Gina Bravo's research while affiliated with Centre de Recherche sur le Vieillissement and other places

Publications (170)

Article
Canada has legalized medical assistance in dying (MAID) for mentally competent persons who satisfy the legal requirements. Debate is ongoing as to whether MAID should be accessible to no-longer-competent persons through an advance request. We conducted an anonymous vignette-based survey among 367 social workers from Quebec to (1) elicit their attit...
Article
Objective Symptoms present at the end of life and the quality of communication with the healthcare team have both been shown to impact family assessments of the quality of dying of their loved one with dementia. However, the relative contributions of these two factors to family assessments have not yet been investigated. To address this knowledge g...
Article
Most Canadians with dementia die in long-term care (LTC) facilities. No data are routinely collected in Canada on the quality of end-of-life care provided to this vulnerable population, leading to significant knowledge gaps. The Quebec Observatory on End-of-Life Care for People with Dementia was created to address these gaps. The Observatory is a r...
Article
Full-text available
Background: In Quebec, medical aid in dying (MAiD) is legal under certain conditions. Access is currently restricted to patients who are able to consent at the time of the act, which excludes most people with dementia at an advanced stage. However, recent legislative and political developments have opened the door to an extension of the legislation...
Article
Full-text available
Background Healthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity. Methods We conducted a vignette-based survey among 1050 Quebec stakeholders (senior citizens,...
Article
The federal and Quebec governments are both considering extending medical aid/assistance in dying (MAID) to non-competent patients who would have requested MAID prior to losing capacity. In 2016–2017, we surveyed 136 Quebec physicians (response rate: 25.5%) on their attitudes towards extending MAID to such patients. Complementing our published find...
Article
In December 2015, the Canadian province of Quebec legalized medical aid in dying (MAID) for competent patients who satisfy strictly defined criteria. Like the rest of Canada, Quebec is considering extending the legislation to incompetent patients under certain conditions not yet specified. With the objective of informing policy developments in this...
Presentation
Levasseur, M., Lussier-Therrien, M., Biron, M. L., Guay, M., Léonard, G., Beaulieu, M., Abdulrazak, B., Bravo, G., Carrier, A., Coallier, J.-C., Cossette, B., Dubois, M.-F., Provencher, V., Boissy, P., Corriveau, H., & Tousignant, M. (4 au 6 février 2020). Définition des situations de vulnérabilité : vers des pratiques favorisant davantage l’inclus...
Article
Objective The Canadian province of Quebec has recently legalized medical aid in dying (MAID) for competent patients who satisfy strictly defined criteria. The province is considering extending the practice to incompetent patients. We compared the attitudes of four groups of stakeholders toward extending MAID to incompetent patients with dementia....
Presentation
29. Lussier-Therrien, M., Biron, M. L., Guay, M., Beaulieu, M., Abdulrazak, B., Bravo, G., et al. (10 mai 2019). Définition des situations de vulnérabilité chez les aînés : vers le développement d'une équipe émergente pour favoriser l'autonomisation et la participation sociale. Journées PIVOT « Mieux vieillir ». Centre de recherche sur le vieilliss...
Article
Purpose: The Functional Independence Measure (FIM) is widely used to assess persons post-stroke. The Quebec government has selected the Functional Autonomy Measurement System (SMAF) for use in all care settings. In this article, we propose simple equations to convert SMAF scores to FIM scores for persons undergoing post-stroke rehabilitation. Meth...
Article
Surrogates' decisions and advance directives currently offer the best opportunities for people to participate in research at times of decisional incapacity. We investigated which of these options better reflects an older adult's willingness to engage in research should he or she be solicited to enroll in a study after losing the capacity to consent...
Article
Objectives To elicit Quebec physicians’ attitudes towards extending medical aid in dying (MAiD) to incompetent patients and to compare the attitudes of family physicians to those of other medical specialists. Methods We conducted a postal survey among physicians caring for patients with dementia. We used hypothetical vignettes to elicit their atti...
Article
Objectives To investigate which of two sources of information about an older adult’s wishes—choices made in an advance directive or proxy’s opinion—provides better insight into the older adult’s preferences measured in hypothetical clinical situations involving decisional incapacity. Methods Secondary analyses of data collected from 157 community-...
Article
Objective: To investigate how confidence in surrogates' ability to make consistent decisions in the future change over time, in the context of an ACP intervention that did not improve surrogates' ability to predict an older adult's hypothetical treatment preferences. Methods: The study involved 235 older adults and surrogates, randomly allocated...
Article
We conducted a survey in a random sample of 514 Quebec nurses caring for the elderly to assess their attitudes towards extending medical aid in dying to incompetent patients and to explore associated factors. Attitudes were measured using clinical vignettes featuring a hypothetical patient with Alzheimer disease. Vignettes varied according to the s...
Article
Euthanasia is a controversial and complex issue, especially when involving incompetent patients. On December 10, 2015, Quebec became the first Canadian province to give access to medical aid in dying (MAiD) (ie, euthanasia performed by a physician) to competent patients who satisfy strictly defined criteria. Less than 2 years later, Quebec is consi...
Article
Full-text available
Background: Alzheimer's disease and related disorders affect a growing number of people worldwide. Quality of life is generally good in the early stages of these diseases. However, many individuals fear living through the advanced stages. Such fears are triggering requests for medical assistance in dying (MAiD) by patients with dementia. Legislati...
Article
Background Family members are often called upon to make decisions for an incapacitated relative. Yet they have difficulty predicting a loved one's desire to receive treatments in hypothetical situations. We tested the hypothesis that this difficulty could in part be explained by discrepant quality-of-life assessments. Methods The data come from 23...
Article
Full-text available
Background Older adults are encouraged by many organizations to engage in advance care planning in the event of decisional incapacity. Planning for future health care often involves anticipating health-related quality of life (HRQoL) in states of reduced cognitive functioning. No study has yet examined whether anticipated HRQoL is stable over time....
Article
Objective: To test an intervention designed to motivate older adults in documenting their healthcare preferences in advance, and to guide proxies in making hypothetical decisions that match those of the older adult. Methods: The trial involved 235 older adults, of which half were assisted in communicating their wishes to their proxy. Hypothetica...
Article
Full-text available
Background: Communicating wishes regarding future research participation in the event of incapacity may help others make enrollment decisions that are more consistent with these wishes. We tested whether an advance planning intervention (1) motivated older adults to document their wishes regarding future research participation and (2) guided proxie...
Article
Background Communicating wishes regarding future research participation in the event of incapacity may help proxies make enrolment decisions that are more consistent with these wishes. Aim To test an advance planning intervention designed to (1) motivate older adults to document their wishes regarding future research participation and (2) guide pro...
Article
Full-text available
In the province of Quebec, Canada, long-term residential care is provided by two types of facility: privately owned facilities in which care is privately financed and delivered and publicly subsidised accredited facilities. There are few comparative data on the residents served by the private and public sectors, and none on whether their respective...
Article
Full-text available
/st>In the province of Quebec, Canada, long-term residential care is provided by two types of facilities: publicly funded accredited facilities and privately owned facilities in which care is privately financed and delivered. Following evidence that private facilities were delivering inadequate care, the provincial government decided to regulate th...
Article
ABSTRACT Private Residential Care Facilities (RCFs) fill the gap between independent community living and institutional settings for seniors. There are marked differences between RCFs which make them difficult to compare. To address this issue, the objective of this study was to develop and validate a classification of RCFs based on their physical...
Article
Private Residential Care Facilities (RCFs) fill the gap between independent community living and institutional settings for seniors. There are marked differences between RCFs which make them difficult to compare. To address this issue, the objective of this study was to develop and validate a classification of RCFs based on their physical and organ...
Article
Background: Comparison of a multimodal intervention WE CALL (study initiated phone support/information provision) versus a passive intervention YOU CALL (participant can contact a resource person) in individuals with first mild stroke. Methods and results: This study is a single-blinded randomized clinical trial. Primary outcome includes unplann...
Article
Background: In Canada and elsewhere, research policies require researchers to secure consent from a legally authorized representative (LAR) for prospective participants unable to consent. Few jurisdictions, however, offer a clear legislative basis for LAR identification. We investigated Canadian researchers' practices regarding the involvement of...
Data
Appendix 2. Characteristics of each study participant
Article
Full-text available
Background Family physicians frequently interact with people affected by chronic diseases, placing them in a privileged position to enable patients to gain control over and improve their health. Soliciting patients’ perceptions about how their family physician can help them in this process is an essential step to promoting enabling attitudes among...
Article
Full-text available
Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of...
Article
Older adults who are incapable of giving informed consent to participate in dementia research require special regulatory protection. We investigated the practices of Canadian research ethics boards (REBs) regarding research protocols that may involve these individuals. We also explored the opinions of REB chairs on related issues, including researc...
Article
Full-text available
Participation refers to the engagement of a person in daily activities and social roles. The goal of this study was to compare changes in older adults' participation over time following a stroke as a function of the presence of deficits in memory, visual perception, executive functions, visual attention or language. A total of 197 persons with stro...
Article
Full-text available
Advance planning for health care and research participation has been promoted as a mechanism to retain some control over one's life, and ease substitute decision making, in the event of decisional incapacity. Limited data are available on Canadians' current advance planning activities. We conducted a postal survey to estimate the frequency with whi...
Article
Full-text available
Background: Dementia research often requires the participation of people with dementia. Obtaining informed consent is problematic when potential participants lack the capacity to provide it. We investigated comfort with proxy consent to research involving older adults deemed incapable of this decision, and examined if comfort varies with the type...
Article
The enablement process is defined as a professional intervention aiming to recognize, support and emphasize the patient's capacity to have control over her or his health and life. The purpose of this article was to study the enablement concept through a concept analysis in the health care context to identify: (1) its attributes and (2) its antecede...
Article
Full-text available
Rationale, aims and objectives Enablement is an intervention by which the health care provider recognizes, promotes and enhances patients' ability to control their health and life. An abundant health literature suggests that enablement is associated with good outcomes. In this review, we aimed at identifying and comparing instruments that assess en...
Article
To assess and compare the ability of the Timed Up & Go (TUG) and subscales of the Functional Autonomy Measurement System (SMAF) to detect change in people undergoing geriatric rehabilitation in inpatient geriatric rehabilitation units (GRUs) and day hospitals. Longitudinal design with repeated measures obtained at admission and discharge from rehab...
Article
Full-text available
More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those wit...
Article
French and Quebec legislation allow the inclusion of decisionally-incompetent subjects in research, provided certain conditions are met. In both jurisdictions, ethics committees are charged with ensuring that research protocols meet these conditions. We investigated committee members' knowledge and opinions regarding substitute consent for research...
Article
Full-text available
Objective: Little is known about the determinants of poststroke depression. The Activity Restriction Model of Depressed Affect (ARMDA) may be helpful in understanding poststroke depression but has never been tested in that context. The goal of this study was to examine the relation between activity restriction and depressive symptoms in stroke surv...
Article
Full-text available
I, if allowed, can activate, demonstrate, educate, initiate, motivate, stimulate, & validate that some brain injuries, when seen beneficially after recovery as cognitive challenges, thus Handicap International has now changed name to Humanity & Inclusion, which ensures more can Believe Achieve Receive Success , over the bars of isolation of depress...
Article
Many studies have investigated the effectiveness of interventions in promoting advance directives (ADs) but there is uncertainty as to what works best, and in whom. We conducted a systematic review of the evidence in this regard, using both classical meta-analysis approaches and multi-level analyses. Eleven databases were searched for relevant repo...
Article
Interest has grown in integrated care models as means of responding better to the needs of frail older adults. In order to provide appropriate input for health policy reforms, the effects of integrated care must be assessed with sound methodologies. Based on three experiments conducted in the province of Quebec, Canada, this article provides practi...
Article
The authors first describe the rules enacted in Quebec and France to protect adults with decisional impairment who may be approached by investigators to participate in research protocols. They then present two consecutive postal surveys conducted among Quebec and French researchers in aging and designed to (1) assess their knowledge of the legal pr...
Article
To identify which characteristics of the physical and organizational environments of residential care facilities (RCFs) need to be known to support the placement process of seniors with cognitive and physical disabilities. We used a 2-round postal Delphi survey based on the RAND/UCLA Appropriateness Method with 2 groups of experts. Participants are...
Article
De nombreuses decisions d'ordre methodologique doivent etre prises lors de la construction d'un cadre d'evaluation des effets d'un reseau integre de services gerontologiques. Le present article vise a guider cette prise de decisions par une comparaison des parametres methodologiques de trois evaluations de reseau integre realisees au Quebec : le pr...
Article
To evaluate the effect of a leisure education program on participation in and satisfaction with leisure activities (leisure-related outcomes), and well-being, depressive symptoms, and quality of life (primary outcomes) after stroke. Randomized controlled trial. Home and community. Sixty-two people with stroke. Experimental participants (n=33) recei...
Article
Context: In 1988, France enacted special legislation to protect vulnerable persons solicited for research. The law was amended in 2004 allowing third party authorization for research on individuals who are unable to provide consent and do not have a legal representative. Objective: To investigate the knowledge, opinions and conduct of French invest...
Article
No comprehensive data are available on the impact of stroke on the spouse's participation level. The purpose of this study was to document changes in participation level over time and explore associations between changes in participation level, burden and depressive symptoms for spouses of people who had had a first stroke. Participants were spouse...
Article
To describe changes in the adaptation process (appraisal and coping) in the six months after a first stroke and identify domains of the adaptation process related to participation and depressive symptoms for both affected individuals and spouses. A short-longitudinal study where data of the two groups were collected at three times: in the first two...
Article
Purpose and method: This descriptive study is aimed at documenting changes in participation level (accomplishment of daily activities and social roles) from quantitative (n = 35) and qualitative (n = 5) perspectives in individuals who have had a first "mild" stroke compared to their prestroke level. With advances in technology (e.g., increased use...
Article
Full-text available
One aspect of clinical integration involves case managers' tools and particularly the individualized service plan. We examined individualized service plan content and use in the PRISMA experiment. We analyzed 50 charts, and conducted and recorded interviews regarding individualized service plan use with all the case managers concerned (n=13). Delay...
Article
Full-text available
Background: Many people who have suffered a stroke require rehabilitation to help them resume their previous activities and roles in their own environment, but only some of them receive inpatient or even outpatient rehabilitation services. Partial and unmet rehabilitation needs may ultimately lead to a loss of functional autonomy, which increases u...
Article
Stroke can have consequences in all areas of a person's life. If not coped with optimally, this life event will have a deleterious effect on the quality of life. The aim of this study was to improve understanding of appraisal and coping, post-stroke. Ten individuals were purposely recruited upon admission for a first stroke to participate in this q...
Article
Full-text available
Psychological distress may decrease adherence to medical treatments and lead to poorer health outcomes of chronic diseases. The aim of this study was to evaluate the relationship between psychological distress and multimorbidity among patients seen in family practice after controlling for potential confounding variables and taking into account the...