Primary Care Team

The Research:

The Primary Care team’s work will focus on using patient and health care professional tools to increase the uptake, impact, and access to advance care planning (ACP) for frail elderly Canadians in primary care. The project aims to determine the impact of  interventions that identify patients in primary care who could benefit from immediate ACP and goals of care conversations. The team will also evaluate a care pathway supported by a clinician conversation guide/training, and patient-facing tools and decision aids designed to increase the feasibility and quality of ACP conversations and goals of care in primary care.


Work to date:

To date, our program of research has focused on decision support tools for engaging and empowering patients and families in ACP and decision-making across different care settings. We have used an ‘incubator unit’ approach to beta test, evaluate and revise seven patient facing tools in primary care practices in the community across 3 provinces.  These tools have been evaluated for feasibility, acceptability and clinical sensibility in over 100 patients and evaluated prospectively for effectiveness to increase engagement in ACP in over 300 patients in primary care. We have learned that these tools are highly acceptable to patients, feasible to use and they increase knowledge and engagement in ACP behaviors among patients.  A clinician facing tool, the ‘Serious illness conversation guide’, which was developed in the U.S. is increasingly being used for clinical education in Canada. It has been tested for feasibility and effectiveness but has not yet been adapted for and evaluated in the family medicine setting in Canada.


Recent Activities:

To date, our program of research testing the implementation of a care pathway using an interprofessional team-led approach has been launched in primary care practice in three provinces in Canada (Alberta, British Columbia and Ontario). The care pathway includes 1) clinician training on how to use the ‘Serious illness conversation guide’, and 2) the use of decision support tools for engaging and empowering patients and families in ACP and health care decision-making. The care pathway has been tailored to the context of implementation. In British Columbia, two care pathways are being implemented; one is for more seriously ill patients to have a conversation with their physician, and the other, community group ACP education, to prepare patients to have a serious illness conversation in the future. Other activities in the project include an inquiry into what outcomes of advance care planning are most important to patients, and inquiry into how different models of family practice implement and sustain advance care planning activities.


Principal Investigators:

Michelle Howard, PhD, MSc

Photo of Michelle HowardMcMaster University

Dr. Michelle Howard is an Assistant Professor in the Department of Family Medicine and an Associate Member of the Department of Clinical Epidemiology and Biostatics at McMaster University. Dr. Howard completed her doctorate at McMaster, and her MSc at the University of Toronto. Her research interests include evaluating and improving primary care models and understanding the mechanisms and impacts of interprofessional care in primary care practices.

Doris Barwich, MD, CCFP

photo of DorisBC Centre for Palliative Care

Doris Barwich is a Clinical Assistant Professor in the University of British Columbia Faculty of Medicine, and the Executive Director of the BC Centre for Palliative Care (BCCPC), a provincial hub to support excellence in evidence-informed practice, education, innovation, collaboration and policy development to improve care for those living with serious illness and their families. Dr. Barwich completed her MD/LMCC and Family Medicine Residency at the University of Manitoba and a Fellowship in Palliative Medicine at the University of Ottawa. Her research interests include the integration of palliative and primary care, bowel care in the palliative population, and Advance Care Planning.

Amy Tan, MD, MSc, CCFP(PC), FCFP

Photo of Amy TanUniversity of Calgary

Amy Tan is an Associate Professor and academic family physician and hospice physician in the Department of Family Medicine at the Cumming School of Medicine, University of Calgary who is on a mission to empower members of the public, patients, families, medical learners, family physicians, physicians of other disciplines, and interdisciplinary team members to engage in quality advance care planning conversations to better achieve care that meets the individual’s goals through research, education and advocacy work. She completed a Master of Science in Palliative Medicine degree from Cardiff University in the UK after completing a thesis study on family physicians’ experiences with end-of-life decision-making with surrogates of dying patients. Her research interests focus on empowering quality advance care planning in family medicine, supporting community-based primary palliative care, and effective teaching of shared decision-making with patients and families for medical learners at all stages of training.


Robin Urquhart, PhD

Photo of Robin UrquhartDalhousie University

Dr. Robin Urquhart is an Assistant Professor, in the Department of Surgery, with a cross-appointment in Community Health & Epidemiology, both at Dalhousie University. She is also an Affiliate Scientist with the QEII Health Sciences Centre, and a Senior Scientist at Beatrice Hunter Cancer Research Institute. She received her Interdisciplinary PhD in 2013 at Dalhousie University with a focus on how multi-level factors influence the movement of complex innovations into practice. Dr. Urquhart’s primary research interests relate to understanding and optimizing the movement of evidence-based innovations into clinical practice as well as the interface between evidence-based medicine and policy.


Dr. Douglas Klein, MD, MSc, CCFP
Dr. Marissa Slaven, MD
Dr. Carrie Bernard, MD

Research Staff

Ms. Dawn Elston, Research Coordinator, MA
Ms. Neha Arora, Research Coordinator, MSc
Dr. Rachel Carter, Research Manager, PhD
Ms. Diana Cochrane, Research Assistant
Mr. Abe Hafid, Research Assistant
Ms. Carley Paterson, Research Assistant, BA