Meredith Vanstone, PhD

Meredith Vanstone, PhD

Associate Professor and Canada Research Chair, Department of Family Medicine, McMaster University

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Current Projects

With Dr. Julia Abelson, I am co-leading a pan-Canadian study of patient partners and advisors within the health system.

 

This multi- year, Pan-Canadian 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. Cara Evans led a sub-analysis to examine how the literature in mental health and addictions describes the history of service user involvement. 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 of survey data describe perspectives on patient partner compensation and conceptions of expertise. The final phase of CPPS involves interviewing patient partners and organizational staff who work with patient partners. Data collection is nearly complete. 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

With co-lead Dr. Arthur Sweetman, I am conducting a study on pay gaps in Family Medicine across Canada. We, and others, have previously established a gender gap in net earnings for Canadian physicians. In this mixed-methods study we use a variety of data sources (Survey, Census, Canada Revenue Agency Data) to better describe pay gaps related to gender, race, location of training, and immigration status.

 

I am also leading a qualitative study of Ontario family physicians which aims to explain our quantitative findings. Data collection is nearly complete and analysis is under way.

 

Contact: paygap@mcmaster.ca

Funded by the Canadian Institutes of Health Research

Several years ago, I conducted a medical education project with a number of family physician colleagues about the optimal role for “indirect patient care activities”, or paperwork, in family medicine residency training. While we didn’t set out to study the practice decisions that family physicians make in response to the growing administrative burden of indirect care, this was a clear finding of the study. Family medicine residents told us repeatedly that the administrative burden of comprehensive practice was influencing their decision to practice in a focused way.

 

In Fall 2024, we received funding to study the relationship between administrative burden and practice decisions in Family Medicine. This project focuses specifically on the administrative work related to managing a clinical inbox and the referral process. With Co-Lead Dr. Lawrence Grierson and a pan-Canadian team of investigators, we will conduct a systematic review, analyze referral forms, observe family physicians doing this work, and interview family physicians and other specialists who participate in the referral process.

 

Contact: ipca@mcmaster.ca

Funded by the Canadian Institutes of Health Research

 

Completed Projects

I am leading a cross-provincial (Ontario and BC) study of how perceptions of Covid-19 risk and Covid-19 circumstances influenced health decision-making in pregnancy. This parallel mixed-methods study began in mid 2022 was completed at the end of 2024. The protocol is available here.

 

It has two objectives:

  1. Quantitative strand: Describe differences between 2019, 2021, and 2022 pregnancy cohorts relative to key outcomes and quality of care indicators related to vaccination, perinatal care (length of hospital stay, gestational diabetes screening participation), mental health and social supports. Examine the differential impacts on racialized and low-income pregnant people.
  2. Qualitative strand: Understand how pregnant people’s perceptions of COVID-19 risk influenced their decision-making about key elements of pregnancy, including vaccination, perinatal care, social support and mental health.

 

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 health administrative data, 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.

 

We have published much of this work, with additional analyses still to come:

 

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 patients to make informed decisions about cannabis use during pregnancy and breastfeeding, and to facilitate harm reduction strategies.

 

The project began with two systematic reviews of evidence on pregnant people and healthcare 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, published in the journal Birth, describes how pregnant people use information to make these decisions. A third analyses describes how people consider and act to mitigate risk of perinatal cannabis (Women’s Health). Finally, we interviewed 23 clinicians who provide pregnancy and lactation care, and combined these datasets to consider how prenatal clinicians and patients interact around cannabis consumption.

 

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 has been published 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), the implications of online child maltreatment education for healthcare and social service providers (here), and stakeholder suggestions for training physicians to address intimate partner violence (here).

A description of the project is available here.

 

Funded by the Public Health Agency of Canada

 

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:

 

 

“Power, Hierarchy, Mistreatment & Abuse in the clinical environment: Welcome to the dark side of medical education.”

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.

 

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 how 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:

 

 

 

 

 

 

 

 

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.