Family medicine announces new Canada Research Chair

Meredith Vanstone, associate professor in the Department of Family Medicine at McMaster University, has been named the Canada Research Chair (CRC) in Ethical Complexity in Primary Care.

Vanstone’s research aims to support patients and clinicians make difficult health care decisions, such as when evidence doesn’t exist or is inconclusive.

“Primary care providers are asked to counsel patients about health decisions where there are so many factors to consider,” says Vanstone. These include the patient’s values, finances, resources and circumstances. When patients face health issues without clear resolution, primary care providers are there to help them manage their symptoms and life over the long term.

“These situations can provoke feelings of uncertainty or distress for both the clinician and the patient,” adds Vanstone.

With so much complexity, how can clinicians support their patients in making optimal decisions? Vanstone intends to clear the muddy waters with her research by pointing to practical changes to improve health outcomes. For example, training medical learners to identify areas of ethical complexity, structural changes to make more resources available or resources differently available, materials to help clinicians understand where patients get stuck in their trajectory or generating patient-centered perspectives on the right research question to study.

Vanstone studies a variety of different areas of health care, but one area of focus is prenatal care. Over the years she has explored topics such as non-invasive prenatal testing, perinatal cannabis use, and health decision-making in pregnancy during the COVID-19 pandemic.

“Pregnancy is a special time of life because the health decisions that a pregnant person makes can impact not just themselves but also their family as it currently exists and as it might change in the future,” says Vanstone. There’s also significant ethical complexity in pregnancy, including moral and decisional complexity.

Moral complexity occurs when one must make a health-care decision that impacts other people. Vanstone’s team found that people who wanted to use cannabis while pregnant did so because they perceived significant benefits from using the substance, such as helping control nausea or anxiety.

“In the case of perinatal cannabis use, it’s about balancing the benefits perceived by the pregnant person and the potential of harm to the fetus. This is a difficult decision for many people to make because the potential for harm is unclear, but often the benefits are very well known to them,” Vanstone says.

Decisional complexity occurs when patients or clinicians need to make a decision when the evidence is not available, equivocal or conflicting, she explains.

During the COVID-19 pandemic, pregnant people had to make daily decisions — whether to eat in restaurants or shop in stores, invite friends over or have someone help take care of the baby — against growing evidence that people who are pregnant had more severe outcomes after contracting COVID-19.

“We have lots of population-level data about COVID-19 outcomes, but this kind of evidence is hard for an individual to apply to their own circumstances,” says Vanstone, especially when the situation is constantly evolving. “This leaves pregnant people having to constantly make very complex risk assessments about even the most ordinary and mundane aspects of their lives.”

Vanstone hopes that her research can improve the care that patients receive and improve the quality of professional life that clinicians are experiencing.