primary care services and home care.

Michelle Howard PhD: Division Senior Researcher

Michelle Howard, PhD is an Associate Professor in the Department of Family Medicine. She has an MSc in Epidemiology from the University of Toronto and a PhD in Health Research Methodology from McMaster University. Her research is on helping with communication and decision-making between patients, families and the health care system to plan for serious illness or end of life, and on understanding how primary care and communities can be organized to ensure quality end-of-life care. She is an adjunct scientist with the Institute for Clinical Evaluative Sciences (IC/ES-McMaster) conducting health system research with health administrative data, and an associate member of McMaster Health Research Methods, Evidence and Impact. She is an Associate Editor with the international journal, Family Practice.

Several division members are actively involved, either leading or participating, in various studies at any given time.

We actively seek opportunities for collaborations and partnerships with colleagues in the Department of Family Medicine, other departments and schools in the Faculty of Health Sciences and colleagues of various disciplines outside the Faculty of Health Sciences and the University.

Key Publications

Howard M, Hafid A, Isenberg S, Hsu A, Scott M, Conen K, Webber C, Bronskill S, Downar J, Tanuseputro P. Intensity of outpatient physician care in the last year of life: a population-based descriptive study. CMAJ Open. 2021;9(2):613–22.

Fortin M, Pereira J, Hutchison B, Ramsden VR, Menear M, Snelgrove D. Nurturing a culture of curiosity in family medicine and primary care, The section of researchers’ blueprint 1 (2018-2023). Can Fam Physician. 2021;67:333-8.

Evans JM, Mackinnon M, Pereira J, Earle CC, Gagnon B, Arthurs E, Gradin S, Walton T, Wright F, Buchman S. Building capacity for palliative care delivery in primary care settings. Can Fam Physician. Apr 2021;67(4):270-278.

Brown CRL, Webber C, Seow HY, Howard M, Hsu AT, Isenberg SR, Jiang M, Smith GA, Spruin S, Tanuseputro P. Impact of physician-based palliative care delivery models on health care utilization outcomes: A population-based retrospective cohort study. Palliat Med. 2021 Jun;35(6):1170-1180.

Howard M, Elston D, Vries B, Kaassalainen S, Gutman G, Swinton M, Carter RZ, Sussman T, Barwich D, Urquhart R, Jayaraman D, Munene P, You JJ. Implementing advance care planning tools in practice: A modified world café to elicit barriers and recommendations from potential adopters. Healthc Q. 2021 Apr;24(1):60-68.

Gallagher E, Carter-Ramirez D, Boese K, Winemaker S, MacLennan A, Hansen N, Hafid A, Howard M. Frequency of providing a palliative approach to care in family practice: a chart review and perceptions of healthcare practitioners in Canada. BMC Fam Pract. 2021 Mar 27;22(1):58.

Azad MA, Swinton M, Clarke FJ, Takaoka A, Vanstone M, Woods A, Boyle A, Hoad N, Toledo F, Piticaru J, Cook DJ. Experiences of bereaved family members receiving commemorative paintings: A qualitative study. JAMA Netw Open. 2020 Dec 1;3(12):e2027259

Pereira J, Arya A, Downar J, Rice P, MacDonald S, Osborne E, Kanji S, Sauls R. Shortages of palliative care medications in Canada during the COVID-19 pandemic: Gambling with suffering. Healthc Q. 2021 Jan;23(4):17-22.

Howard M, Robinson, C, McKenzie M, Fyles G, Hanvey L, Barwich D, Bernard C, Elston D, Tan A, Yeung L, Heyland DK. Effect of ‘Speak Up’ educational tools to engage patients in advance care planning in outpatient healthcare settings: a prospective before-after study. Patient Educ Counc. Nov 2020; S0738-3991(20):30652-2.

Guerriere D, Husain A, Marshall D, Zagorski B, Kennedy J, Coyte PC. Transitions in labour force participation over the palliative care trajectory. Healthc Policy. 2020 Nov;16(2):25-40.

Tedesco A, Shanks L, Dosani N. The good wishes project: An end-of-life intervention for individuals experiencing homelessness. Palliat Med Rep. 2020 Nov 18;1(1):264-269.

Arora S, Shaikh S, Karachi T, Vanniyasingam T, Centofanti J, Piquette D, Meade M, Boyle A, Woods A, Downar J, Cook D. End-of-life skills and professionalism for critical care residents in training: The ESPRIT Survey. J Intensive Care Med. 2020 Sep 10:885066620946316.

Lawlor PG, McNamara-Kilian MT, MacDonald AR, Momoli F, Tierney S, Lacaze-Masmonteil N, Dasgupta M, Agar M, Pereira JL, Currow DC, Bush SH. Melatonin to prevent delirium in patients with advanced cancer: a double blind, parallel, randomized, controlled, feasibility trial. BMC Palliat Care. 2020 Oct 21;19(1):163.

Patel T, Christy K, Grierson L, Shadd J, Farag A, O’Toole D, Lawson J, Vanstone M. Clinician responses to legal requests for hastened death: a systematic review and meta-synthesis of qualitative research. BMJ Support Palliat Care. 2021 Mar;11(1):59-67.

Perri M, Dosani N, Hwang SW. COVID-19 and people experiencing homelessness: challenges and mitigation strategies. CMAJ. 2020 Jun 29;192(26):E716-E719.

Pfaff KA, Dolovich L, Howard M, Sattler D, Zwarenstein M, Marshall D. Unpacking ‘the cloud’: a framework for implementing public health approaches to palliative care. Health Promot Int. 2020 Feb 1;35(1):160-170.