Utilization of Psychosocial Oncology Services by Oral Cancer Patients According to their Minority Language Profile in Montreal area.

Several patients with oral cancer experience psychosocial distress during their care trajectory, and even afterwards. In recent years, psychosocial oncology services (SOP) have been implemented in many hospital centers to support cancer patients with emotional, psychological, or social support needs. The use of SOP by patients with oral cancer has not yet been documented, which hinders monitoring and continuous improvement of care. In Quebec, shortages of healthcare personnel, persistent barriers to distress screening, and stigma surrounding the use of mental health services may influence the use of SOP in oral oncology, especially among the anglophone minority where difficulties accessing healthcare and mental health services have been reported. Our objective is to generate surveillance data on the use of SOP by patients and survivors of oral cancer, according to their official linguistic status in Quebec. Therefore, we are conducting a retrospective study based on data from real patients with oral cancer who are followed in one of the major hospital centers in Montreal. In addition to sociodemographic and clinical data, francophone and anglophone patients will be compared on the rate of referral to the psychosocial oncology department, the delay and response rate to these requests, and the type of SOP received. Analyses will be conducted to explore factors related to potential differences in SOP utilization between francophone and anglophone patients. Communicating our data to healthcare providers and policymakers will help them review their policies and strategies to promote comprehensive care for patients in oral oncology while ensuring equitable access to services between linguistic minorities and majorities.

Bilingual Simulations in Nursing: Virtual Reality, Interlinguistic Pairing, and Authentic Reinforcement

In recent years, researchers in computer-assisted language learning have been exploring the potential of immersive technologies to support second language (L2) acquisition. Virtual reality (VR), defined as the computer-generated simulation of an environment in which users experience a sense of presence (Sadler et al., 2013), can immerse L2 learners in interactive scenarios where they practice communication in real-life situations. Such learning environments can reduce L2 anxiety (Gruber & Kaplan-Rakowski, 2022) while increasing willingness to communicate (Papin, 2018, 2022). However, little is known about the impact of participation in immersive interactive simulations on L2 self-efficacy (i.e., learners' belief in their ability to use the L2 to perform linguistic and non-linguistic tasks (Mills, 2014)). Given the positive impact of self-efficacy on L2 learning (Bai & Wang, 2022), the research objective of this exploratory study is to examine the impact of conducting VR simulations on L2 self-efficacy. The participants will be 48 intermediate French L2 learners enrolled in a nursing education program at two post-secondary institutions, one English-speaking and the other French-speaking. Before participating in an in-person internship at a hospital, they will be asked to individually conduct two simulations on ImmerseMe. During these simulations, which mimic daily conversations in a professional setting, learners will be individually immersed in a virtual environment. This environment will place them in a virtual hospital room using 360-degree videos, and they will have to orally interact with pre-programmed virtual agents. The simulations are based on scenarios depicting authentic interactions encountered in a hospital setting: 1) assessing a patient's level of pain; and 2) interacting with a patient as part of a postoperative protocol. Through ImmerseMe's voice recognition capabilities, the utterances of L2 learners will be compared to a pre-established script, allowing the simulations to progress if the produced sentence matches one of the possible responses.

Integrating French second-language experiences into clinical psychology training to enhance retention of English-speaking trainees

Context: Minority communities need access to linguistically/culturally sensitive mental health services. In this respect, Québec Anglophones face a retention challenge: Many English-speaking clinical psychology trainee students leave Québec upon graduation, thereby reducing the available pool of English-speaking mental health practitioners. Reasons include linguistic challenges in establishing a sustainable clinical practice in Québec, such as inability to meet French-language requirements of the Ordre des psychologues du Québec and/or inability to build a practice that includes Francophone clients. Concordia's Psychology Department is instituting a novel approach to addressing this challenge by integrating French-language experiences for English-speaking trainees into its program. This provides the project setting; we will closely study Concordia's experience and conduct a systematic review of literature on relevant best practices.

Main objective: Deliver a report on best practices for French second-language training and assessment for trainees in clinical psychology with a focus on potential implications for trainee retention.

Procedures: Procedures include (1) Examining the literature worldwide on best practices for language-training of mental health clinicians; (2) Interviewing 30 Concordia clinical psychology trainees; (3) Interviewing participating clinical supervisors; (4) Consulting community-based practicing clinicians about experiences using their secondlanguage-French with Francophone clients.

Data analyses: Systematic Reviews of the literature; Qualitative Analyses of interview data.

Potential contributions:

• enhancing retention of English-speaking clinical psychology trainees in Québec, thereby increasing support for the Anglophones community; laying foundations for future mixed-methods assessments of such second-language training support;

• providing support for similar English-language experiences for Francophone trainees, thereby further increasing the availability of practitioners for Anglophones.

Linguistically- and Culturally-Sensitive Psychotherapy: Improving Communications to Improve Outcomes

Context: Linguistic mismatch can lead to communication problems that interfere with psychological treatments for mental health problems. Cultural misunderstandings can exacerbate these problems. Past research funded by Dialogue McGill has identified ways in which psychotherapists can effectively intervene to overcome linguistic and cultural barriers. The current research proposes to directly evaluate these interventions.

Main Objectives: We will: (1) carry out a systematic review of psychotherapy effectiveness in cross-linguistic and cross-cultural settings; use (2) use qualitative inquiry to study linguistic/cultural misunderstandings between clients and their therapists; and (3) use quantitative techniques to study the impact of interventions designed to mitigate these misunderstandings.

Research Procedures: Participants will be 12 anxiety and/or depression patients from a migrant and/or minority background, all of whom speak English as a second language and prefer English as their first official language. Half will be in a situation of language match with their therapist, and half will have a mismatch, in terms of preferred official language.

Data Analysis:  Qualitative inquiry will give us a close reading on best practices when working with linguistic and cultural diversity. Quantitative modeling will allow us to study the impact of change over time through daily self-report assessments. Some models will include participants from previous Dialogue McGill-funded projects, enhancing statistical power.

Potential Contributions: We anticipate this project will improve mental health care for English-speaking patients in Quebec, as well as improving training of mental health professionals. Results will be relevant to other settings characterized by linguistic and cultural complexity.

Remotely-Delivered CBT for English-Speaking Psychiatric Outpatients across Quebec: An Evaluation of Treatment Effectiveness, Treatment Acceptability and Barriers to Accessing Care

Cognitive behavioural therapy (CBT) is the ‘gold standard’ psychological intervention for most mental health problems, however, access to CBT is often challenging due to long clinic waitlists and limited availability of trained professionals in all communities. In Quebec, English-speaking Quebecers are faced with additional challenges in accessing care due to their status as a linguistic minority. One method of increasing access to CBT is using a model of remote service delivery whereby clinics that specialize in CBT can provide services in English to patients located anywhere in the province. Using a non-randomized design, we aim to examine whether providing remotely-delivered CBT to English-speaking Quebecers from across the province will lead to similar improvements in symptoms and functioning compared to patients receiving in-person treatment. We will also examine questionnaire results and identify themes in patients’ written feedback to assess their treatment satisfaction and to better understand their experiences of receiving remotely-delivered CBT. This study will be conducted in the Centre for CBT Research, Training and Intervention (Centre for CBT-RTI), a clinic located in the McGill University Health Centre. The Centre for CBT-RTI is a non-sectorized clinic staffed by bilingual mental health professionals with expertise in CBT who provide in person and remotely-delivered CBT for patients from across Quebec. The findings from this research are anticipated to increase awareness among mental health professionals and key stakeholders in government and hospital administration about the benefits of remote-delivered CBT and patient preferences for service-delivery.

Sustainable human resource management of healthcare personnel working in a minority linguistic context – comparative phase in border regions

This project aims to address strategic human resources management (HRM) issues faced by the part of the healthcare system serving the English-speaking population and other cultural minorities in regions of Quebec outside the Montreal metropolitan area. Its initial phase took place in the Quebec City region at Jeffery Hale - Saint Brigid's Hospital (JHSB), grouped as part of CIUSSS de la Capitale-Nationale, and then has proceeded to a comparative analysis of recruitment processes between CIUSSS de la Capitale-Nationale and CISSS des Laurentides. The present project aims to conduct further comparative analysis between these two establishments and regions of Quebec bordering the English-speaking provinces: Outaouais, Montérégie-Ouest and Côte-Nord. The first objective of the project is to report on the current bilingual staffing process (recruitment, selection, on-boarding and integration) for four job categories in high demand in the Quebec healthcare system, in designated English-speaking facilities. Its aim is to establish the degree of adequacy between published language requirements, initial assessment of candidates and upgrading measures offered to newcomers. Secondly, the project aims to identify HRM practices that can help retain staff working in a bilingual healthcare context. The entire non-agreement-based HRM process will be covered (staff appraisal, skills development, non-monetary recognition), while investigating the potential strategic contribution of the surrounding English-speaking community in this respect.

A review of migration patterns of English-speaking healthcare workers in Québec and existing French-language supports

In 2022, PERT published a report titled “French-language support for Québec’s English-speaking professionals.” This report examined the role of French language policies in professional orders and the language supports available to English-speaking prospective and current members of professional orders. We concluded that there is no comprehensive framework for supporting individuals who need to improve their French. Additionally, we found that most institutional stakeholders were not mandated nor had adequate capacity to provide French-language support to English-speaking health professionals. Since the publication of this report, the situation for English speakers within Québec’s healthcare system has become more complex. There are acute shortages of healthcare professionals, concerns about reduced access for English speakers, outmigration of healthcare workers, and the implementation of new French-language policies that may impact the hiring and retention of English-speaking healthcare workers.

In this project, we will expand on the findings of the report. The objectives are to:

• Understand the immigration and out-migration of English-speaking healthcare professionals in order to identify the impacts of outmigration and immigration and analyze the existing capacity of English-speaking workers to fill existing labour shortages and healthcare needs

• Identify the government-funded French-language training programs targeted at healthcare professionals in Québec

• Formulate policy recommendations to support English speakers’ entry into and retention in Québec’s healthcare industry

This will be accomplished in two ways: an inventory of existing government-funded French-language training for healthcare workers, and analysis of education and migration patterns of English-speaking healthcare professionals through 2016 and 2021 census data.

Pregnancy outcomes of Anglophones compared with Francophones in Québec

A growing number of studies suggest that Anglophones may be at risk of preterm birth and stillbirth in Québec. However, pregnancy outcomes such as gestational diabetes and preeclampsia have not been studied. These two pregnancy complications are major causes of morbidity in pregnant women and have potential to explain why some Anglophones have a greater risk of preterm birth and stillbirth. Gestational diabetes is a type of hyperglycemia that develops specifically during pregnancy, and can lead to complications in infants and mothers. Preeclampsia is a life-threatening pregnancy complication that can lead to severe hypertension, seizures, and maternal death. The objective of this research proposal is to investigate if Anglophones have a higher risk of gestational diabetes and preeclampsia, compared with Francophones. We will perform population-based studies using linked data that include birth characteristics and medico-administrative information in Québec from 2008 to 2020. The main exposure will be English or French maternal mother tongue. The main outcomes will be gestational diabetes and preeclampsia. We will measure the association between maternal mother tongue and the risk of gestational diabetes and preeclampsia using regression models. We will also determine if maternal characteristics such as age, country of origin, education, and socioeconomic status influence the relationships of interest. Our findings will help assess the extent to which Anglophones have high risk pregnancies that may benefit from enhanced obstetric care to prevent adverse outcomes.

---

Outcomes:

• Auger N, Bilodeau-Bertrand M, Ayoub A, Lafleur N, Wei SQ. (2024; submitted). Increasing risk of gestational diabetes in the Anglophone minority of Quebec. Canadian Journal of Diabetes.

• Auger, N., Bilodeau-Bertrand, M., Lafleur, N., & Lewin, A. (2024). Underlying Causes of Ethnocultural Inequality in Pregnancy Outcomes: Role of Hospital Proximity. Journal of immigrant and minority health, 26(1), 54–62. https://doi.org/10.1007/s10903-023-01545-7

• Auger N, Bilodeau-Bertrand M, Lafleur N. (2023). Access to perinatal healthcare: Risk of adverse birth outcomes among minority Anglophones in Montreal, Canada [Poster presentation]. Colloquium 2023 on the Health of OLMCs, Health Canada, Ottawa, Ontario, Canada.

• Auger N, Bilodeau-Bertrand M, Lafleur N, Lewin, A. (2023). Ethnocultural inequality in pregnancy outcomes: Comparison of Francophones and Anglophones in Montreal [Poster presentation]. Colloquium 2023 on the Health of OLMCs, Health Canada, Ottawa, Ontario, Canada.

• Auger N. Pregnancy outcomes of Quebec Anglophones: recent research results. (unknown). QUESCREN Concordia Lunch and Learn. Montreal, Québec, Canada.

Digital cognitive assessments for Quebec English-speaking older adults and patients on the Alzheimer’s disease spectrum

About 1 in 9 people above 65 years old has Alzheimer’s disease (AD). Timely and precise diagnosis, along with comprehensive cognitive assessment, play crucial roles in managing this disease effectively. A precise evaluation of cognition is essential for making accurate diagnoses, including the identification of the prodromal phase of AD known as mild cognitive impairment (MCI). However, conventional cognitive tests come with significant limitations, especially for the English-speaking population in Quebec. These issues encompass the absence of tests tailored to English speakers in Canada or Quebec, outdated norms exceeding 20 years, a lack of contemporary digital assessment tools, and the failure to consider social determinants of health (SDOH) in normative data. Our project has two primary goals:

1. to validate and standardize a cognitive battery incorporating digital adaptive tests for English-speaking older adults in Quebec, while accounting for SDOH;

2. to compare the diagnostic accuracy of a traditional paper-pencil cognitive battery with a digital counterpart for MCI. Our study will involve 150 cognitively unimpaired older adults and 20 MCI patients, who will undergo both traditional and novel digital cognitive assessments.

This project holds immense significance for clinical practice and Quebec's English-speaking communities, as it will provide novel open-access digital tools for researchers and clinicians. These tools will offer a more accurate, efficient and engaging experience for patients and clinicians.

Virtual Reality Exposure Therapy for Severe Anxiety Disorders: Effectiveness and Acceptability in English-Speaking Quebeckers

Exposure therapy consists in approaching one’s fears without avoidance. It is known to be the best psychological intervention for anxiety disorders, which are some of the most common, debilitating mental health problems in Quebec. Recently, virtual reality exposure therapy (VRET) has been developed to address some of the accessibility and acceptability concerns of traditional exposure therapy conducted in “real life”—one of these being the need for consistently clear communication between therapists and patients. Through computer-generated, language-free environments, VRET helps individuals confront the virtual counterparts of their fears, without extensive therapeutic discussions. VRET’s potential to increase access to a first-line anxiety treatment for English-speaking Quebec residents is thus promising. Although the efficacy of VRET has been shown to be comparable to traditional exposure therapy, most of this research has been conducted in well-controlled laboratories focusing on subclinical anxiety. This project aims to examine the effectiveness and acceptability of VRET for severe symptoms of anxiety disorders in a non-sectorized mental health clinic, accessible to all Quebec residents. English-speaking Quebeckers with an anxiety disorder will receive twelve sessions of VRET and will complete symptom measures pre- and post-intervention. Results will be compared to symptoms of individuals who have already undergone traditional exposure therapy at the clinic. Demonstrating that VRET is as effective as traditional exposure therapy in a real-life and language minority context will help increase access to a gold standard intervention, using approachable, language-free technology. Lastly, themes will be extracted from participants’ feedback to compare the treatments’ perceived accessibility and acceptability

---

Outcomes:

• Gagné, J. P. (2023, April). Using virtual reality in exposure therapy for a specific phobia of flying: Two case studies. Talk presented at the First Annual McGill University Health Centre Mental Health Mission Research Day, Montreal, QC.

Increasing access to pediatric sleep care for youths in the English-speaking community in Quebec.

Abundant evidence indicates that the negative impacts of sleep disorders can be significantly reduced by effective treatment. However, interventional opportunities that would improve the sleep and overall health of children and adolescents in the English-speaking community in Quebec are currently being missed because healthcare providers serving this community are either unaware of the tools available or do not know how to use the tools effectively. Significant progress towards increasing access to pediatric sleep services could be made if healthcare professionals serving the English-speaking community in Quebec be provided with knowledge and skills in pediatric sleep medicine. Thus, the objective of the proposed activities is to disseminate pediatric sleep training to healthcare professionals who treat youths in the English-speaking community. This is important as it is expected to facilitate increased access to pediatric sleep care for youths with sleep problems and disorders in the English-speaking community in Quebec.

Catalyzing Capacity Building in Rehabilitation Post-Solid Organ Transplant

Solid organ transplant (SOT) patients have low levels of physical activity before and after transplantation which has a negative impact on their health and survival. Despite this, in Quebec, there is limited availability of rehabilitation and physical activity programming for transplant candidates and recipients. Importantly, many healthcare professionals do not feel confident in counselling SOT recipients about physical activity that is appropriate for them due to lack of specific education about transplantation in their training.

Our objective is to develop a free online continuing education course on exercise prescription in SOT recipients for English-speaking exercise professionals in Quebec that will include interactive lectures, case studies and evaluation materials. This will ultimately improve the confidence of exercise professionals when they deal with SOT recipients and the quality of rehabilitation that they are able to offer.

The development of the course will involve 4 steps:

1. A scientific committee, including both professionals and patient partners, will participate in a video conference call to define the learning objectives and the most relevant content (theory, case studies, evaluations) to be included in the course.

2. The Co-PIs, the coordinator, a trainee, patient partners, Maria Sedeno (RESPIPLUS) and Becky Zucco (Wilkin) will draft the first version of the online course including the learning objectives, content, case studies, evaluation materials as well as visual aspects and interactive components of the module.

3. Feedback from the scientific committee will be sought via email. At least two rounds of revision are planned.

4. Feedback will be integrated into the module. This initiative was made possible through a financial contribution by Health Canada. 7 By providing English-speaking exercise professionals in Quebec with the knowledge and tools to effectively prescribe exercise to SOT recipients, the availability of rehabilitation services and physical activity programming for SOT recipients in Quebec may increase.