I am leading a pan-Canadian study of how pregnant and lactating people make decisions about using cannabis products during pregnancy and breastfeeding.

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 in Canadian women 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, and interact with healthcare providers will follow.

The final stage of this project is underway. We are currently recruiting prenatal health 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 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.

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.

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:

• the initiation of public funding for this new technology,

• ethics and policy considerations,

• women’s ethical perspectives,

• women’s decision-making processes,

• tensions between economic and ethical conceptions of value,

• involvement of industry in the provision and marketing of NIPT,

• clinician perspectives on the integration of NIPT into the publicly funded healthcare system in Ontario

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.