Dr. Arminee KazanjianProfessor, School of Population and Public HealthFaculty of MedicineUniversity of British Columbia

Telephone: 604-822-4618Email: a.kazanjian@ubc.ca Website: http://www.spph.ubc.ca/?p2=/modules/hce/faculties/faculty.jsp&fId=27

CURRENT PROGRAM OF RESEARCH

The CIHR Team for Supportive Cancer CareFunded by Canadian Institutes of Health Research (CIHR)

Twenty to forty percent of people with a diagnosis of cancer will experience significant distress. Canadians have said they wish to see improved access to quality cancer care. Studies by advocacy groups describe the cancer care system as complex and difficult to navigate. In response cancer care systems are working to implement improved access to supportive care strategies. Supportive cancer care is care that helps the patient and their family cope with cancer from pre-diagnosis, through the process or diagnosis and treatment, to cure, continuing illness or death and into bereavement. In Canada, supportive cancer care is not always available to those most in need.

Some provinces have established cancer patient navigation programs. Other provincial cancer care systems are experimenting with on line technologies to increase access. These areas are new and have not been extensively researched.

Our team works on increasing access to supportive cancer care by 2 main strategies: patient navigation and use of on line technologies. We are also researching the medical cost offset involved in using supportive care.

We propose that providing supportive care will reduce anxiety in cancer patients, help them maximize the effects of treatment and reduce overall medical and hospital costs. We are interested in developing methods to screen for supportive care needs to provide the right kind of support for individuals. We want to learn about new methods to monitor outcomes of cancer survivors to ensure the system is providing the right kind of care at the right time.

Our team is composed of researchers, administrators, decision makers, clinicians and cancer survivors. We work in 6 provinces of Canada: BC, Alberta, Manitoba, Ontario, Quebec and Nova Scotia. Many of our members are active in the Canadian Strategy for Cancer Care and are working hard to transform the experience of cancer care to meet the person’s unique needs.

Palliative Care in the Cross Cultural Context:A NET for Equitable and Quality Cancer Care for Culturally Diverse PopulationsFunded by Canadian Institutes of Health Research (CIHR)

While Canadians value their health care system and expect that excellent care remains a right of every Canadian, the Subcommittee to update “Of Life and Health” (2002) reports that “at present the provision of end-of-life care is characterized by uneven access to services, and disruptive and ineffective care leading to substandard outcomes.” Moreover, 75% of Canadians die in hospital in spite of a recent poll indicating that 90% of Canadians wish to remain in their own homes during the final stages of life and the fact that an acute care hospital bed is the most expensive resource in our health care system.

A. Kazanjian Research Summary http://www.spph.ubc.ca/?p2=/modules/hce/faculties/faculty.jsp&fId=27

An integrated, comprehensive and quality approach to end-of-life care is crucial and it must address patients’ and families’ needs beyond the physical to encompass the psychological, social, cultural and spiritual determinants of health. Cancer cannot be understood separated from its cultural meanings and this is more critical at the end-of-life (EOL). Cultural meanings shape how individuals make meaning out of illness, suffering, and dying. Canada is a nation that has becoming increasingly multi-ethnic and multi-cultural and consequently the risk of cross-cultural misunderstanding during patient/family and health care provider encounters is increasing. Not surprisingly, current literature indicates that most of the dissatisfaction, even suffering, associated with EOL care is associated with poor or inadequate communication leading to mistrust and poor health outcomes.

The development of a number of research networks in Canada, notably the Sociobehavioural Cancer Research Network (SCRN) – with our BC team being of its four Satellite Centres – provides insight regarding the contributions national networks can offer. Our team incorporates proven approaches in establishing new research networks to create a multidisciplinary team of researchers committed to foster excellence in palliative and end-of-life (PC/EOL) care and nurture trainees and new investigators interested in this field.

CURRENT RESEARCH PROJECTS

Who Will Care In The End: A Pan-Canadian Study Of Palliative Care ProvidersFunded by Canadian Institutes of Health Research (CIHR)

The research will first identify care providers among whom palliative care is a component of their work and describe the range of their duties and workload, their formal and informal experience and credentials, and their work settings. As well, recent qualitative research has examined caregiver suffering from unrelieved cumulative grief, but this basis of knowledge is narrow with gaps existing in the current understanding of compassion satisfaction and compassion fatigue among care providers in palliative care settings. Although the triggers and impact of compassion satisfaction, compassion fatigue, and stress among care providers in palliative settings have been the subject of some study, these studies are few in number and often plagued by methodological issues, inconsistent definitions and analytical techniques, poorly validated instruments, or an excessively narrow analytical focus. A new Canadian survey instrument will be developed and applied to reliably assess Compassion Satisfaction and Compassion Fatigue among providers of palliative care across Canada. Given the crucial role of these individuals, the results of the analysis will help to identify strategies for intervention and prevention of the adverse outcomes of compassion fatigue and assist in the development of policies and programs to enhance the positive outcomes of compassion satisfaction.

A Methodology To Understand Care Screening Behaviour Of Culturally Diverse Populations: A Feasibility Study Using Administrative DataFunded by Canadian Institutes of Health Research (CIHR)

Immigrants represent 18% of Canada’s population. They bring with them health beliefs and practices that are different from those in their new adoptive country; these differences need to be better understood in order to develop better programs and policy to serve these diverse communities. There is some evidence that minorities and immigrants in British Columbia have lower rates of participation in breast and cervical cancer screening services, but data used in existing studies have limitations. The proposed study will enhance available data for research on the subject by linking administrative databases. The immigration records of all immigrants who arrived in BC between 1990 and 1995 will be linked to the databases from the province’s screening mammography and Pap testing programs from 1990 to 2004. The linkage results in a database that allows researchers to examine the differences in utilization of cancer screening services by immigrant women and the relationship between utilization of the two types of screening. Attention will also be paid specifically to Chinese, South Asian and Filipino women who comprise the majority of recent immigrants to BC. Such knowledge will inform policy and program development and contribute to health promotion and cancer prevention among culturally diverse populations.

A. Kazanjian Research Summary http://www.spph.ubc.ca/?p2=/modules/hce/faculties/faculty.jsp&fId=27

Assessing Timely Access To Health Care For NewcomersFunded by Canadian Institutes of Health Research (CIHR)

One in six people in Canada is an immigrant, a proportion that does not include students, refugee claimants (approximately 30,000 to 40,000 persons per year) and other temporary residents. This large group of newcomers in turn includes a spectrum of cultures, educational backgrounds and migration histories. The ability of newcomers to access health care in a timely manner is of utmost importance to addressing the various health needs among this group. Certain subgroups of newcomers have been shown to suffer more from certain illnesses, including diabetes, mental health issues, and specific cancers. Refugees form an important sub-group of immigrants in that they are at higher risk for several known determinants of poor health including poor nutrition, reduced social support and histories of abuse. Unfortunately, barriers in access to care due to language and navigability of the system have been documented among newcomers. The main goal of this study is to contribute to the body of knowledge regarding immigrant health and health service utilization. A particular focus will be placed on refugees to Canada who are not immediately covered by provincial health insurance, a group consisting primarily of refugee claimants. Additionally, particular attention will be paid to preventive and ambulatory care sensitive chronic conditions (certain cancers, diabetes, etc.), as well as mental and reproductive health. First and foremost, however, this study will assess the feasibility and ht practicality of using a new data source for the purposes of such an analysis.

Gender And Blindness: Testing Gender-Specific Community Interventions In Upper EgyptFunded by Canadian Institutes of Health Research (CIHR)

Egypt has sufficient clinical capacity to restore vision to most of its approximately 800,000 blind people, two-thirds of who are women and almost all of who live in poverty. Despite this technical capacity, rural populations rarely use these urban and suburban services, even if the services are free. We study the cost – effectiveness of a community strategy to reduce blindness, particularly among women living in poverty, that packages eye health with acknowledged women’s health needs, within the National Mother and Child Care Program. The proposed project is a one year, prospective, controlled observational study testing community interventions to increase eye service utilization in Menia District (total population 104,000). Outcome measures are service utilization, visual function, and cost. The project focuses on utilization of existing eye care services. It adds training of community women, in leadership roles, to take advantage of those eye care services, both initially during the one year study and as a sustainable focus for healthy women, both as mothers and daughters. The findings from this project will form the basis for a larger integrated community eye and population health program in Upper and Lower Egypt.

CURRENT RESEARCH AFFILIATION

Research Associate – BC Cancer Agency: Sociobehavioural Research CentreHistory: Founded in 2003, the Sociobehavioural Research Centre (SRC) co-ordinates research under the BC Cancer Agency’s Cancer Rehabilitation Network. Contributing to the development of programs and research priorities that are consistent with the Canadian Strategy for Cancer Control’s priority action to Rebalance Focus, SRC research focuses on psychosocial oncology, cross cultural health care, palliative and end-of-life care, oncology nutrition, lifestyle and population health.

Vision: The SRC envisions a patient-centred cancer care system that integrates evidence-based knowledge of psychological, social, cultural and behavioural dimensions into all aspects of the cancer control continuum – from prevention to diagnosis to treatment to survival and palliative care – in order to improve the quality of life for patients, their families and caregivers.

Mission: To provide leadership on quality of life issues by generating, translating and disseminating knowledge to support evidence-based practice of cancer patients’ physical, social, cultural, spiritual, psychological, nutritional, informational and practical needs.

A. Kazanjian Research Summary http://www.spph.ubc.ca/?p2=/modules/hce/faculties/faculty.jsp&fId=27

Goals: The SRC maintains national partnerships with multidisciplinary researchers, health practitioners and community organizers in order to:

• Develop cost-effective, evidence-based psychological care interventions by conducting cutting-edge multidisciplinary research with a focus on clinical applications;

• Provide provincial leadership for psychosocial oncology by researching, translating and disseminating quality standards of management for cancer patients’ biopsychosocial needs;

• Facilitate cross-disciplinary learning and uptake of psychosocial ‘best-practices’ among current and new generation cancer care providers, including physicians, nurses and therapists;

• Conduct collaborative, multidisciplinary research to develop a more comprehensive and holistic patient-centred model of care where psychosocial interventions are part of the adjuvant therapy offered to improve patient symptom management and quality of life.

SOME RECENTLY COMPLETED STUDIES

1. Labonte, R., Packer, C., Klassen, N., Kazanjian, A., Apland, L., Adalikwu, J., Crush, J., McIntosh, T., Schrecker, T., Walker, J., Zakus, D. “The Brain Drain of Health Professionals From Sub-Saharan Africa to Canada.” Southern African Migration Project (SAMP), IDASA and Queen’s University, and Institute of Population Health, University of Ottawa; Kingston and Ottawa, Ontario; 2006; 83 pages.

2. Kazanjian, A., Weinerman, B., et al. “Developing a teleoncology program: Where the will finds a way.” E-Health 2008: Extending the Reach, Canada’s Health Informatics Association (COACH)/Canadian Institute for Health Information (CIHI); Vancouver, BC; May 2008.

3. Kazanjian, A., Bosma, H., Apland, L. “Understanding Culture in Palliative Care: Using systematic reviews for theory building.” 2007 CAHSPR Conference, Toronto, ON; June 13, 2007.

4. Slocum, S., Kazanjian, A., Bosma, H., Apland, L. “A systematic review of complementary and alternative medical (CAM) therapies within palliative care and end-of-life treatment.” Taking Difference into Account: Issues of Diversity in Psychosocial Oncology, Canadian Association of Psychological Oncology (CAPO) 2008 Conference; Halifax, NS; May 2008.

A. Kazanjian Research Summary http://www.spph.ubc.ca/?p2=/modules/hce/faculties/faculty.jsp&fId=27