Scientific Series

This presentation will provide an overview of ongoing novel technological research with older adults. The implications this work has on next steps and clinical settings. Key steps to successfully engage older adults and caregivers as partners starting from the conception and design of research studies.

This presentation analyzes the participatory process of creating and implementing the EDI Action Plan at the Research Institute of the McGill University Health Centre (RI-MUHC) called “Together towards inclusion”. Two questions guide the reflection: 1) What opportunities did the consultations and implementation of the EDI Action Plan create for equity-seeking groups at the RI-MUHC to be effectively recognized, heard and influential? 2) What institutional changes have resulted from this participatory design and implementation process? Through self-reflective analysis of a concrete case, we present lessons learned about the role of participatory action in the organizational changes necessary to create an inclusive work experience in a health research institute.

Worldwide, there are over 300 million major surgeries performed each year. International ‘Enhanced Recovery From Surgery’ (ERAS) guidelines include patient-led behaviours to reduce post-surgical complications and length of hospital stay, such as early mobilisation, and rapid resumption of feeding and fluids, and breathing and physiotherapy exercises. However, patients need support to adhere to these guidelines, and a digital health intervention (DHI) may be an effective, cost-effective, and scalable solution. In response, we co-designed the RecoverEsupport intervention (with researchers, clinicians and patients). RecoverEsupport consists of a website and SMS/email prompts to encourage patient self-management using evidence-based behaviour change strategies such as information provision, goal setting, skills training, behavioural self-monitoring and feedback, and prompts and cues. This presentation describes the RecoverEsupport support research program, which includes patient surveys, qualitative studies and 2 randomised controlled trials (currently in progress) targeting colorectal and breast cancer patients. Both trials aim to evaluate the effectiveness and cost-effectiveness of the RecoverEsupport intervention. If effective, the RecoverEsupport intervention could be rapidly scaled up and/or adapted for other surgical patient groups.

The aim of this presentation is to discuss the social determinants of the perceived health of precarious-status migrants without medical insurance. Between June 2016 and September 2017, we conducted a cross-sectional survey of uninsured international migrants in Montreal. We met and interviewed 806 migrants in various spaces across the city, and through a snowball strategy and media advertisements. The questionnaire covered socio-demographic, socio-economic and psychosocial characteristics, social determinants, health needs and access to healthcare, as well as health perception. In our study, almost half of migrants without health insurance perceived their health negatively. Our study also suggests a high rate of unmet healthcare needs among migrants with precarious status, a situation that correlates with poor health perception. Measures need to be put in place to guarantee access to resources and social care and services for all migrants, with or without authorized status. At the end of this session, participants will: 1. Understand the notion of precarious migratory status. 2. Understand the links between migration status, medical insurance and health status. 3. Understand why migratory status can be seen as a determinant of health and thus contribute to social inequalities in health. Dr. Patrick Cloos is a professor at the School of Social Work and the Department of Social and Preventive Medicine, Université de Montréal. His courses focus on health and the environment. Before joining the academic field, Dr. Cloos practiced emergency medicine in hospital and humanitarian settings for Médecins sans frontières in several regions of the world, notably in wartime. He was also Director of Public Health in Dominica (West Indies). His doctoral thesis was completed as part of an interdisciplinary program in the social sciences, and focused on public health and racism. Dr. Cloos is currently involved in several global health studies. In particular, he is conducting research into the links between climate change, migration and health in the Caribbean.

Working with older adults living with cognitive impairments is often difficult because of their communication difficulties. This can lead to behaviour that is difficult to understand. This has consequences for them as well as for their family care partners and caregiving staff. The relationship-centred approach can improve everyone's experience. The principles of this approach will be outlined, based on each person's unique needs, the reciprocity of their relationships, and their shared aspirations. Examples of the application of this approach in clinical settings will be presented. Using a relationship-centred approach when working with older adults living with cognitive impairments can help both caregiving staff and family care partners better understand the sometimes difficult or out-of-the-ordinary behaviour that these patients may show. At the end of this session, participants will: 1. Recognize the experience of older persons living with cognitive impairment. 2. Define the relationship-centred approach with older persons living with cognitive impairment. 3. Describe strategies for implementing this approach. Anne Bourbonnais, RN, PhD is a full professor in the Faculty of Nursing at the Université de Montréal, she is the Chairholder of the Canada Research Chair in Care for Older People and of the Research Chair in Nursing Care for Older People and their Families. She is also a researcher at the Research Centre of the Institut universitaire de gériatrie de Montréal (CRIUGM). She has expertise in the care of older people living with a major neurocognitive disorder. As a researcher, she is particularly interested in the behaviours of these older people and the development of interventions to promote their well-being, as well as that of their family care partners and caregiving staff, from a clinical and social perspective.

The DIRECT research group will present an overview of its comprehensive program of studies aiming to improve the management of depression for older adults. This interdisciplinary team of researchers, primary care physicians, mental health specialists, trained non-medical mental health workers, and community stakeholders has focused on understanding the complex needs of older adults with chronic physical conditions and depression. Recognizing the urgent need for mental health support in this population, it has collaboratively developed, evaluated and disseminated depression self-care interventions for use in different contexts. These models utilize brief, low-intensity psychological interventions that encourage self-care. The DIRECT team developed a depression self-care toolkit specifically for community-based patients. The toolkit, which can be modified according to the needs of specific target populations, acknowledges the interconnectedness of mental and physical health and addresses both aspects in a coordinated manner. The team has shown the feasibility of delivering supported depression self-care based on cognitive behavioral therapy principles using telephone or internet modalities. This model of guided mental health self-care is innovative, accessible, and employs low-cost self-care tools and trained lay guides who may be recruited from communities-at-large. Multiple randomized trials of this guidance model have been conducted by the team, demonstrating better mental health outcomes compared to both self-directed use of self-care tools as well as usual care. The team has also explored dyadic interventions involving family or friends in depression self-care to further enhance outcomes. The patient-centered approach promotes empowerment and active participation of older adults in decisions regarding their mental health and overall well-being. This model offers an option for older adults’ active management of mental health issues; and from work done using these tools on younger populations (e.g., depression in post-partum women and in cancer survivors), it appears that what is learned from using the tools may be applied preventively in later life. At the end of this session, participants will: 1. Describe the components in a supported mental-health self-care intervention. 2. Understand how supported mental-health self-care interventions can be adapted to various clinical populations. 3. Describe the outcomes of studies having evaluated supported mental-health self-care interventions. Dr. Mark Yaffe is a Tenured Professor of Family Medicine at McGill University, a Full Scientist at St. Mary's Research Centre and a practicing family physician at the St. Mary's Family Medicine Group. Dr. Yaffe maintains a large family practice and has received the Quebec College of Family Physicians’ Award of Excellence for his work as a clinician. He is also the recipient of a Lifetime Achievement in Family Medicine Research Award from the College of Family Physicians of Canada, and an early inductee into the McGill Faculty of Medicine Honour Roll for teaching excellence. He led an interdisciplinary team that developed and validated the Elder Abuse Suspicion Index (EASI), a simple tool to assist family physicians in detecting elder abuse. The EASI has been translated into 17 languages and the World Health Organization has found it to be valid in a number of countries. Dr. Yaffe has also extensively studied family caregiving, depression and patient-self-care. Today, he speaks about the DIRECT program in which he has been involved for over 15 years. Dr. Yaffe and the DIRECT research team have recently been awarded a Seniors’ Mental Health Outstanding Care and Integrative Practice Award from the Canadian Coalition for Seniors' Mental Health.

This presentation will provide participants with an overview of Indigenous world view and perspectives of health and wellness; a view of Canadian colonial history and impacts from an Indigenous lens with an aim to facilitate discussion on understanding the importance of cultural safety in building relationships with Indigenous patients. At the end of this session, participants will: 1. Reflect on their culturally safe, personal practices of patient engagement. 2. Understand that cultural safety is a personal journey beyond attending cultural information workshops. 3. Appreciate Indigenous patients’ perspectives of seeking respectful provincial health services. Alex M. McComber is Bear Clan Kanien'keha:ka, a husband, father, and grandfather from Kahnawake Territory, Quebec. He is a community health activist, researcher and consultant; areas of expertise include diabetes prevention, Indigenous community-based participatory research, health promotion, community mobilization and mentorship, personal and community empowerment, Indigenous health and wellness, and research ethics. Alex was invited to join the McGill Dept. of Family Medicine in 2016 as an Assistant Professor to support the creation of an Indigenous Program within the Dept. of Family Medicine that focuses on Indigenous teachings and respectful knowledge exchange, cultural safety education in health research and care, and patient participation in health research. He has developed and delivered a graduate level course and lectures on Indigenous health research, Indigenous world view and culture, understanding colonial history and health impacts, and understanding cultural safety. He involved with various community, regional and national research endeavors including the Indigenous Health Centre of Tiohtia:ke urban Indigenous clinic; the Indigenous Expertise & Indigenous Patient Partner Circle and the McGill University Data Vaolorisaton Axis (both with the Quebec SPOR Support Unit); the Tahatikonhsontóntie' Network Environment for Indigenous Health Research (NEIHR); the Teionkwaienawa:kon Quebec Indigenous Mentorship Network (QIMNP); and the Indigenous Youth Mentorship Project (IYMP).

This presentation will help participants understand some of the challanges and barriers faced by immigrant women with breast cancer when accessing care. Population level data from Ontario demonstrating differences in quality of care measures for immigrant and non-immigrant women with breast cancer will be presented. At the end of this session, participants will: 1. Understand the differences that exist in quality of care measures between immigrant and non-immigrant women in Ontario. 1. Understand the limitations of the data available on immigrant populations and avenues for future research. Dr. Elena Parvez is a Surgical Oncologist at the Juravinski Hospital and Cancer Center in Hamilton, Ontario and Assistant Professor of Surgery at McMaster University. The focus of her clinical practice is in breast cancer surgery. She completed medical school and general surgery residency at McMaster University, and went on to complete a Surgical Oncology fellowship at McGill University. She attained a Master of Science from the University of Toronto, with training in both clinical trials and qualitative research. She is the recipient of the W.E. Noonan Fellowship early career award and the New Investigator Fund from Hamilton Health Sciences to support her research to build a better understanding of breast cancer care for immigrant women.

The BRILLIANT learning health care community focuses on patient-centered care through digital health and data feedback to focus care on individuals and their families' needs. Developed based on rehabilitation best practices, BRILLIANT integrates digital health tools for both patients and clinicians, aiming to enhance the quality of care for individuals with chronic conditions. Key features include a patient health portal, clinical information system, and various technologies to monitor and improve community-based rehabilitation. This system supports transitions from in-patient to community care, particularly for those with cardiovascular and neurological conditions. The program's multidisciplinary approach, involving healthcare, engineering, computer science, and other fields, emphasizes collaboration with patients, clinicians, and industry partners. This presentation will showcase BRILLIANT's role in setting new ways of approaching person centered care using data-driven, patient-centered rehabilitation care and its potential for broader application in healthcare. At the end of the session, participants will: 1. Understand the role and benefits of digital health in personalized healthcare, including clinical information systems and monitoring patient reported outcomes and mobility. 2. Discuss advancements in patient-centered care through multidisciplinary collaboration and data-driven approaches. Sara Ahmed, PT, PhD, is a Professor in the Faculty of Medicine and Health Sciences, McGill University, and a senior scientist at the McGill University Health Center. Professor Ahmed conducts research aimed at improving health outcomes for individuals with chronic diseases. Her research addresses the implementation of digital health solutions and patient-centered outcomes across trajectories of care to inform clinical and health system decision-making. She leads a research program in person-centered digital health research and is the Scientific Director of the international BRILLIANT learning health community project. She is an advisor for the Implementation of Patient-Centered Outcomes for the Quebec Strategy for Patient Oriented Research (SPOR). Professor Ahmed is leading the development of a provincial Digital Health Network that aims to advance the training of the next generation of digital health scientists and innovators, and accelerate the development, implementation, and evaluation of patient and clinician digital health solutions.