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

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. 

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. In this study, we aim to produce information and guidance on how to engage patients and other stakeholders in scaling up.

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 to be able to scale up an SDM innovation in home care across Canada.

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. The 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.

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.

ARIMED est un laboratoire de recherche de première ligne offrant la possibilité aux résidents en médecine de famille de raffiner leurs connaissances scientifiques ou de participer à des projets de recherche innovateurs. Il a été fondé en 2017 par le Dr Jean-Sébastien Paquette au sein du Groupe de médecine de famille universitaire de Saint-Charles-Borromée (GMF-SCB). Il est affilié au département de médecine familiale et de médecine de l'Université Laval (DMFMU) et au Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL) dont nous sommes une extension régionale. Nous avons créé une structure organisationnelle qui a pour but de favoriser l'épanouissement de la recherche de première ligne par l’enseignement, l'innovation et l'optimisation des trajectoires pour différents projets de recherche qui émergent de notre milieu ou qui sont réalisés en collaboration avec d'autres chercheurs.

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.

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.

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.

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). 

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.

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.

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.

Le programme Decision+2 s’est avéré efficace pour réduire le taux de recours à une antibiothérapie dans le traitement des IVRS en première ligne et ce, sans augmenter le taux de complications associées (1). Or, son applicabilité au département d’urgence était incertaine. En effet, les départements d'urgence sont des environnements chaotiques où l'achalandage est élevé et où la pression de voir des patients rapidement sont des facteurs importants à considérer lorsque l’on souhaite y implanter une nouvelle pratique (2). Grâce à l’utilisation d’un design centré sur l’utilisateur ayant impliqué 18 patients, plusieurs urgentologues de l’Hôtel-Dieu de Lévis et du CHUL et des designers graphiques de l’Université Laval, nous avons adapté l’outil d’aide à la décision au contexte de l’urgence. Cet outil d’aide à la décision est toutefois utilisable dans tous les milieux de soins. 

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. 

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.

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.  

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.  

La santé des populations autochtones (Premières Nations, Métis et Inuits) est un enjeu important à l’échelle canadienne. Les médecins de famille doivent être outillés et sensibilisés aux enjeux spécifiques rencontrés par ces clientèles. Fort d’un partenariat de plus de cinq ans avec le Centre de santé Masko-Siwin situé dans la communauté attikamekw de Manawan, le GMF-U Saint-Charles-Borromée offre aux résidents en médecine familiale une occasion unique de développer leurs aptitudes et compétences à offrir des soins appropriés aux patients vivant en communauté et à l’extérieur de la communauté. Tablant sur ce lien unique, le laboratoire ARIMED s’est donné comme axe de recherche prioritaire de promouvoir les projets en lien avec une meilleure compréhension des barrières auxquelles font face ces patients dans l’accès aux soins et sur les meilleures stratégies pour les surmonter. 

La recherche translationnelle est une science innovatrice en soi. Elle fait le pont entre deux réseaux de recherche afin d’optimiser les découvertes. Traditionnellement, la recherche fondamentale s’intéresse à effectuer des travaux expérimentaux ou à élaborer des théories dans le but d’acquérir des nouvelles connaissances sur les fondements des phénomènes et des faits sans qu’il y ait un but d’application pratique, il s’agit donc de travaux éloignés de la réalité clinique. D’un autre côté, la recherche en première ligne, qui consiste à effectuer des travaux ayant un impact réel sur le terrain, ne mets pas toujours à sa disposition les récentes découvertes fondamentales. L’écart entre les deux communautés de pratique est si grand que de nombreux travaux de recherche sont gaspillés et n’atteignent jamais le niveau de l’application des connaissances. Ce fossé est surnommé la « Vallée de la Mort » (Valley of death). Bien que ce surnom n’ait pas pour objectif de créer un scénario hollywoodien, il veut surtout représenter l’ampleur du problème. Le fait que peu de chercheurs s’y intéressent est un signe que chacun travaille dans son domaine sans bien connaitre les autres secteurs d’activité. Notre laboratoire développe la recherche translationnelle grâce à l’expertise du Dr Jean-Sébastien Paquette acquise dans le cadre du programme TUTOR-PHC (Transdisciplinary Understanding and Training on Research Primary Health Care). Nous élaborons une plateforme pour mettre en contact fondamentalistes, chercheurs, cliniciens et patients-partenaires. Ainsi, le fil conducteur qui relie tous ces intervenants constitue la richesse de la recherche translationnelle. 

L’obésité et les problèmes de santé associés constituent une réelle menace à la santé et à la vitalité des communautés dans le monde, en plus d’occasionner des coûts importants aux systèmes de santé. Ce qui est le plus inquiétant n’est pas le surpoids lui-même, mais également la maladie métabolique sous-jacente. Plusieurs facteurs (environnementaux, nutritionnels, activité physique, génétique et psychologiques) ont un impact métabolique important sur notre physiologie. De plus, il y a un lien entre l’obésité et plusieurs maladies chroniques dont l’hypertension, le diabète, les maladies cardiovasculaires et le cancer. Notre laboratoire s’intéresse à développer une expertise en santé métabolique à divers niveaux. Dans un premier temps, nous voulons implanter une clinique de première ligne en traitement et prévention de l’obésité et des problèmes de santé associés. Parallèlement, nous désirons approfondir les connaissances des mécanismes physiologiques et biologiques impliqués dans le syndrome métabolique afin d’intégrer des outils innovateurs de dépistage et de suivi en première ligne. Par conséquent, nous désirons travailler à optimiser les stratégies thérapeutiques à divers niveaux (physique, pharmacologique, psychologique, physiologique et biologique) pour les adapter au patient. 

La prescription de PIM chez la personne âgée de 65 ans et plus peut avoir de graves conséquences chez cette clientèle (augmentation de la mortalité et de la morbidité). Il existe plusieurs outils pour aider le clinicien à identifier et déprescrire ces médicaments (Voir les Outils de déprescription plus bas). Nous avons mené notre étude dans notre GMF-U en utilisant un de ces outils, les critères de BEERS, dont les résultats ont été publié dans La Revue de Gériatrie (voir le résumé ci-joint). Cette page d’information a été rendu possible grâce à une bourse de Réseau-1 Québec et grâce à la collaboration de l’équipe du Dre France Légaré. Laboratoire de recherche et d’innovation en médecine de 1ère ligne situé au GMF-U de St-Charles-Borromée. 

Shared decision making (SDM) is a process by which a healthcare choice is made by the patient, significant others, or both with one or more healthcare professionals. However, it has not yet been widely adopted in practice. This is the second update of this Cochrane review. This review aimed to determine the effectiveness of interventions for increasing the use of SDM by healthcare professionals. Authors considered interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both.