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Associate Professor and Canada Research Chair, Department of Family Medicine, McMaster University
Meredith Vanstone, PhD
Current Projects
I am leading a cross-provincial (Ontario and BC) study of how perceptions of Covid-19 risk and Covid-19 circumstance influenced health decision-making in pregnancy. This parallel mixed-methods study began in mid 2022, and the protocol is available here.
It has two objectives:
The quantitative strand will use a retrospective, quasi-experimental (pre-post) design to assess cohort differences in rates of clinical care and health outcomes. Using administrative data from ICES (Ontario) and PopulationData British Columbia, we will compare health outcomes of three cohorts, which we will pair with the Canadian Index of Multiple Deprivation to explore the influences of demographic and socioeconomic variables. The qualitative strand uses a qualitative descriptive approach to interview people who have given birth during the pandemic about their changing circumstances, risk perception, and decision-making process relevant to vaccination, perinatal care, social support and mental health. Data integration will occur during design and interpretation.
Contact: pregnancy@mcmaster.ca
Funded by Canadian Institutes of Health Research
I am leading a pan-Canadian study of how pregnant and lactating people make decisions about using cannabis products during pregnancy and lactation.
Cannabis is the most commonly used non-prescribed substance in pregnancy, but we know very little about the maternal and neonatal outcomes of use, have little evidence about motivations for cannabis use, and a clear prevalence of use of prenatal use in Canada has not been established. These gaps in information present a challenge of prenatal health care providers who seek to counsel women to make informed decisions about cannabis use during pregnancy and breastfeeding, and to facilitate harm reduction strategies.
pregnant peoplehealth care providers’here
In the second phase of the project, we interviewed 52 pregnant and lactating people about how they made decisions to continue, cease, or change their cannabis use. Our first publication, on reasons for cannabis use throughout perinatal stages, was published by the Canadian Medical Association Journal. Our second analysis of this project, recently published in the journal Birth, describes how pregnant people use information to make these decisions. Further analysis about how people consider and act to mitigate risk of perinatal cannabis use has recently been accepted by Women’s Health. Our final analysis will describe how clinicians and patients describe an ideal clinical counselling session about perinatal cannabis use.
The final analysis for this project is underway. We interviewed prenatal clinicians and social care providers about the challenges they experience when counselling pregnant and lactating people about cannabis use.
Contact: canpreg@mcmaster.ca
Funded by the Canadian Institutes of Health Research
With Drs. Melissa Kimber and Donna Stewart, I am co-leading an evaluation of the impact of Family Violence education materials.
We have completed an environmental scan of existing resources, which is available on our project website. A discourse analysis of these materials is forthcoming in Violence Against Women.
A description of the project is available here.
Contact: Ilana Allice (allicei@mcmaster.ca)
Funded by the Public Health Agency of Canada
With Dr. Julia Abelson, I am co-leading a pan-Canadian study of patient partners and advisors within the health system.
This three year study will look at how the patient partner role has been conceptualized and operationalized across the health system. The aim of this study is to address a critical gap in the patient engagement field, which is our lack of understanding of the origins, motivations, defining features, anticipated contributions, and experiences of the patient partner and advisor role in the Canadian health system.
conceptualizedCanadian patient partners arehow Covid-19 impacted their workPublic and Patient Engagement Collaborative
Contact: Laura Tripp (mccamml@mcmaster.ca)
Funded by the Canadian Institutes of Health Research
Completed Projects
With Dr. Lawrence Grierson, I co-lead an evaluation of the Certificates of Added Competence (CAC), an education credential provided by the College of Family Physicians of Canada (CFPC) to recognize Family Physicians with enhanced skills in particular clinical areas.
This project focused on the CACs for Palliative Care, Care of the Elderly, Sports and Exercise Medicine, and Family Practice Anesthesia. We have also published on the implications of the CAC in Emergency Medicine. This research consisted of a multiple embedded case study of 6 different groups of Family Physicians across Canada, followed by a nation-wide survey of Family Physicians to confirm the propositions we developed in the qualitative work.
Our report to the CFPC is available here and our first paper on the impact of CACs is available through CMAJ Open. Our second describes the motivations of family physicians for pursuing enhanced skill credentials. Additional manuscripts about the particular CACs are linked above.
Conducted in partnership with the College of Family Physicians of Canada.
In collaboration with colleagues and graduate students, I conducted a program of research examining the use of power within the clinical learning environment. This work has generated multiple theses and publications on the following issues in the clinical learning environment:
Merit Rounds, October 2018
"Tackling abusive behaviours in the clinical workplace."
McMaster's Health Leadership Academy, September 2019
Funded by the Health Leadership Academy and Canadian Association of Medical Education.
With Dr. Deborah Cook, I’ve worked on a number of projects related to compassion and dignity at the end-of-life. The 3 Wishes Project is a clinical program which started at St. Joseph’s Healthcare Hamilton and is currently active in dozens of ICUs in North America.
Annals of Internal Medicineorganizational compassionempowering frontline clinical stafftangible keepsakes created through this programword cloudspersonal gifts in service of honouring patientsemphasized leadership decision-making that recognizes that “not everything that counts can be counted”3WP on organ donationpost-mortem sympathy cards
Non-Invasive Prenatal Testing (NIPT) is a morally complex technology that provides genetic information about a fetus as early as 10 weeks into gestation, by analyzing samples of cell-free fetal DNA obtained from maternal blood. It is a rapidly developing technology which has important ethical and organizational implications for health policy, health professional education and patient education.
I’ve worked with policymakers, patients, and clinicians to generate social and ethics evidence about this technology for 5 years. This work came to fruition in 2018 when I participated in generating evidence to support a recommendation to the Ontario Ministry of Health and Long-Term Care about the public funding of NIPT in Ontario. My work in this area has been supported by funding from the Government of Ontario and the Canadian Institutes of Health Research.
With this funding, I conducted primary research about NIPT in Ontario, publishing papers about:
I have also participated in research examining the implementation of NIPT in the Netherlands, Quebec, and Lebanon.
I have actively engaged as an expert consultant with several decision-maker bodies including the Provincial Council of Maternal and Child Health, the Ontario Genetics Advisory Committee and the Ontario Health Technology Advisory Committee.
This work built upon my doctoral work on counselling models, patient education materials, and discursive implications of health professional counselling about Integrated Prenatal Screening.
Socially and morally complex decisions during pregnancy have long been of interest to me. Beyond my work about prenatal testing and cannabis use during pregnancy, I have also participated in research about:
I continue to use reproductive and prenatal care as a fruitful topic to study how policies impact health professional practice and healthcare.
Since my postdoctoral fellowship in 2013, I have been interested in the ways in which health policy decision-makers gather and incorporate social and ethics evidence into decisions about health programs and technologies.
As part of this work, I established partnerships with health technology policy-makers to produce social and ethics evidence to support their considerations about the funding and implementation of particular health technologies. I did this by producing qualitative evidence syntheses on topics such as:
This work has also generated methodological contributions about qualitative evidence synthesis reporting and quality appraisal.
Meredith Vanstone,
Associate Professor, Department of Family Medicine
DBHSC 5001F, McMaster University
100 Main St. W., Hamilton, ON L8P 1H6
Meredith.Vanstone@mcmaster.ca
I am leading a pan-Canadian study of how pregnant and lactating people make decisions about using cannabis products during pregnancy and lactation.
Cannabis is the most commonly used non-prescribed substance in pregnancy, but we know very little about the maternal and neonatal outcomes of use, have little evidence about motivations for cannabis use, and a clear prevalence of use of prenatal use in Canada has not been established. These gaps in information present a challenge of prenatal health care providers who seek to counsel women to make informed decisions about cannabis use during pregnancy and breastfeeding, and to facilitate harm reduction strategies.
The project begins with two systematic reviews of evidence on pregnant people and health care providers’ experiences, opinions, and beliefs about this topic. You can view a keynote presentation on this first systematic review here.
In the second phase of the project, we interviewed 52 pregnant and lactating people about how they made decisions to continue, cease, or change their cannabis use. Our first publication, on reasons for cannabis use throughout perinatal stages, was published by the Canadian Medical Association Journal. Our second analysis of this project, recently published in the journal Birth, describes how pregnant people use information to make these decisions. Further analysis about how people consider and act to mitigate risk of perinatal cannabis use has recently been accepted by Women’s Health. Our final analysis will describe how clinicians and patients describe an ideal clinical counselling session about perinatal cannabis use.
The final analysis for this project is underway. We interviewed prenatal clinicians and social care providers about the challenges they experience when counselling pregnant and lactating people about cannabis use.
Contact: canpreg@mcmaster.ca
Funded by the Canadian Institutes of Health Research
With Drs. Melissa Kimber and Donna Stewart, I am co-leading an evaluation of the impact of Family Violence education materials.
This cross-Canada project will implement and evaluate the VEGA materials, which aim to help health and social service providers recognize and respond to people who have experienced Family Violence. The protocol for this project is available here.
We have completed an environmental scan of existing resources, which is available on our project website. A discourse analysis of these materials is forthcoming in Violence Against Women.
Analysis for the second phase of the project is ongoing, with some initial publications detailing resident physician understanding of child maltreatment (here), and the implications of online child maltreatment education for healthcare and social service providers (here).
A description of the project is available here.
Contact: Ilana Allice (allicei@mcmaster.ca)
Funded by the Public Health Agency of Canada
With Dr. Julia Abelson, I am co-leading a pan-Canadian study of patient partners and advisors within the health system.
This three year study will look at how the patient partner role has been conceptualized and operationalized across the health system. The aim of this study is to address a critical gap in the patient engagement field, which is our lack of understanding of the origins, motivations, defining features, anticipated contributions, and experiences of the patient partner and advisor role in the Canadian health system.
This project begins with a critical interpretive synthesis of existing evidence on how the patient partner role has been conceptualized. Next, we conducted a survey of over 500 Canadian patient partners. So far, we have published some information about who Canadian patient partners are and how Covid-19 impacted their work. Additional analyses are ongoing. The final phase of CPPS involves interviewing patient partners and organizational staff who work with patient partners. Data collection is in progress. Project updates will be available through the: Public and Patient Engagement Collaborative
Contact: Laura Tripp (mccamml@mcmaster.ca)
Funded by the Canadian Institutes of Health Research
By eliciting and implementing wishes that honour the identity and legacy of the dying patient, the 3 Wishes eases the grief of families and helps clinicians re-identify and connect with the meaningfulness of the work they do. We published the results of our evaluation in Annals of Internal Medicine, with a variety of other publications detailing the way that 3WP fosters an environment of organizational compassion by empowering frontline clinical staff to adapt to local needs and resources. We have also described the meaningfulness of the tangible keepsakes created through this program , such as word clouds, the benefits of clinicians finding ways to share their personal gifts in service of honouring patients, emphasized leadership decision-making that recognizes that “not everything that counts can be counted”, and described the influence of 3WP on organ donation and the impact of post-mortem sympathy cards.
While the research was completed in 2019, the clinical program continues to grow and expand. We have recently published a paper about the ways in which compassion and connection fostered by the 3 Wishes helps alleviate some of the trauma associated with death during the COVID-19 pandemic, when families are restricted from being physically present at the bedside of dying patients.