Capstone research projects database
The Capstone research project is where students work on real-world issues.
See the Capstone projects TRP students have worked on over the years.
STAMPS: Strategies to Access Mental-health Perinatal Services
The STAMPS study explores the mental health care pathways of birthing parents and providers in Toronto, identifying structural, process, and contextual barriers to support for perinatal depression and anxiety using the Donabedian framework.
Background
The STAMPS study investigated the mental health care experiences of birthing parents and healthcare providers within Toronto, with a specific focus on perinatal depression and anxiety. We aimed to understand the barriers and facilitators to mental health support and uncover the resources available for birthing parents who are experiencing perinatal depression or anxiety.
Perinatal mood and anxiety disorders are a spectrum of mental health conditions affecting individuals during the perinatal period, spanning the entire pregnancy and up to one year after childbirth. Perinatal depression, one of these conditions, is the most common complication of childbirth. In addition, perinatal anxiety is another common condition and is a strong predictor of postpartum depression.
In Canada, perinatal depression and anxiety symptoms are estimated to affect around 23% of women, yet not everyone who experiences these conditions talks to someone about their mental health. In fact, only around 50% of those who do reach out for help talk to a professional!
Even with the high number of people affected, there are no formal screening guidelines for perinatal depression or anxiety in Canada. However, as other countries have shown, the problem may not be with screening but with referral networks, available resources, or follow-up.
Before creating solutions to improve perinatal mental health in Toronto, we need to understand the mental health care pathways of birthing parents who experience perinatal depression or anxiety and of healthcare providers who offer perinatal services. This is the gap we aimed to fill. Birthing parents in Toronto are currently experiencing the burdens of untreated perinatal depression and anxiety.
Our objective was to discover the mental health care pathways of birthing parents and the current perinatal mental healthcare support systems in Toronto. By understanding the mental health care journey of birthing parents, we aimed to identify gaps in perinatal mental health care in Toronto. To ensure inclusivity of sex and gender diversity, this study was open to any individual who had given birth or was pregnant, and who self-identified as a woman or mother, including those who identify as transgender, transsexual, two-spirited, androgynous, agender, intersex, bigender, gender questioning, gender fluid, non-binary, genderqueer, or gender-non-conforming.
In terms of healthcare providers, we included professions that are part of the perinatal circle of care, including nurses, psychiatrists, family doctors, neonatologists, midwives, obstetricians, social workers, and doulas. The study relied on one-on-one semi-structured interviews with birthing parents and healthcare providers to gather their lived experiences with perinatal mental health care. We collected information about symptom awareness and diagnosis, as well as how they found support services for perinatal mental health, what services they found, the treatments or services offered for perinatal mental health, and whether these services were beneficial for the treatment of their mood disorders.
Common themes between care pathways were highlighted and analyzed. Given the complexity of the Canadian healthcare system, we needed a conceptual framework to categorize our exploration including barriers and facilitators to perinatal mental health service and care delivery.
We decided to use the Donabedian Model, which we combined with context of care to organize these themes into the following main categories:
- Structure - represents the attributes of the settings in which care occurs like resource access and wait times
- Process - denotes the exchange between patients and providers, such as perinatal mood disorder diagnosis and care management https://sydneytaylor58.wixsite.com/stamps
- Outcome - represents the effects of care on the health status of patients, such as mental health awareness and patient satisfaction
- Context of care - individual influences on perinatal mental health care, such as social determinants of health and mental health stigma
Project team
- Dr. Nancy Mingo
- Dr. Ayeshah Mohiuddin
- Sydney Taylor
- Susan Elizabeth Zelko
TRP supervisors
See our community directory for more on committee members.
The 1 in 5 Perinatal Mental Health Project; Understanding Clinician awareness in Ontario (Kanadario) of a Treatment Pathway devised to assist patients and clients suffering from Perinatal or Postpartum Mood and Anxiety Disorders (PMAD)
This mixed-methods study evaluates Ontario clinicians’ awareness and uptake of the PCMCH Care Pathway to improve treatment of perinatal mood and anxiety disorders.
Background
Mental health resources and clinicians available to provide timely and cost-effective treatment have diminished as the number of individuals requiring care has steadfastly risen in the province of Ontario. (1,) Individuals in the perinatal period, which spans from conception to the first year following childbirth, are no exception. In 2019 the Maternal Mental Health Survey conducted by Statistics Canada showed 23% of respondents, or circa 1 in 5, reported symptoms in line with the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) definition of mood disorders depression and anxiety (1, 2) Research from all provinces and territories across Canada is definitive that perinatal mood and anxiety disorders (PMAD) are neither uncommon nor insignificant and that the repercussions that follow are far-reaching and profound to both birthing person and their infant.(3,4,5,6,7)
The 1 in 5 Perinatal Mental Health Project is a mixed-method cross-sectional study in survey format which aims to evaluate clinician awareness and uptake of the Provincial Council for Maternal and Child Health (PCMCH) Care Pathway for the Management of Perinatal Mental Health published in July 2021(8). The 1in 5 Perinatal Mental Health Project assumes an iterative process analyzing the PCMCH treatment pathway usage and how this may influence perinatal care providers in Ontario and impact their patient’s health and well-being. Data collected can be used to inform further development of treatment options that are accessible, timely and beneficial to clinicians and birthing persons suffering from PMAD.
Project team
- Suzan Lorenz
TRP supervisors
Project advisory committee
- Sabrina Kolker
- Rohan D'Souza
- Kristin Horsley
See our community directory for more on committee members.
The ADAPTS Project: Advancing Diabetes Care for Adolescents preparing for healthcare transition in Saskatchewan
This study explores the transition needs of adolescents with type 1 diabetes in Saskatchewan, highlighting key support gaps and priorities to inform the development of a formal transition care program.
Background
The transition from pediatric to adult care for adolescents with type 1 diabetes mellitus is a particularly challenging and vulnerable period, leaving adolescents at high risk for deterioration of their physical and mental health. Transition programs have been shown to support adolescents, improve their quality of care, and minimize negative health consequences related to transition. Currently, however, no formal transition support program exists in Saskatchewan for adolescents with diabetes. This survey-based exploratory study examined perspectives, anticipated challenges, and needs for transition of adolescents with type 1 diabetes followed in the LiveWell Pediatric Diabetes Program in Saskatoon, Saskatchewan and their caregivers. Respondents identified the need for supports to facilitate increasing adolescent independence and negotiation of responsibility for diabetes-related tasks between adolescents and their caregivers. Education regarding smoking, substance use, and sexual health needs to be improved. Adolescents and their caregivers also conveyed the need for information about their future adult diabetes care provider, wanting to meet them in advance, and their preference of in-person individual meetings to facilitate transition readiness. These findings, which better our understanding of transition challenges and needs, will be instrumental in guiding further transition care initiatives to minimize gaps in care, reduce patient and family anxiety related to transition, and improve adolescent health and independence.
Project team
- Katherine Backman
TRP supervisors
Project advisory committee
- Mark Inman, MD
- Ryzel Shulman, MD
See our community directory for more on committee members.
The Effects of the Recent COVID-19 Pandemic on Solid Organ Transplantation: An Essential Medical Service
This qualitative study explores how stakeholders at the Multi-Organ Transplant Program (MOTP) at Toronto General Hospital adapted to disruptions in care during the COVID-19 pandemic.
Background
The saturation of healthcare services during the COVID-19 pandemic has imposed multiple challenges on healthcare delivery, with disruption across all essential medical services. One such service that has been impacted at-large is organ transplantation.[1] The COVID-19 pandemic has affected not only processes related to donors or recipients, but also the administration of resources in the healthcare systems, mental health of different stakeholders, safety of healthcare professionals (HCPs), ways of communicating, and research activities, amongst others.[2] This project aimed to understand how various stakeholders at the MOTP at TGH in Toronto, Canada, were affected by and responded to the COVID-19 pandemic. These findings may be used to inform and contribute to improved healthcare delivery responses and strategies during times of systemic strain on the healthcare system. This project employed a qualitative approach to understand and compare organ transplantation processes at the MOTP before and during the COVID-19 pandemic. A modified Journey Mapping Method – Organ Mapping – was employed to describe and visualize regulatory, institutional, and individual tasks and responsibilities along the organ transplant pathway, from donor to recipient. An initial draft of the Organ Map was designed using publicly available MOTP data, and then complemented after discussions with key stakeholders.
To further investigate the institutional, professional, and individual experiences of healthcare delivery among MOTP stakeholders, 1-hour-long semi-structured interviews were conducted. This project recruited a sample size of 16 participants from three cohorts: healthcare professionals (HCPs); administrative staff; and patients and families. Interviews were transcribed and analyzed by the TRP Capstone Team using thematic content analysis[3] to uncover key barriers and facilitators to organ transplantation during COVID-19. The interviews focused on changes to practices during the COVID-19 pandemic, including workflow, protocols, methods of communication, education and training, decision-making processes and priorities, and the use of clinical and administrative resources. The TRP Capstone Team synthesized and analyzed these data to learn from the experiences of participants in healthcare delivery during systemic strain, such as in a pandemic. We expect that our findings will help to identify areas (systemic, professional, and personal) that can be improved while enhancing best-practices and future optimization for the MOTP and healthcare delivery. The next steps of this project include the dissemination of the results through a publication in a peer-reviewed journal, report for all stakeholders, Capstone defense presentation, and presentation at an upcoming transplant conference.
Project team
- Fabricio Batistella Zasso
- Atina Boonchit
- Katherine Puerto Nino
- Sabrin Salim
TRP supervisors
Project advisory committee
- Alex Jadad
- Heather Boon
- Gary Levy
See our community directory for more on committee members.
The MEND (Meaningfully Empowering the Neurodiverse) Initiative: Helping Autistic Adults in the GTA Express their Mental Health Needs
The MEND Initiative is a student-led Capstone project within the TRP. Our goal is to collaborate with autistic adults (18 years of age and older) in the Greater Toronto Area (GTA) to develop an intervention that empowers them to express their mental health needs to their chosen healthcare provider(s).
Project team
- Katie Boddison
- Alena Moya
- Abitha Suthakaran
- Mouzhan Varshoueitabrizi
TRP supervisors
TransCoRe: Translational Success in Corneal Regenerative Medicine
Globally, 12.7 million people await corneal transplantation. Since only 1 in 70 are treated due donor tissue shortage, researchers have turned to regenerative cell-, tissue-engineering-, gene- and drug-based alternatives. However, despite decades of research, few have crossed the “valley of death” of translation to assume a well-defined role in the corneal blindness treatment paradigm. Today, corneal transplantation remains the gold standard therapy. The need to accelerate the translation of emerging regenerative therapies to overcome the burden of corneal blindness is clear. The problems is that there is no objective way to determine the translational potential of emerging therapies.
Background
Determining the translational potential of emerging therapies is essential both for deciding whether their development is worth pursuing and for building customized strategies to accelerate their translational progress. Our aim is therefore to develop a translational potential assessment tool for emerging cornea regenerative therapies. In this project, we will:
- Map the current rate of translation of corneal regenerative therapies, process bottlenecks, and factors predictive of translational success.
- Design a low-fidelity prototype of a translational potential assessment tool.
- And test the prototype to collect feedback from cornea researchers on concept, content, design and utility.
This tool would be the first of its kind and would directly impact cornea researchers, funding entities, and industry who must make resource allocation and directional decisions early in technology development. The ambition is to make safe and effective alternatives available to cornea-blind patients faster.
Project video
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Project team
- Cristina Bostan
TRP supervisors
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Transforming mental health in anesthesia education
Anesthesia residents have been reported to be at very high risk for developing mental health problems. There is a need to address mental health concerns in anesthesia residents.
Background
Anesthesia trainees are unique in that they work with a faculty member intimately one-to-one on a daily basis and this makes faculty key persons that can recognize those trainees in trouble. With the implementation of the new competency-based curriculum in 2017, this will entail a greater number of one-to-one assessments placing even more emphasis on the importance of faculty in maintaining resident wellness.
Project team
- Fahad Alam
- Clyde Matava
TRP supervisors
Project advisory committee
- Dr. Lisa Bahrey, Education Director, Department of Anesthesiology UHN-SHS
See our community directory for more on committee members.
Transitioning Cancer Follow-Up Care from Specialized Oncology Teams to Primary Care Providers
Oncology units at Princess Margaret are overburdened, and the integration of PCPs could ease the burden on the hospital. There is a need to test the validity and usability of an End-of-Treatment letter prototype, which aims to improve the communication barriers faced by oncology teams and PCPs. This project involves the iterative refinement of a tool for clinics at PM by embedding specific PCP feedback. In doing so, this project builds on existing literature to gather first-hand experiences, translated into a refined communication tool for use by PM to effectively optimize the communication between providers during this transition.
Background
Integrating cancer survivorship care with primary care providers (PCPs), specifically family physicians, may ease the burden on hospitals and allow cancer care specialists to focus on patients receiving primary treatment. This project aimed to examine the overall views of PCPs regarding their role in cancer survivorship care and identify the resources they require to effectively manage this responsibility.
The Toronto Translational Framework was used to guide the approach, identify the problem and need, verify the need, and test a prototype. This project employed a multi-method approach, including a survey distributed to family physicians for general perspectives on providing cancer survivorship care and semi-structured interviews to gather feedback on the end-of-treatment letter. Overall, 28 surveys and 9 interviews were conducted with family physicians. Findings from the surveys and interviews indicated a clear disparity in the communications between family physicians and oncology teams, with a need for a better definition of roles and improved information formatting of the end-of-treatment letter. A primary barrier towards optimizing the transition of patients is the lack of clinician buy-in and clinical support (e.g. human resources) to facilitate projects that address the communication barriers. To better understand the specific communication barriers, updating and validating a tool that could facilitate better communication, such as the end-of-treatment letter, could help optimize the transition of patients from specialized care teams back to their primary care providers and support better coordination of care.
Project team
TRP supervisors
See our community directory for more on committee members.
Understanding Peer Support Needs of Adolescents and Young Adults with Cancer in Pediatrics
This project explores how to design meaningful peer support for adolescents and young adults (AYA) with cancer, evolving from an initial idea into a translational, mixed-methods approach grounded in stakeholder input and system understanding.
Background
This project started with three colleagues in the same program who had an idea – to help teens with cancer in pediatrics. We had very different backgrounds and experiences; one geriatrician with subspecialty training in cognitive neurology, one mental health research project manager with experience transitioning youth from pediatric to adult mental health services, and one pediatric hematologist/oncologist with an interest in AYA oncology. The idea was born after a brainstorming session in which we discussed the results of an informal needs assessment study previously conducted at SickKids. Our initial plan was to design a solution to help teens with cancer connect to each other. The early phases of our project involved brainstorming ideas for solutions, and we were quite focused on social media as a platform and designing a physical space or “teen lounge”. However, from learning about translational research, we realized that: A) we needed to better understand this problem space and the needs of our population, and B) that we were jumping to solutions without actually knowing what patients want. From the literature, we also learned about the vastness of peer support possibilities. The initial informal interviews conducted did not contain nearly enough information or data on which to base our project, as it was too broad and not adequate to properly understand a specific patient need. We went back to the drawing board. We decided to focus on one area that was a suspected need based on the literature, first-hand experience, an environmental scan of existing programs, and trends from the results of the informal needs assessment. Our goal had evolved – to connect teens with cancer to each other: peer support for AYA in pediatrics. As academic clinicians, scientific rigor was important to us; however, we are grateful for the constant reminders that conducting a single-component scientific study is unlikely to provide sufficient information on which to base a successful patient intervention. Brainstorming the design of the mixed methods study came rather naturally to us, and this was initially our entire plan. However, the Translational ThinkingTM Framework introduced to us at the Translational Research Program (TRP) stresses the importance of understanding the current landscape by speaking to a wide variety of stakeholders, which we realized would be critical to ensure future success. We learned that there are several obstacles and required steps before an idea can become a solution and before that solution can be successfully implemented and sustained. Hence, we developed the two-component translational approach and decided to informally explore the perceived value of peer support among key stakeholders in AYA oncology in parallel to the formal study. In addition, we came to realize the importance of knowledge translation (KT) in the process of ultimately implementing a successful and sustainable intervention. Of course the process of this project did not go as we anticipated; many people we met along the way helped to guide us, and our project, in various directions. Each step of the way, we re-grouped, made decisions, changed our plans, and learned about flexibility, ambiguity, and health care system, and research intricacies. We have learned more than we ever thought possible.
Project team
- Philippe Desmarais
- Katye Stevens
- Danielle Weidman
TRP supervisors
Project advisory committee
- Abha Gupta, MD, Sick Kids;
- Jackie Bender, MSc, PhD, UHN research;
- Christopher Klinger, PhD, University of Toronto
- Heather Colquhoun, PhD, OT Reg, University of Toronto
See our community directory for more on committee members.
UNITE: Understanding the needs and desires of primary stakeholders in long-term dementia care
The UNITE study amplifies the voices of long-term care residents with cognitive impairment in Toronto, revealing key structural and relational factors that shape their quality of life and offering insights for sector-wide improvement.
Background
The UNITE study uniquely features the voices of PWDs living in LTC in Toronto, Ontario. Semi-structured interviews with residents of Kensington Gardens, as well as loved ones of residents, and subsequent descriptive data analysis revealed aspects of care that impact the residents’ quality of life. Residents of Kensington Gardens who are living with mild to moderate cognitive impairment value meaningful engagement in activities that they enjoy, such as playing games, listening to music and going outside, as well as those which make them feel useful. Having a sense of purpose and autonomy are desired, but not always achievable in the context of LTC. This, along with the discomfort of dealing with the symptoms of their peers and/or themselves, can lead to a dissonance between their current and former or desired lives. Resultingly, residents may experience feelings of sadness, apathy, loneliness, and/or frustration. This perceptual dichotomy can currently be combatted through maintaining a daily routine, having consistent care providers, and cultivating friendships with staff and other residents. Residents appreciate receiving care from staff who can anticipate their needs and relate to them on a personal level. Ultimately, residents appreciate a LTC home that is centred on the comfort and enjoyment of its residents; is bright, clean, and offers private personal space; and which offers personalized care from staff who are not rushed. Loved ones mirrored the sentiments of residents, also identifying the importance of communication between staff and adapting supports and activities for varied levels of impairment. A synthesis of interview findings within the context of Donabedian’s framework for healthcare quality indicates whether factors that influence resident quality of life are structural or process-oriented in nature. Additionally, a comparison of study findings to the home’s most recent satisfaction survey identified priority areas that contribute to QoL not captured through the survey: (1) access to meaningful activities that make residents feel useful, (2) support in coping with group living while dealing with the cognitive decline of self and others, and (3) substantial friendships between residents and staff as well as residents. Kensington Gardens can use the findings of this study to prioritize quality improvement initiatives. The information may also be useful to other stakeholders in the sector, such as the Ministry of Long-Term Care, as they work to build LTC services that meet the needs and desires of residents and their families.
Project team
- Katherine Tucker
TRP supervisors
Project advisory committee
- Andrea Austen
- Vinita Haroun
- Lisa Cranley
See our community directory for more on committee members.