Research projects

Our team specializes in training healthcare professionals by helping them developing the skills that will allow them to promote patient participation in decision making.

Ongoing projects

  • Improving the quality of life of older adults living with neurodegenerative diseases by studying the scaling up of tools supporting care transitions within French-speaking communities in Canada

    Program: Team Grant: Canadian Consortium on Neurodegeneration in Aging (CCNA) – Phase III: Research Teams

    Funding Organization: Canadian Institutes of Health Research

    Funding Type: Grant

    Lead Institution: Université Laval

     

    2025-04-01 to 2029-03-31

  • Co-construction of an Intersectional Approach to Improve the Decision-Making of Migrant Women from Ethnic and Racialized Minorities in the Pre- and Postnatal Care Pathway in Quebec (CoDecide)

    Program: Project Grant

    Granting Organization: Canadian Institutes of Health Research

    Funding Type: Grant

    Lead Institution: Université Laval

    Principal Researcher

     

    2025-07-01 to 2028-06-30

  • PriCARE Integration - Case management in primary healthcare for people with complex healthcare needs to improve integrated care: a large-scale implementation study

    Program: Implementation Science Team Grants — Rethinking Health through Integrated Care (RSSI)

    Funding Organization: Canadian Institutes of Health Research

    Funding Type: Grant

    Lead Institution: Université de Sherbrooke

     

    2023-04-01 to 2028-03-31

  • Scaling Up Shared Decision Making in the Health System: Role and Contribution of Public Policy Leaders

    Program: Strategic Research Development Fund

    Funding Organization: CIUSSS - CN - VITAM Sustainable Health Research Center

    Funding Type: Grant

    Lead Institution: Université Laval

    Principal Researcher

     

    2025-02-12 to 2026-03-31

  • Evolving SSA Mapping

    Program: Patient-Oriented Research Strategy (SPOR) Support Units

    Funding Organization: Canadian Institutes of Health Research

    Funding Type: Grant

    Lead Institution: Université Laval

    Principal Researcher

     

    2024-06-25 to 2025-12-31

  • Scaling Up the Peer Support Model

    Program: Patient-Oriented Research Strategy (SPOR) Support Units

    Funding Organization: Canadian Institutes of Health Research

    Funding Type: Grant

    Lead Institution: Université Laval

    Principal Researcher

     

    2024-10-01 to 2025-12-31

  • Factors Influencing the Completion Rate of Online Training Activities

    Funding Organization: Quebec Federation of Medical Specialists

    Funding Type: Grant

    Lead Institution: Université Laval

    Principal Investigator

     

    2024-11-01 to 2025-12-31

  • Scaling Up Shared Decision Making for Patient-Centered Care : Foundation Grant.

    Canadian Institutes of Health Research (CIHR)

    Principal Investigator

    2018-2028

  • Engaging women and girls in the Global South in decisions concerning their health and well-being through the implementation of shared decision-making (ENGAGED)

    New Frontiers in Research Fund competition – research for post-pandemic recovery 2022.

    Principal investigator

    2023-2026

  • Development of decision support tools meeting high quality criteria to facilitate shared and informed decision-making related to the various screening programs and to optimize the use of the Guide to Good Practices in Clinical Prevention, through the SRAP Quebec Support Unit.

    Quebec Ministry of Health and Social Services (MSSS). 

    Principal investigator

    2023-2026

  • CAUCUS: Strengthening the Application of Knowledge Uetmiss in CiUssS. Support for research in the evaluation of cutting-edge technologies and practices in university hospitals.

    Quebec Research Fund – Health (FRQS)

    Principal investigator

    2020-2026

  • THE AGING, COMMUNITY AND HEALTH RESEARCH UNIT COMMUNITY PARTNERSHIP PROGRAM (ACHRU-PPC)

    Full title

    Diabetes Self-Management in Seniors: Community Partnership Program of the Research Unit on the Linkages Between Aging, Health and Community (Canada)
     
     
    Description
    The Aging, Community and Health Research Unit Community Partnership Program (ACHRU CPP) is a 6-month self-management intervention for older adults with diabetes and other chronic conditions and their family/friend caregivers. The research program builds on our prior work and is designed with scale-up in mind.
     

    Project Aim

    To test the ACHRU CPP in diverse primary care and community settings, with diverse populations and across jurisdictions and plan for scale-up.
     

    Project design

    A multi-site, pragmatic, randomized controlled trial with equal emphasis on examination of implementation and effectiveness of the ACHRU CPP.
     

    Settings

    The CPP will be implemented in primary care settings or diabetes education centres in Ontario, Quebec and Prince Edward Island (2 sites per province, 6 sites in total), in partnership with community-based agencies (e.g., YMCA, seniors centres).
     

    Participants

    A total of 44 community-living older adults with diabetes and at least one other chronic condition and their caregivers, will be enrolled in each of the six study sites; of these, 22 participants will be randomly assigned to receive the intervention – the Aging, Community and Health Research Unit Community Partnership Program.
     

    Intervention

    The ACHRU CPP will be coordinated by a Registered Nurse and provided by an interprofessional team including a Registered Dietitian (RD)/Nutritionist from the primary care site or diabetes education centre and a Program Coordinator from the community partner site. Participants will be offered up to 3 home visits by the RN and/or RD/Nutritionist over 6 months, supported by phone calls. Participants will also be invited to attend 6 monthly group wellness sessions (at the community partner site) delivered by the RN, RD/Nutritionist and Community Program Coordinator. Each session will include education, exercise, a light meal and peer support.

     

    Timeline

    Recruitment will begin in May, 2019 and will end in November, 2019. The intervention period will start in May, 2019 and end in May, 2020 (13 months). 

     

    Community Advisory Boards

    A Community Advisory Board will be formed in each of the study sites that includes patients and caregivers, community representatives (e.g., providers, managers, policy makers). The overall goal of the CABs is to provide advice to the research team on how to tailor and adapt the program to the local setting.



    Project team

    Coordonnators

  • PERSONALIZED GENOMICS FOR PRENATAL ANEUPLOIDY SCREENING USING MATERNAL BLOOD - PEGASUS 1

    Full title

    PEGASUS: PErsonalized Genomics for prenatal Aneuploidy Screening USing maternal blood
     
     
     
    Description

    Each year, 450,000 Canadian women become pregnant and, as a result of their participation in prenatal screening for Down syndrome, approximately 10,000 of them will have an amniocentesis (i.e. sampling of liquid surrounding the fetus) and of those, 315 will be found to carry a baby with Down syndrome and 70 normal pregnancies will be lost from complications of the procedure. It has been discovered recently that, during pregnancy, there is fetal DNA in maternal blood in sufficient quantities to be analyzed and methods have been proposed to detect the presence of a fetus with Down syndrome using maternal blood. The introduction of genomic blood testing as proposed in the context of this project could lead to increased detection of Down syndrome, less invasive screening with 9,700 amniocenteses avoided each year in Canada, improving the peace of mind of pregnant women, and preventing the accidental loss of 70 normal fetuses, at a lower overall cost than current practice. However, these methods still need to be validated before being appropriately introduced in routine care. This project proposed to carry out an independent study that validated the performance and utility of these new genomic technologies for screening in pregnant women using maternal blood. The team of researchers identified an evidence-based cost-effective approach for implementation of this new technology in the Canadian health care system. They developed decision-making tools that assist couples in making informed decisions, as well as educational tools for health care professionals, all integral components of the implementation of genomics-based non-invasive prenatal diagnosis. The results of this project may enable decision makers–pregnant women and their partner–to make informed choices pertaining to prenatal genetic screening and diagnosis, such as screening for Down syndrome, and to reduce the risk to pregnancies associated with amniocentesis.

     

    Tools

    • Decision box:What are my options regarding prenatal screening tests? Next update: April 2018
    • Official website: PEGASE

     

    Publications

  • TRANSLATING SHARED DECISION MAKING INTO CLINICAL PRACTICE - INTERNATIONAL COLLABORATION

    Full title

    Translating shared decision making into clinical practice

     

    Description 

    Shared decision making (SDM) is defined as the process by which a healthcare decision is made by both the practitioner and the patient (i.e. the practitioner-patient dyad). Engaging patients as partners in their own care increases patient satisfaction and correlates with a better quality of life. Yet the SDM approach has not been adopted by the population at large. There are several important barriers to the successful implementation of SDM in primary care. To identify and overcome these barriers, it is important to simultaneously evaluate patients' and health professionals' perspectives of the SDM process (dyadic decision-making).

     

    Phase 1: Proof of concepts
    Shared decision making (SDM) is defined as the process by which a healthcare decision is made by both the practitioner and the patient (i.e. the practitioner-patient dyad). Engaging patients as partners in their own care increases patient satisfaction and correlates with a better quality of life. Yet the SDM approach has not been adopted by the population at large. There are several important barriers to the successful implementation of SDM in primary care. To identify and overcome these barriers, it is important to simultaneously evaluate patients' and health professionals' perspectives of the SDM process (dyadic decision-making). The main goal of this project was to bring together the resources and the expertise needed to develop an international research team dedicated to implementing SDM in clinical practice. This international collaboration addresses the challenges posed by the implementation of SDM through the use of a dyadic perspective. Ultimately, the results will improve how the Canadian healthcare system and its professionals understand and respond to public expectations about health services and healthcare management.
     
     
    Protocole
    Légaré F, Elwyn G, Fishbein M, Frémont P, Frosch D, Gagnon MP, Kenny DA, Labrecque M, Stacey D, St-Jacques S, van der Weijden T. Translating shared decision-making into health care clinical practices: Proof of concepts. Implementation Science. 2008 Dec;3(1):2.
     
     
    Phase 2 : Convening a community of practice
    In clinical settings, the ideal pathway for knowledge transfer is through the sharing of decisions between clinician and patient. Embedded in a specific relationship, this process is known as shared decision making (SDM). Despite evidence supporting the merits of SDM, medical decision-making has been studied as if clinicians and patients lived in separate worlds. The main goal of this CIHR-funded project was to bring together the resources and the expertise necessary to develop an interdisciplinary and international research team dedicated to the study of implementing SDM in clinical practice using a theory-based dyadic perspective–that is, a relationship-centered approach.
     
    The objective of Phase 2 of the project is to foster and sustain a community of practice in this area. First, we will hire a project manager responsible for publicizing our activities; recruiting new participants; facilitating participant activities, including the e-journal club; acting as webmaster and updating the website; and tailoring activities to the participants' needs. Second, we will produce all of our materials in both of Canada's official languages (French and English). Third, we will create three new open-access sections on our public website: 1) a virtual library of relevant documents; 2) a training section for researchers and trainees for which OPD-165691 workshop material will be used; and 3) a dyadic data analytical exercise in the implementation of SDM in clinical practice.

  • IMPLEMENTING SHARED DECISION-MAKING IN INTERPROFESSIONAL HOME CARE TEAMS - IPSDM - STEPPED WEDGE

    Full title

    Implementing shared decision-making in interprofessional home care teams

     

    Description

    One of the toughest decisions faced by the frail elderly in Canada is whether to stay at home or move to a care facility. Decisions that are informed, shared and supported produce better results. An interprofessional approach to shared decision making is when older persons and their caregivers are supported by not just one but by all the professionals involved in their care. In the case of the frail elderly in home care services, there are many health care professionals involved, e.g. the doctor, nurse and social worker. In this case decisions should be shared by all the professionals involved with the elderly person along with his or her caregivers. We have designed a training program that teaches interprofessional teams how to share decisions with their frail elderly patients. Results of a previous project (IPSDM - DOLCE) showed that caregivers followed by the trained home care teams felt more involved in the decision making process, and that there was a better fit with the prefered choice and the choice made. This project uses a stepped wedge cluster randomized trial design. It will measure the impact of the training program in interprofessional shared decision making (IPSDM) above that of the passive dissemination of the decision guide by measuring to what extent older persons and their caregivers say they took active part in the decision-making process. Other outcome measures will be: i) what option they chose, whether they feel conflict or regret about their decision, and the burden of care they feel; ii) the quality of life of the frail elderly.

     

    Tools

     

    Publications

  • DECISION+

    Description

    DECISION+ is an innovative training program for physicians. It integrates multiple educational/behavioural change components that aim to promote shared decision making about taking antibiotics for acute respiratory infections. We hypothesized that shared decision making should result in a common decision based on best evidence and on the patients' values, leading to best prescribing practices for physicians and their best use by patients. The objective of DECISION+ pilot RCT was to evaluate the feasibility of a larger trial, in order to determine the program's efficacy for promoting optimal use of antibiotics for acute respiratory infections.

     

    Tools

     

    Publications

  • DECISION+2 : RANDOMIZED CONTROL TRIAL

    Description

    Acute respiratory tract infections (ARIs) such as otitis media, rhinosinusitis, acute pharyngitis and bronchitis account for up to 10% of consultations in emergency departments. Several studies have shown that these infections are overwhelmingly of viral etiology and therefore self-limiting. Although antibiotic therapy is unnecessary in the treatment of acute respiratory infections of viral etiology, the use of antibiotics is still widespread among clinicians in North America. Inappropriate antibiotics consumption is associated with antibiotic resistance, increased risk of side effects and a higher rate of readmission. This is a major public health problem. Information tools are a promising way to inform patients and doctors about this problem. Information tools can support informed decision-making about an individual health issue. This can open the dialogue for shared decision-making between the patient and the doctor. Shared decision-making is a decision-making process in which the physician, the patient, and those around them share information that is informed by the highest level of evidence, evaluate all possible diagnostic and therapeutic options, identify the patient's priorities, deliberate, and jointly decide on the best care for the patient. This project was based on the data gathered during a pilot randomized control trial of Decision+. The main aim of the pilot was to establish the feasibility of conducting the project on a larger scale. The pilot project assessed the impact of DECISION+ on antibiotics use for acute respiratory infections (ARI) – the main reason for consultations in primary care. This project was funded by the FRSQ-Conseil du Medicament.

     

    Funding

    This project is funded by the FRSQ-Conseil du médicament.

    2009-2012

     

    Publications

  • EXPLOITING THE CLINICAL CONSULTATION AS A KNOWLEDGE TRANSFER AND EXCHANGE ENVIRONMENT - EXACKTE 2

    Full title

    Exploiting the Clinical Consultation as a Knowledge Transfer and Exchange Environment

     

    Description

    Shared decision making requires two basic elements: the patient being actively involved in decisions pertaining to his or her health, and knowledge to be adequately transferred from the healthcare worker to the patient. The transfer and exchange of knowledge through clinician–patient interactions requires both parties sharing information, being sensitive to the others' preferences and positions, and coming to an agreement about tests and treatments that influence healthcare outcomes. Even if brief, a consultation can affect the other person's emotions and behavior. In order to improve the effectiveness of knowledge translation interventions in clinical encounters, our study aims to use a SDM model to explore how patients and clinicians influence one another. Using a longitudinal design, with 400 clinician–patient pairs, our study will unfold in three phases: 1. development and validation of a set of reciprocal measures; 2. performance of a series of statistical analyses that explore how patients and clinicians influence one another during the translation and exchange of knowledge within the SDM model; 3. use of the results of these analyses as reference material for designing new knowledge translation interventions for clinical encounters. The acceptability and feasibility of these interventions will be tested during a pilot study with focus groups of patients and clinicians. This project emphasizes the "exchange" aspect of knowledge translation and exchange during clinician–patient interactions.

     

    Publications

  • ANTIBIOTICS IN EMERGENCY MEDICINE

    Description

    The Decision+2 program has proven effective in reducing the rate of antibiotic use for treating acute respiratory tract infections (ARTIs) in primary care, without increasing the rate of associated complications (1). However, its applicability in the emergency department was uncertain. Indeed, emergency departments are chaotic environments with high patient volumes and significant pressure to see patients quickly—factors that must be considered when implementing a new practice in such settings (2). Using a user-centered design approach involving 18 patients, several emergency physicians from Hôtel-Dieu de Lévis and CHUL, as well as graphic designers from Université Laval, we adapted the decision aid tool to the emergency context. That said, the decision aid remains applicable across all healthcare settings.

     

    Publications

     

    Tool

    You are suffering from a respiratory infection that will likely heal without antibiotics. Tool inspired by Decision+ and adapted for the emergency medicine context by Létourneau J.S. et al., 2016.

  • IMPROVING DECISION MAKING ON LOCATION OF CARE WITH THE FRAIL ELDERLY AND THEIR CAREGIVERS - IPSDM - DOLCE

    Full title

    Improving decision making on location of care with the frail elderly and their caregivers

     

    Description

    One of the toughest decisions faced by the frail elderly in Canada is whether to stay at home or move to a care facility. It is certainly difficult to make this decision alone, but can be even harder if someone else makes it for you. Shared decision making is when, instead of making decisions for the patient, healthcare professionals share information about what the evidence says, and they talk about what's important with the patient, and then make the decision together. In the case of the frail elderly in home care services, there are many health care professionals involved, e.g. the doctor, nurse and social worker. In this case decisions should be shared by all the professionals involved with the elderly person along with his or her caregivers. Unfortunately, in this context, shared decision making rarely occurs. We have designed a training program that teaches interprofessional teams how to share decisions with their frail elderly patients, and tested it in one Quebec City and one Edmonton home care team. This project tested the training program on a broader scale with 16 home care teams attached to community health centres across the province of Quebec, and compared the results with what happens when no one has completed the training (usual care). Results show that caregivers followed by the trained home care teams felt more involved in the decision making process, and that there was a better fit with the prefered choice and the choice made. 

     

    Tools 

     

    Publications

  • CONTINUING PROFESSIONAL DEVELOPMENT

    Description 

    The Research Chair organized a workshop to bring together professional development decision makers, health services researchers, professors and clinicians in order to identify continuing professional development’s specific needs as well as to determine the foundation of an integrated research program dedicated to the development of research on continuing professional development (CPD). The objective of this initiative was to: 1) review the literature on CPD and identify any gaps; 2) identify strategies that would respond to the identified gaps while at the same time promoting the development of evidence in the field of CPD; and 3) propose a specific research project which would address some of the identified knowledge gaps in CPD. The workshop, titled Continuing Professional Development for the Implementation of Shared Decision Making in Primary Care, took place on November 18th and 19th, 2010 In developing this research network, the methods of implementing shared decision making in primary care were catalogued and submitted to critical evaluation. Gaps in knowledge on what makes CPD efficient for the implementation of shared decision making have been identified. The results can help CPD policy and decision makers, health service researchers, professors as well as clinicians to coordinate their efforts to improve knowledge of CPD and the understanding of its unique contribution to population health.  

     

    In fact, the objective of these CPD activities is to maintain, improve, and broaden health professionals’ knowledge and skills. These activities are considered essential to improving professional practice and, by extension, the quality of care offered by the health system. Evidence on CPD needs to be improved and its use encouraged by those responsible for this important area of knowledge translation. The Research Chair and already completed several projects in this regard.

     

    Measurement Tool

    The lack of a widely accepted instrument to evaluate the impact of CPD on clinical practice makes it almost impossible to compare the efficiency of CPD activities. Using an integrated model to study the behaviour of health professionals, a project on CPD in partnership with knowledge translation has allowed for the development of an all-encompassing, broad based, instrument based on theory, validity, and reliability in order to evaluate the impact of CPD activities on clinical practice. This tool, titled DPC-Reaction Questionnaire, is available in French and English.

     

     

    Publications

  • A CLUSTER-RANDOMIZED TRIAL COMPARING TEAM-BASED VERSUS PRIMARY CARE CLINICIAN-LED ADVANCE CARE PLANNING IN THE META-LARC PRACTICE-BASED RESEARCH NETWORKS - META-LARC ADVANCE CARE PLANNING

    Full title

    A Cluster-randomized Trial Comparing Team-based Versus Primary Care Clinician-led Advance Care Planning in the Meta-LARC Practice-based Research Networks

     

    Description

    The Serious Illness Care Program (SICP) is an advance care planning program targeting people with reduced life expectancy. It is a validated tool and is designed to help clinicians initiate meaningful conversations about health care at the right time and in the right way so that patients and families can make more informed choices based on their values and preferences. The objective of this project is to determine whether, in primary care settings, it is more effective to target the implementation of the SICP with a clinician-centred approach, where a single clinician is responsible for having a conversation about advance care planning given the nature of the patient-clinician relationship, or whether it would be better to use a team-based approach given the time and resource constraints faced by clinicians. The target population is adults living in the community with serious diseases who have a life expectancy of two years or less, as well as their families. This is a cluster randomized trial. This study will be conducted in 42 primary care settings within seven Practice-Based Research Networks (PBRNs) 5 located in U.S. states and 2 in Canadian provinces: Colorado, Iowa, North Carolina, Oregon, Wisconsin, Quebec and Ontario. The specific objectives are to 1) evaluate the comparative effectiveness of the two approaches on the match between care and patients' goals and time spent at home (primary outcomes) and on patients' anxiety, depression and quality of life (secondary outcomes); and 2) explore the contextual factors influencing the implementation of the two approaches.  Data collections for patients and caregivers will be conducted at study entry, at 6 months and 12 months, while healthcare professionals will be interviewed after receiving training, as well as at 1 and 2 years after training. The data from this study will help determine the most effective approach to advance care planning for primary care settings. Healthcare professionals who are trained in the use of the SICP will be more comfortable having conversations about advance care planning with their patients. Thus, this study has the potential to improve the delivery of care to patients with serious illnesses and reduced life expectancy, by ensuring that the care provided is consistent with the objectives, values and preferences of the patient and family.  

     

    Project team

    • Annette Totten, Oregon Health & Science University
    • France Légaré, MD, Université Laval
    • Lyle J. Fagnan, Oregon Health & Science University
    • Donald Nease, University of Colorado 
    • David Hahn, University of Wisconsin
    • Rowena Dolor, Duke University
    • Barcey Levy, University of Iowa
    • Michelle Greiver, University of Toronto
    • Jean-Sébastien Paquette, Université Laval
    • Patrick Archambault, Université Laval
    • And the Meta-LARC ACP Trial Team
     
    Coordinators
    • LeAnn Michaels, Oregon Rural Practice-Based Research Network
    • Sabrina Guay-Bélanger, Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
    • Danielle Caron, Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
     
     

    Funding

    Patient Centered Outcome Research Institute (PCORI)

    2017-2021

  • POTENTIALLY INAPPROPRIATE PRESCRIPTIONS IN ADULTS AGED 65 AND OVER (PIMs)

    Full title 

    Potentially Inappropriate Prescriptions in Adults Aged 65 and Over (PIM)

     

    Summary

    Our research team, composed of family medicine residents and family physicians from the St-Charles-Borromée University Family Medicine Group (U-FMG), conducted a study as part of a scholarly project on the prescription of potentially inappropriate medications (PIMs) in individuals aged 65 and over. The study was published in La Revue de Gériatrie (see link and abstract above) and received the Réseau-1 Québec award recognizing scholarly projects by family medicine residents in 2016, as well as the 2016 award for "Best Research Article – Resident Category" from the College of Family Physicians of Canada.

     

    Issue: Potentially Inappropriate Medications (PIMs)
    Prescribing PIMs to adults aged 65 and over can have serious consequences for this population (increased mortality and morbidity). Several tools exist to help clinicians identify and deprescribe such medications (see Deprescribing Tools below). We conducted our study at our U-FMG using one of these tools—the BEERS criteria—whose results were published in La Revue de Gériatrie (see attached summary). This information page was made possible through a grant from Réseau-1 Québec and the collaboration of Dr. France Légaré’s team at the Research and Innovation Lab in Primary Care Medicine, located at the GMF-U, St-Charles-Borromée.

     

    Tools
    There are several tools available to identify PIMs in adults aged 65 and over. Among them are the BEERS Criteria, STOPP/START, and FORTA. According to a recent study, STOPP/START may outperform BEERS:
    https://www.sciencedirect.com/science/article/pii/S075549821630207X

     

    Prevalence and Risk Factors of Potentially Inappropriate Medication (PIM) Prescriptions in Adults Aged 65 and Over

     

    Background
    Studies on PIM prescriptions in older adults report a prevalence ranging from 23% to 74.7%. However, the factors associated with PIM prescribing are less well known.

     

    Objectives
    First, to measure the prevalence of PIM prescriptions in a sample of patients followed in a family medicine clinic using the Beers Criteria. Second, to identify characteristics of patients receiving PIMs and of physicians prescribing them.

     

    Methodology
    This was a non-interventional cross-sectional study involving the records of 296 adults aged 65 and over. Visits under study took place in two primary care clinics: one in a semi-urban academic setting and the other in a rural clinic.

     

    Results
    Among the 296 patients studied, 72 received at least one potentially inappropriate medication (PIM) prescription, representing 24.3%. The most common types of PIMs were benzodiazepines (53.2%) and zopiclone (16.5%). For patients, being male (OR 0.53, p = 0.02) and having no medical history (OR 0.26, p = 0.002) were associated with a lower risk of receiving a PIM. For each additional medication on a patient’s list, the risk of being prescribed an additional PIM increased by a factor of 1.18 (OR 1.18; p = 0.003). Having a psychiatric history was associated with a significantly higher risk of receiving a PIM (OR 7.15, p < 0.001). For physicians, only having attended a geriatrics conference within the past two years was associated with a lower risk of prescribing a PIM (OR 0.39, p = 0.0035).

     

    Conclusion
    This study contributes to a better understanding of the issue of potentially inappropriate medications in older adults and raises awareness among clinicians to promote positive changes in prescribing practices.

     

    Reference

    Rev Geriatr 2017 ; 42 (8) : 455-63. http://www.revuedegeriatrie.fr/

     

    Resources

  • PEGASUS 2

    x

  • DEVELOPMENT OF STANDARDS FOR A REPORTING GUIDELINE FOR SCALING STUDIES - SUCCEED

    Full title

    Development of standards for a reporting guideline for scaling studies

     

    Description

    Health research generates evidence-based knowledge that need to be reported adequately to be effectively translated into practice and decision making by clinical and policy decision makers and members of the public. Moreover, health interventions proven to be effective need to be scaled up to help improve health outcomes for the entire population in order to promote health equity. However, gap in the quality of reporting of health research are well documented in the literature, particularly for scaling up studies, as documented in a systematic review. The aim of this research project is to develop the standards for reporting scaling studies. The project is guided by the steps recommended for developing health research reporting guidelines by EQUATOR, an international network that promotes transparent and accurate reporting of health research. The project is unique in its integration of the principles of patient-oriented research and sex and gender considerations, as successful scaling of innovations is highly context-dependent. The whole process involves national and international collaborators. As a result, the guidelines developed will be useful both in Canada and around the world to improving the quality of reporting of scaling studies and facilitate the replication and dissemination of the health innovations studied.

     

    Project team

    International Executive Committee
    • Emmanuelle Aubin, Patient Partner, Canada
    • Ali Ben Charif, Université Laval, Canada
    • Amédé Gogovor, Université Laval, Canada
    • France Légaré, Université Laval, Canada
    • Robert McLean, International Development Research Centre, Canada
    • Andrew Milat, University of Sydney, Australia
    • David Moher, Ottawa Hospital Research Institute, Canada
    • Karina Prévost, Patient Partner, Canada
    • Paula Rochon, Women’s College Research Institute, Canada
    • Luke Wolfenden, University of Newcastle, Australia
    • Hervé Tchala Vignon Zomahoun, Quebec SPOR-SUPPORT Unit, Canada

     

    Responsibles
    • Amédé Gogovor, Université Laval, Canada
    • France Légaré, Université Laval, Canada
    • Hervé Tchala Vignon Zomahoun, Quebec SPOR-SUPPORT Unit, Canada

     

    Collaborators
    • Nathalie Rheault, Quebec SPOR-SUPPORT Unit, Canada
    • Giraud Ekanmian, Université Laval, Canada
    • Louise Légaré, Quebec SPOR-SUPPORT Unit, Canada
    • Karine Plourde, VITAM – Centre de recherche en santé durable, Canada

     

    Funding

    Canadian Institutes of Health Research (CIHR) grant awarded to the Quebec SPOR SUPPORT Unit / CIHR Patient-Oriented Research Fellowship

    2018-2022

     

    Publication and registration of the protocol

    1. Registration with EQUATOR Network. http://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-clinical-trials/
    2. Protocol registration. https://osf.io/vcwfx/
    3. Protocol publication. Gogovor A, Zomahoun HTV, Ben Charif A, Robert K.D. McLean RKD, Moher D, Milat A, Wolfenden L, Prévost K; Aubin E, Rochon P, Ekanmian G, Sawadogo J, Rheault N, Légaré F. Essential items for reporting of scaling studies of health interventions (SUCCEED): protocol for a systematic review and Delphi process. Systematic Reviews. 2020; 9(1): 11. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-019-1258-3

  • RESEARCH ON PATIENT-ORIENTED SCALING UP - RePOS

    Full title

    Research on Patient-Oriented Scaling Up (RePOS)

     

    Lay description

    Despite major public investment and a favourable climate for creating health improvement projects in Canada, few initiatives, that are successful on a local scale, are scaled up to reach more people. In fact a former health minister described Canada as “a country of perpetual pilot projects”. Scaling-up is a process that aims to increase the number of users of a successful health initiative so as to benefit more health services users. By including patients in designing, planning and carrying out new health initiatives, researchers make sure that their projects meet patients’ needs and reflect their priorities. Research shows that patient involvement also improves health outcomes, reduces costs, and results in a better healthcare experience. However, efforts to scale up these initiatives rarely include patients or the public, either in their design, planning or execution. Those who carry out scaling up should involve patients and indeed all stakeholders (including policy makers, clinicians, and researchers) to make sure their results are relevant in the real world, and especially for those whom they are meant tobenefit—the patient. Often, scaling up is top-down process initiated by governments, and the perspective of the patient is forgotten. 

    In this study, we aim to produce information and guidance on how to engage patients and other stakeholders in scaling up. We will start by finding out what guidance already exist for this purpose, by searching the scientific literature (including unpublished works). Then we will ask a diverse group of people around the world, including patients, to come to a consensus on which are the best guidance we found for engaging patients and other stakeholders in scaling-up initiatives. This diverse group will evolve into an international stakeholders network for carrying out and advising others on future patient-oriented research and practice in scaling up.

     

    Objective

    To build patient-oriented research capacity in the science and practice of scaling up in health and social services, by ensuring that patients, the public, and other stakeholders are meaningful and equitably engaged.

     

    Project team

    Project leaders

    • Ali Ben Charif, Université Laval, Canada
    • Ron Beleno, Patient partner, Age-Well NCE, Canada
    • France Légaré, Université Laval, Canada

     

    Project coordinators

    • Sabrina Guay-Bélanger, VITAM - Centre de recherche en santé durable, Canada
    • Karine Plourde, VITAM - Centre de recherche en santé durable, Canada

     

    Collaborators

    • Martin Beaumont, Réseau universitaire intégré en santé de l’Université Laval, Canada
    • Arlene Bierman, Agency for Health care Research & Quality, United States of America
    • Johanne Blais, Hospital Saint-François d’Assise, Canada
    • Carol Fancott, Canadian Foundation for Healthcare Improvement, Canada
    • Friedemann Geiger, Universitätsklinikum Schleswig-Holstein, Germany
    • Amédé Gogovor, Université Laval, Canada
    • Kathy Kastner, Patient partner, Bestending, Canada
    • Robert McLean, International Development Research Centre, Canada
    • Andrew Milat, University of Sydney, Australia
    • Jean-Sébastien Paquette, Université Laval, Canada
    • François Rivest, Health Canada, Canada
    • Sharon Straus, University of Toronto, Canada
    • Guy Thibodeau, CIUSSS de la Capitale-Nationale, Canada
    • Luke Wolfenden, University of Newcastle, Australia
    • Hervé Tchala Vignon Zomahoun, Quebec SPOR-SUPPORT Unit, Canada

     

    Funding

    Canadian Institutes of Health Research (CIHR)

    2020-2022

  • SCALING UP SHARED DECISION MAKING FOR PATIENT-CENTRED CARE - LEGACy

    Full title

    ScaLing up sharEd decision makinG for pAtient-centred Care

     

    Description

    Most Canadian older adults lived in private households and want to stay at home as they age. Aging at home optimizes older adults’ health, independence, sense of well-being, and social connectedness. However, with declining health and autonomy, many older adults receive informal or formal care at home. Home care is a setting where seniors/caregivers face difficult decisions that significantly affect wellbeing. Shared decision making (SDM) is a collaborative process whereby healthcare providers support clients in making decisions informed by best evidence and what matters most to them. Although SDM results in better outcomes, most Canadians do not experience SDM and even fewer seniors. To benefit more Canadians, SDM needs to be scaled up. However, there is a persistent failure to do so as scaling up remains an understudied phase of knowledge translation. Since 2007, I have evaluated the implementation of SDM in home care with an emphasis on local/regional context and demonstrated its positive impact. I now propose to reduce knowledge gaps about scaling up SDM in home care across Canada.
     
     

    Objectives

    Our research question is “What are the steps to scaling up access to shared decision making for a majority of older Canadians?” Our objectives are to determine the most difficult decisions faced by older Canadians receiving home and community care and their caregivers, design and pilot a decision support intervention, and using the best available evidence on scaling up, scale up the intervention across 5 Canadian jurisdictions.

     

    Methods

    The program has 5 principal aims corresponding to separate phases. In the first phase, in partnership with patients, healthcare professionals and decision-makers, we seek a consensus on the most difficult decisions faced by older adults and their caregivers in the home care context. In the second phase, we review existing decision support interventions targeting older people in home care and select the closest match for the identified priority decision using a Delphi process; we identify behaviour changes and policy changes associated with the decision, select appropriate behaviour change mechanisms, and adapt or design a new decision support intervention. Concurrently, we review the literature on scaling up healthcare interventions using an environmental scan, a realist review, a living review and a review of reviews, and develop a scale-up plan. In the third and fourth phase, we a) assess the effectiveness, validate feasibility, acceptability and scalability of LEGACy, and b) conduct a pragmatic stepped-wedge trial to scale up LEGACy in five provinces in Canada, and ensure ongoing monitoring, process evaluation and tailoring of the scaled-up intervention. The aims 5 is to build capacity in the practice and science of scaling up and SDM. We will train scientists, empower and educate patients, and disseminate knowledge as we produce it.

     

    Conclusion

    The final outputs of the program will be a validated and sustainable intervention that addresses one of the most difficult decision faced by older Canadians in home and community care implemented across the country; a comprehensive guide to the design, implementation and scaling-up of decision support interventions; and a new generation of experts schooled in the science of scaling up.

     

    Project team

    • France Légaré, MD, Université Laval
    • Patrick Archambault, Université Laval
    • Ali Ben Charif, Université Laval
    • Marie-Claude Boily, Imperial College (London, England)
    • Emelie Braschi, University of Ottawa/Université d'Ottawa
    • Emmanuelle Careau, Université Laval
    • Angela Coulter, University of Oxford (England)
    • Suzanne Dupuis-Blanchard, Université de Moncton
    • Lyle J. Fagnan, Oregon Health & Science University
    • Audrey Ferron Parayre, University of Ottawa/Université d'Ottawa
    • Pierre-Gerlier Forest, University of Calgary
    • Anik Giguère, Université Laval
    • Ian Graham, University of Ottawa/Université d'Ottawa
    • Gary Groot, University of Saskatchewan
    • Jayna Holroyd-Leduc, University of Calgary
    • Paul Nolyoke, Saint Elizabeth Health Care
    • Allyson Jones, University of Alberta
    • Eric Kavanagh, Université Laval
    • Maude Laberge, Université Laval
    • John Lavis, McMaster University
    • Hélène Lee-Gosselin, Université Laval
    • Fabiana Lorencatto, London's Global University Centre Behaviour Change
    • Andrew Milat, University of Sydney
    • Léon Nshimyumukiza, Université Laval
    • Jean-Sébastien Paquette, Université Laval
    • Véronique Provencher, Université de Sherbrooke
    • Vardit Ravitsky, Université de Montréal
    • Louis-Paul Rivest, Université Laval
    • Geneviève Roch, Université Laval
    • Dawn Stacey, University of Ottawa/Université d'Ottawa
    • Sharon Straus, University of Toronto
    • Annette Totten, Oregon Health & Science University
    • Holly O. Witteman, Université Laval
    • Luke Wolfenden, University of Newcastle
    • A large team of knowledge user

    Coordinators

    • Sabrina Guay-Bélanger, Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)
    • Karine Plourde, Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL)

     

    Funding

    Canadian Institutes of Health Research (CIHR)

    2018-2025

     

    Publication

  • TECHNOLOGY TO SUPPORT DECISION MAKING ABOUT AGING AT HOME : COORDINATEs

    Full title

    teChnology tO suppORt DecIsioN Making about Aging aT homE: COORDINATEs

     

    Description

    Most older adults prefer to stay at home as long as possible. Effective self-management for people losing autonomy depends on reliable monitoring of their mobility, health and safety and active implication in decision-making. New technologies have the potential to provide information about changing patterns that reflect changing care needs. This information could support older adults, their caregivers and healthcare professionals in shared decision making (SDM) about housing options.

     

    Objectives

    1. Assess autonomy and mobility of older adults with early-stage dementia living at home, 
    2. Codesign technology that facilitates self-management 
    3. Inform shared decision making processes about housing options for all those involved.

     

    Methods and expected results

    A 3-year multiple-case, mixed-methods study in Canada, Sweden and the Netherlands. We will a) use mixed methods to assess autonomy and mobility of 20 older adults in their homes and neighbourhoods; b) with end-users, co-design an enhanced version of a health tracking platform; c) use mixed methods to assess use of enhanced platform and larger feasibility survey; d) triangulate and compare data in 3 countries. Self-reported and objectively measured data about mobility and health changes in older adults living at home in 3 countries; enhanced technical support platform for selfmanagement; factors influencing potential uptake; instructions and recommendations for implementation; information for shared decision making about housing options among endusers, including policy makers.

  • TRANSLATING SHARED DECISION MAKING INTO CLINICAL PRACTICES: PHASE 1. AN INTERNATIONAL COLLABORATION

    Description

    Shared decision making (SDM) is defined as the process by which a healthcare decision is made by both the practitioner and the patient (i.e. the practitioner-patient dyad). Engaging patients as partners in their own care increases patient satisfaction and correlates with a better quality of life. Yet the SDM approach has not been adopted by the population at large. There are several important barriers to the successful implementation of SDM in primary care. To identify and overcome these barriers, it is important to simultaneously evaluate patients' and health professionals' perspectives of the SDM process (dyadic decision-making). The main goal of this project was to bring together the resources and the expertise needed to develop an international research team dedicated to implementing SDM in clinical practice. This international collaboration addresses the challenges posed by the implementation of SDM through the use of a dyadic perspective. Ultimately, the results will improve how the Canadian healthcare system and its professionals understand and respond to public expectations about health services and healthcare management.

     

    Publication

    Phase 1 protocol was published in 2008 in Implementation Science

     

  • INTRODUCING PATIENT PERSPECTIVE IN HEALTH TECHNOLOGY ASSESSMENT

    Description

    Recent recognition of the importance of engaging patients in decisions regarding their own medical care has led decision makers to incorporate patient perspectives in the decision making process. In the province of Quebec, university hospitals have created units for evaluating health technologies and intervention methods (Health Technology Assessment Units, or HTA Units) to meet their evaluation responsibilities and to promote evidence-based decision making. The creation of HTA Units within university hospitals is an opportunity for decision makers to increase the involvement of patients and the general public in decisions about health technologies. This said, little is known about interventions that have succeeded in achieving this. The present project aims at answering the needs of decision makers working in the sector of health technology assessment by exploring ways to involve patients in HTA Unit activities. To accomplish this objective, the study has three goals: 1. to synthesize international knowledge and experiences of patient involvement in health technology assessment activities; 2. to explore the perceptions of stakeholders (administrators, clinical managers, clinicians, other health professionals, health technology assessors, and patients) regarding strategies that involve patients in the various stages of health technology assessment; 3. to produce a consensual framework that will guide interventions for introducing a patient perspective into health technology assessment activities in HTA Units. This collaboration between decision makers, HTA experts, and a research team with complementary knowledge will allow participants to identify the best type, degree, and timing of patient involvement for any given HTA activity in an HTA Unit. The framework will be discussed among collaborators from the following bodies: Quebec's agency for the evaluation of health technologies and intervention methods (AETMIS), Quebec's university hospitals, the HTA Unit at McGill University Hospital, the HTA Unit of Centre Hospitalier de l'Université de Montréal, patient associations, and the research team.

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