Department of Medicine Members Win 2024 Michael Smith Health Research BC Health Professional-Investigator and Scholar Awards

Dr. Stephen Chia, Professor, Division of Medical Oncology

Project: Understanding and Overcoming Disparity in Care of Breast Cancer Patients in Rural British Columbia

Patients living in rural BC face geographical inequalities in cancer care delivery and research. We have recently demonstrated a worse breast cancer survival for patients in rural BC. A gap exists in understanding, from patients and the health care system, the disparities in the care of breast cancer patients in rural BC.

The plan is to establish a research and training program with collaborative research in partnership with patients, health care practitioners, research scientists and program leaders involved in cancer care in the North. The program will involve patient informed research methodologies and prospective clinical trials. The plan is to also work collaboratively with the Indigenous breast cancer population in rural BC to develop a respectful and integrated holistic treatment strategy. KT activities will include patient education forums, CME events and updates to the BC Cancer policies.

Anticipated outcome include involvement of breast cancer trainees in the program. Novel and effective models of cancer survivorship care. Increased enrollment of rural patients into clinical research and trials. The impact would be a systemic approach to improve equitable delivery of BrCa care leading to improved outcomes in rural BC.

Dr. Denise Jaworsky, Clinical Associate Professor, Division of General Internal Medicine – Community

Project: Seeking Rural Equity by Increasing Rural Engagement in Clinical Trials: An East Kootenay Clinical Research Program

Clinical trials play a key role in medical advances, helping to identify new treatments or improved ways to treat illnesses. Clinical trials generate information that can guide treatment decisions. By participating in clinical trials, individuals may have access to new treatment options for serious conditions. However, when clinical trials do not include people from rural areas, the knowledge generated may not be useful in rural settings. This program of research aims to help people in rural communities in the East Kootenay area have access to clinical trials. Partnerships with universities, major urban hospitals, and researchers across Canada (the Accelerating Clinical Trials Canada Consortium) will help East Kootenay Regional Hospital to build a program of research for people living in rural communities. This will enable people in the East Kootenay region to participate in certain clinical trials. Successes and lessons learned from this program will help other rural areas to build their own clinical research capacity with the goal of making clinical research in Canada more inclusive of rural populations.

Dr. Alyson Wong, Clinical Assistant Professor, Division of Respiratory Medicine

Project: Administrative-based case-finding algorithms to evaluate health inequities: a methodological framework and an application in progressive pulmonary fibrosis

The ability to study disease at the population level is required to understand the causes for delays in diagnosing a disease. Administrative data are collected when patients have an encounter with the healthcare system and are commonly used to identify individuals with disease. However, there is no way to specifically identify patients whose disease is getting worse over time and would benefit the most from treatment. The proposed research program will create a framework to develop algorithms that identify patients with worsening disease using administrative data. Research will start with people who have progressive pulmonary fibrosis (lung scarring conditions) and then extend to other common lung diseases. Using these algorithms to identify people with progressive lung diseases, we will then study health inequities that prevent people from receiving treatment. We will use these findings to inform health system and policy changes by working with patients, researchers, clinicians, and policymakers.

Dr. Andrew Ivsins, Assistant Professor, Division of Social Medicine

Project: Exploring the shifting landscape of medication-based drug treatment and safer supply in the fentanyl era: a research program to address the evolving overdose crisis in BC

Canada continues to grapple with an overdose crisis driven by illicitly manufactured fentanyl and novel psychoactive substances (e.g., etizolam, xylazine). The drug treatment landscape is rapidly evolving in response, and includes the implementation and expansion of a number of medication-based drug treatments (e.g., oral and injectable hydromorphone) and prescribed safer supply programs (SSP) that provide pharmaceutical alternatives to the toxic drug supply. However, socio-structural factors have impeded broader expansion and support, and SSP remain controversial with many healthcare providers expressing concern. This ethno-epidemiological research program will gather the views of people who use drugs, policymakers, and health system actors across BC to explore how individual, social, structural and environmental factors shape access to and outcomes from existing and emerging medication-based drug treatment programs and SSP. This is a critical opportunity examine the rapidly shifting drug treatment and overdose response landscape to better inform public health approaches to the ongoing overdose crisis. Knowledge gained will inform and guide future policy and public health developments to improve the lives of people who use drugs.

Dr. Kate Johnson, Assistant Professor, Division of Respiratory Medicine

Project: The Lifetime Exposures and Asthma Outcomes Projection Model (LEAP): A Platform for Improving Asthma Prevention in Canada

Asthma is the most common chronic disease among children in Canada. It has several main causes that occur in utero and early in life. These ‘risk factors’ can be reduced through public health interventions that prevent asthma before it develops. Despite the opportunity to drastically reduce asthma in Canada, little progress has been made on asthma prevention due to a poor understanding of which interventions to invest in and when they should be applied. The objective is to provide high quality evidence to patients, providers and policy makers on how healthcare resources can best be used to prevent asthma in children. This research program will accomplish its objective using a computer simulation model of asthma (the Lifetime Exposure and Asthma Outcomes Projection [LEAP] model), which simulates the development and life trajectory of asthma. We will evaluate a series of preventative interventions that patients and knowledge users have identified as priorities, and determine their lifetime health benefits and impact on the healthcare system. We will work closely with patients, providers and policy makers to make sure the resulting policy recommendations are aligned with their values and can be implemented in healthcare systems.

Dr. Hudson Redden, Assistant Professor, Division of Social Medicine

Project: Evaluating the impact of cannabis exposure and access on substance use trajectories among people who use unregulated drugs during the fentanyl era

The impact of cannabis access and use on the development of high-risk substance use behaviours remains controversial during the opioid overdose crisis. To address this knowledge gap, our research aims to identify how cannabis access and use impact early substance use careers, including the use of opioids, stimulants and injection drug use among at-risk youth; analyze how cannabis access and use impact overdose, as well as risk factors for overdose (e.g., binge opioid use) among high-risk subgroups of people who use drugs (e.g., people with chronic pain, HIV); and characterize how cannabis use impacts engagement and effectiveness of addiction treatments. We will also investigate how cannabis use intentions (e.g., recreational vs. therapeutic use) shape addiction treatment outcomes.

This project will analyze data from three studies (N=3,375) of people who use drugs (PWUD). Established partnerships with the BC Ministry of Health and community groups of people with living experience of substance use will support the production of scientific evidence, policy briefings and community resources that will be important to inform clinical and public health practice, as well as policy responses to the overdose crisis during the fentanyl era.