Clinical Research

In Detail

Current Research Projects

1) Project Title: A Phenomenological Analysis of Health Care Aides’ ‘Experience of the Ethical’ in Caring for Dying Patients in a Personal Care Home

Canada’s population is aging, with seniors (those adults aged 65 years and over) constituting the fastest growing demographic in the nation. Health Canada projects that with the aging of the baby boomer generation, the number of seniors will reach 6.7 million in 2021 and 9.2 million in 2041, with the fastest growth occurring in those Canadians 85 years of age and over. Chronic health conditions, limited social support, functional decline and cognitive impairment experienced by seniors may necessitate admission to a personal care home setting up until the time of death. Ethical problems that arise in the care of dying patients are numerous and complicated. However, the care of dying seniors in personal care homes is largely provided by front-line workers such as health care aides (HCAs), who usually have little if any training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of health care aides in personal care home settings is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding patient contact, failing to provide good physical care, and increased staff turnover an examination of health care aides’ experiences of ethically challenging situations appears warranted.

Objective: Using the qualitative research method of interpretive hermeneutic phenomenology, the purpose of this study is to illuminate the lived experience of health care aides as they encounter ethical challenges in providing end-of-life care to dying seniors. Attention will be directed at accessing the salient features, meanings, and processes that shape these experiences. Consistent with the aims of phenomenological inquiry, the overarching research question to be addressed is: What are health care aides’ lived ‘experience of the ethical’ in caring for dying seniors in personal care homes?

Sub-Questions:

• How do HCAs characterize ethical challenges providing end of life care?
• What themes and meanings assigned by health care aides are characteristic of these challenges?
• What actions or behaviors occur in response to ethical challenges?
• How do ethical challenges affect the way that HCAs provide care to the dying?

Addressing these questions will help explicate an initial understanding regarding the ways HCA’s experience and respond to the ethical dimensions of their work, and the effects such experiences have on their caregiving role. This pilot work will provide the foundation from which educational interventions designed to assist HCAs with ethical decision-making can be developed and tested. Because hermeneutic phenomenology brings to the fore the experiences and perceptions of individuals from their own perspectives, it is also particularly effective at challenging structural or normative assumptions.Thus the findings from this pilot work may also inform future research aimed at examining policy and organizational factors that influence the ethical climate in which HCA’s perform their work.

2) Project Title: Lung Cancer Stigma: Attributional Effects on Informal Caregiver Perspective-taking and Accuracy Outcomes on Symptom Experiences. (PI: Dr. Michelle Lobchuk )

In light of extensive media coverage on the linkage between smoking and lung cancer, lung cancer is now being perceived as a stigmatized disease where the patient can experience negative reactions by friends and family caregiers. A small number of studies reported that informal caregivers experience intense feelings of anger, worry, and fear as a result of blaming the patient, and perhaps even themselves, for engaging in a high risk behavior such as smoking. As a result, communication patterns are reported to change where patients and caregivers may not share their rears and concerns with one another. However, patient and caregiver held illness attributions have not been explored in relation to help-intended communication or perspective taking and perceptual accuracy by informal caregivers on patient pain experiences.

A descriptive comparative study with a cohort of 84 advanced stage lung cancer patients and their caregivers is being conducted to explore the potential effects of patient and caregiver smoking history, held illness attributions, and affect on caregiver perspective-taking and perceptual accuracy related to patient pain experiences. A secondary aim is to explore differences between patient and caregiver reports on their smoking history, held attributions, perceptions of caregiver perspective-taking as potential factors that influence caregiver perceptual accuracy outcomes on patient pain experiences.

3) Project Title: Dignity conserving Therapy: A Randomized Controlled Trial of a Novel, Brief, Individual Psychotherapeutic Intervention for Cancer Patients at the End of Life (PI: Dr. H.M. Chochinov)

One of the greatest challenges facing palliative care today is how to address suffering of dying patients, particularly suffering that derives fro psychosocial, spiritual or existential domains of the patients’ experience. Patient distress associated with symptoms such as pain, nausea, dyspnea, and even to a degree depression and anxiety, have been the focus of some targeted research. Less known about how to address sources of distress outside of these traditional domains. Over the past three years, our palliative care research group has developed an pilot tested and refined a novel individual brief intervention called Dignity Psychotherapy This intervention is based on an empirically derived theoretical model developed from our qualitative and quantitative work on dignity in the terminally ill. This therapeutic approach is unique, in that it is a brief practical bedside intervention designed to enhance a sense of purpose, meaning, and overall quality of life for patients nearing death.

A randomized trial is under way aimed at testing the efficacy of this innovative intervention for patients with advance cancer. A multi-centered international randomized control trial is being conduced in Winnipeg, Perth Australia, and NYC, New York. Three hundred and sixty patients will be randomized to one of three arms, comparing the efficacy of Dignity Psychotherapy, Client Centered Visits, and standard care in a cohort of dying patients. Patients complete a number of baseline self-report measures, and post-intervention. One family member per patient provides baseline self report data on their own psychosocial distress; standardized grief inventories, and family satisfaction measures 6-9 months following the patients’ death to obtain useful information regarding this approach as a potential bereavement intervention. This study will provide essential data regarding the impact of this intervention for dying patients and their families.

4) Project Title: Reliance on Tube-Feeding: A Grounded Theory Study of Dysphagic Head & Neck Cancer Patients’ Experiences

Head and neck cancer may profoundly affect swallowing, whether as the result of progressive tumor growth, or treatment related sequelaae. Survival and radiation-based function preservation approaches aimed at minimized deficits in swallowing have been developed for use in patients in both early and late stages of disease. However, patients may experience long-term dysphagia require partial or total dependence on tube-feeding to meet their nutritional needs. The psychological and social impact of dysphagia and reliance on tube-feeding can be profound, yet empirical work examining these challenges from an ’emic’ or patient perspective are lacking. The ability of health professionals to respond to patient care needs is predicated on an understanding of the clinical challenges these patients face. This grounded study aimed at explicating experiences of dysphagic head and neck caner patients reliant on tube feeding is a critical first step in arriving at such and understanding, and will provide the basis from which future psychosocial intervention-based research projects can be mounted to help patients deal with this facet of their illness experience.

5) Project Title: Family Presence During Resuscitation: Perceptions of Family Members and Health Care Providers

Clinicians are beginning to revisit the practice of excluding family members from being present during the cardio-pulmonary resuscitation of a relative in hospital. Contrary to objections raised by some health care providers concerning this practice, research in the United States and U. K. suggests family members neither suffer negative psychological effects nor disrupt the efforts of the health care team when allowed to be present during resuscitation interventions. These empirical findings must be viewed tentatively, however, owing to the retrospective non-random survey data from small, non-representative samples on which the findings are based. Moreover, survey research presupposes that the variables of interest about a topic of are already known and that their prevalence, distribution, and interrelationships can be captures. However, the extant literature on family presence during resuscitation is in its infancy making survey work premature. What is first required are detailed, qualitative descriptions of the experience of being present during resuscitation from those directly involved—namely family members and health care provides. A descriptive exploratory study is currently underway using qualitative interviews to capture the experience of these individuals. The findings from this work will provide a means from which the experience of being present during resuscitation can be understood within a Canadian context, and provides the foundation for future interventions work designed to support family members who opt to be present during the resuscitation of a loved one.

 

MANUSCRIPTS IN PRESS

Lobchuk, M.M., Bapuji, S.B., McClement, S.E., Sisler, J., Katz, A., Martens, P.J., Turner, D., & Clouston, K. (in press). What is the role of family in promoting fecal occult blood test screening?

Exploring physician, average-risk individual, and family perceptions. (in press) Cancer Epidemiology

Penner, J., McClement, S., Lobchuk, M., Daeninck P. (in press). Family members’
experiences caring for patients with advanced head and neck cancer receiving tube-feeding. A descriptive phenomenological study. Journal of Pain & Symptom Management.

Thompson, G., Chochoinov HM, McClement, S.E. (in press). How respect and kindness are experienced at the end of life by nursing home residents. Canadian Journal of Nursing Research.

Bokhari, F., MacMillan, D., McClement, S.E., & Daeninck, P. (in press) Pilot study of a survey to identify the prevalence and risk factors for chronic neuropathic pain in women following breast cancer surgery. European Journal of Cancer Nursing

MANUSCRIPTS PUBLISHED IN REFEREED JOURNALS

Hearson, B., McClement, S.E., & McMillan D.E., & Harlos, M. (2011) Sleeping with one eye open: the sleep experience of family members providing palliative care at home Journal of Palliative Care, 27(2), 69-78.

Lowe, M., McClement, S.E. (2011). The lived experience of young Canadian widows. Omega, 62(2), 127-148.

McClement, S.E., Lobchuk, M.M., Chochinov, H.M., & Dean, R.K. (2010). “Broken covenant: Health care aides’ ‘experience of the ethical’ in caring for dying seniors in a personal care home. Journal of Clinical Ethics, 21(10), 201-211.

Hack, T.F., McClement, S.E., Chochinov, H.M., Cann, B.J., Hassard, T. H., Kristjanson, L.J., & Harlos, M. (2010). Learning from dying patients during their final days: life reflections gleaned from dignity therapy. Palliative Medicine E24, 715-723.
McClement, S.E., Wowchuk, S., Klaasen, K (2009). “Caring as if it were my family”: Health Care Aides’ Perspectives about Expert Care of the Dying Resident in a Personal Care Home. Palliative & Supportive Care, 7: 449-457.

Chochinov, H., Hassard, T., McClement, S., Hack, T., Kristjanson, L. J.,
Harlos, M., Sinclair, S., Murray, A. (2009). The landscape of distress in the terminally ill. Journal of Pain & Symptom Management. 38, 641-649.

McClement, S.E., & Fallis, W.M. (2009). Family Presence during Resuscitation: Canadian Critical Care Nurses’ Perspectives. Image: Journal of Nursing Scholarship, 41:3, 233-240

Thompson, G.N., Menec, V. H., Chochinov H.M., & McClement, S.E. (2008). Family satisfaction with care of a dying loved one in nursing homes: What makes the difference? Journal of Gerontological Nursing, 34(12), 37-44.

Chochinov H.M., Hassard, T., McClement, S., Hack, T., Kristjanson, L.J., Harlos, M., Sinclair, S., & Murray, M. (2008). The patient dignity inventory: A novel way of measuring dignity-related distress in palliative care. Journal of Pain and Symptom Management, 36(6), 559-571.

Lobchuk, M.M., Murdoch, T., McClement, S.E., McPherson, C. (2008). A dyadic affair: Who is to blame for causing and controlling the patient’s lung cancer? Cancer Nursing, 31(6), 435-443.

Fallis, W.M., McClement, S.E., & Pereira, A. (2008). Family presence during resuscitation: A survey of Canadian critical care nurses’ practices and perceptions. Dynamics: The Official Journal of the Canadian Association of Critical Care Nurses, 19(3), 22-28.

Lobchuk, MM, McClement SE, McPherson C, & Cheang, M. (2008). Does blaming the patient with lung cancer affect the helping behaviour of primary caregivers? Oncology Nursing Forum, 35(4), 681-689.

Penner JL, & McClement SE. (2008). Using phenomenology to examine the experiences of family caregivers of patients with advanced head and neck cancer: Reflections of a novice researcher. International Institute for Qualitative Methodology (IJQM), 7(2), 92-101.

McClement, SE, & Harlos M. (2008). When advanced cancer patients won’t eat: Family member responses. International Journal of Palliative Nursing, 14(4), 185-191.

McClement SE, Chochinov, HM. (2008). Hope in advanced cancer. European Journal of Cancer, 44, 1169-1174.

McClement SE, Chochiniov HM, Hack TF, Hassard T, Kristjanson L, Harlos M. Dignity Therapy: Family Member Perspectives. (2007) Journal of Palliative Medicine, Oct:10(5), 1076-1082.

Hearson, B., McClement SE. (2007). Sleep Disturbance in Family Caregivers of Community Dwelling Palliative Cancer Patients. International Journal of Palliative Nursing, 13(10): 495-501.

Wowchuk, S.M., McClement, S., & Bond J. (2007). The challenge of providing palliative care in the nursing home part II: internal factors. International Journal of Palliative Nursing, 13(7), 345-350.
Fallis, W.M., Silverthorne, D., Franklin, J.F., & McClement, S.E., Andries, A. (2007). Client and Responder Perceptions of a Personal Emergency Response System: Lifeline. Home Health Care Services Quarterly Volume 26, No.3, 1-19.

Penner, JL, McClement SE, Sawatzky, J (2007). Dysphagia in advanced oropharyngeal cancer patients. International Journal of Palliative Nursing, 13(5), 206-212.

Lobchuk, MM, McClement SE, Daeninck PJ, Shay C, Elands H. (2007). Asking the right question of informal caregivers about patient symptom experiences: Multiple proxy perspectives and reducing interrater gap. Journal of Pain and Symptom Management, 33(2):130-145.

Schnell K.N., Naimark, B.J., & McClement, S.E. (2006). Influential factors for self-care in ambulatory care heart failure patients: a qualitative perspective. Canadian Journal of Cardiovascular Nursing, 16(1), 13-9.

Beel, A.C., Hawranik P.G., McClement S., Daeninck, P. (2006). Palliative sedation: Nurses’ perceptions. International Journal of Palliative Nursing, 12(11), 510-518.

Kelly B, McClement S, Chochinov HM (2006). Measurement of psychological distress in palliative care. Palliative Medicine, 20, 779-789.

Wowchuk, SM, McClement, S.E., & Bond, J. Jr. (2006). The Challenge Of Providing Palliative Care In The Nursing Home: Part I: External Factors. International Journal of Palliative Nursing, 12(6): 260-267.

Chochinov HM, Kristjanson LJ, Hack TF, Hassard T, McClement S, Harlos M. (2006). Personality, neuroticism, and coping towards the end of life. Journal of Pain and Symptom Management, 32(4):332-41.

Chochinov H, Kristjanson L, Hack T, Hassard T, McClement S, Harlos M. (2006). Dignity in the Terminally Ill: Revisited. Journal of Palliative Medicine, 9(3):666-672.

Thompson, G., McClement, S.E., & Daeninck, P. (2006). Changing lanes: Facilitating the transition from curative to palliative care. Journal of Palliative Care, 22(2):91-98

Schnell, K.N., Naimark, B.J., & McClement, S.E. (2006). Influential factors for self-care in ambulatory care heart failure patients: A qualitative perspective. Canadian Journal of Cardiovascular Nursing, 16(1) 13-19.

McClement, S.E. (2006). Acquiring an Evidence-Base in Palliative Care: Challenges and Future Directions. Pharmacoeconomics & Outcomes Research, 6(1), 37-40.

Thompson, G., McClement, S.E., & Daeninck, P. (2006). Nurses’ perceptions of quality end-of-life care on an acute medical ward. Journal of Advanced Nursing, 53(3), 169-177.

Chochinov, H.H., Hack, T., Hassard, T., Kristjanson, L.J., McClement, S.E., & Harlos, M. (2005). Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology 23(24): 5520-5525.

Dean M, McClement SE, Bond, J., Daeninck PJ, Nelson, F. (2005). Parental experiences of adult child death from cancer. Journal of Palliative Medicine, 8(4):751-765.

McClement, S.E., & Degner, L.F. (2005). Knowing is not enough: We must do. CJNR Guest Editorial. Canadian Journal of Nursing Research, 37(2) June: 9-12.

McClement, S.E. (2005). The Manitoba Palliative Care Research Unit: Collaboration in action. Canadian Journal of Nursing Research, 37(2) June: 101-104.

McClement, S.E. (2005). Cancer anorexia-cachexia-syndrome [CACS]: Psychological impact on the patient and family. Journal of Wound, Ostomy, and Continence Nursing JWOCN. Jul-Aug:32(4):264-8.

McClement, S.E., Care, W.D., Dean, R.A., & Cheang, M. (2005). Evaluation of a theoretical course in palliative care: Impact on registered nurses’ knowledge about cancer pain management and attitudes toward care of the dying patient. Journal of Palliative Care, 21(1), 44-48.

McCormick, K., Naimark, B., & McClement, S.E. (2005) A qualitative analysis of the experience of uncertainty while awaiting coronary artery bypass surgery. Canadian Journal of Cardiovascular Nursing. 15(1), 10-22.

Chochinov, H.M., Hack, T., Hassard, T., Kristjanson, L.J., McClement S., & Harlos, M. (2005). Understanding the will to live in patients nearing death. Psychosomatics 46:1, January-February, 7-10.

Hack, T., Chochinov, H. M., Hassard, T., Kristjanson, L., McClement, S., & Harlos, M. (2004). Defining dignity in terminally ill cancer patients: A factor analytic approach. Psycho Oncology, 13:700-708.

McClement, S.E., Chochinov,, H.M., Hack, T.F., Kristjanson, L., & Harlos, M. (2004). Dignity-conserving care: application of research findings to practice. International Journal of Palliative Nursing, 10(4), 173-179.

Chochinov, HM, Hack, TF, Hassard, T, Kristjanson, LJ, McClement, S., & Harlos, M. Dignity and psychotherapeutic considerations in end of life care. (2004) Journal of Palliative Care, 20(3): 134-142.
McClement, S.E., Degner, L.F., & Harlos, M.S. (2004). Family responses to declining intake in a terminally ill relative: Part I:”Fighting back”. Journal of Palliative Care, 20(2), 93-100.

McClement, S.E., Chochinov, HM, Hack, TF, Kristjanson, LJ, & Harlos, MS. (2004). Dignity conserving care: Application of research findings to practice. International Journal of Palliative Nursing, 10(4):173-179.

McClement SE, Degner LF, Harlos MS. (2003). Family beliefs regarding the nutritional care of a terminally ill relative. Journal of Palliative Medicine, 6(5):737-748

Chochinov, H.M., Hack, T., Hassard,T., Kristjanson, L., McClement S, Harlos, M. (2002). Dignity in the terminally ill; a cross sectional cohort study. Lancet; 360: 2026 2030.

Dean, R.A., & McClement, S.E. (2002). Palliative care research: methodological and ethical challenges. International Journal of Palliative Nursing, 8(6), 376-379.

Thompson, G., & McClement, S.E. (2002). Defining and determining quality in end-of-life care. International Journal of Palliative Nursing, 8(6), 288-293.

Beel, A., McClement, S.E., & Harlos, M. (2002) Palliative sedation therapy: a review of definitions and usage. International Journal of Palliative Nursing, 8(4) 190-199.

Chochinov, H.M., Hack, T.F., McClement, S.E., Kristjanson, L.J., & Harlos, M.S. (2002). Dignity in the terminally ill: A developing empirical model. Social Science & Medicine, 54, 433-443.

McClement, S.E. (2001). Carers bear the burden of home care. (Invited Guest Editorial) International Journal of Palliative Nursing, Nov 7(11), 520.

McClement, S.E., & Hack, T.F. (1999). Audio-taping the oncology treatment consultation: A literature review. Patient Education and Counseling,36(3), 229-238.

McClement, S.E., & Woodgate, R.L. (1998). Conducting research with families in palliative care: Conceptual and methodological challenges. European Journal of Cancer Care, 7, 247-254.

Woodgate, R.L., & McClement, S.E. (1998). Symptom distress in children with cancer: the need to adopt a meaning-centered approach. Journal of Pediatric Oncology Nursing, 15(1), 3-12.

Fallis, W.M., Bilodeau, B. & McClement, S.E. (1998). Making sense of research. The Canadian Nurse, 94(5), 26-30.

McClement, S. E., Woodgate, R. L., & Degner, L. F. (1997). Symptom distress in adult cancer patients. Cancer Nursing, 20(4), 236-243.

McClement, S. E., & Woodgate, R. L. (1997). Care of the terminally ill cachectic cancer patient: Interface between nursing and psychological anthropology. European Journal of Cancer Care, 6, 295-303.

Woodgate, R. L., & McClement, S. E. (1997). Sense of self in children with cancer and childhood cancer survivors: A critical review. Journal of Pediatric Oncology Nursing, 14(3), 137-155.

McClement, S. E., & Degner, L. F. (1995). Expert nursing behaviors in care of the dying adult in the intensive care unit. Heart & Lung, 24(5), 408-419.

Hanson, E. J., McClement, S. E., & Kristjanson, L. J. (1995). Psychological support role of night nurses on an acute oncology unit: A Canadian pilot study. Cancer Nursing, 18(3), 237-246.

Book Chapters:

McClement S.E., & Chochinov HM (2011). Spirituality in supportive oncology. In C. Zimmerman, (Ed.), Supportive Oncology (1st edition) New York: Elsevier (pp. 521-525).

McClement, S.E. (2010). Involuntary weight loss and altered body image in patients with cancer anorexia-cachexia syndrome. In: E. Del Fabbro, V. Baracos, W. Demark-Wahnefried, T. Bowling, J. Hopkinson, & e. Bruera, (Eds.), Nutrition and the cancer patient. Oxford: Oxford University Press (pp. 499-508).

McClement, S.E. (2009). Chapter 24: Eating issues in palliative cancer patients. In: Chochinov, H.M., & Breitbart, W. (Eds.), Handbook of psychiatry in palliative medicine. (2nd edition). Oxford: Oxford University Press (pp. 417-426).

McClement, S.E., & Chochinov, HM. (2009). Spiritual issues in palliative care. In G. Hanks, N. I. Cherny, N. A. Christakis, M. Fallon, S. Kaasa and R. K. Portenoy, (Eds.), Oxford Textbook of Palliative Medicine (4th edition). Oxford: Oxford University Press (pp. 1403-1409).

McClement SE, Chochinov HM. (2009) Chapter 157: Depression. In Walsh TD, et al. (Eds.), Palliative Medicine Philadelphia: Saunders Elsevier (pp 865-871).

McClement S.E., & Chochinov, HM (2006). Chapter 13: Dignity in palliative care. In: E. Bruera, I. Higginson, C. Ripamonti, and C. Von Gunten, (eds.) Textbook of Palliative Medicine London: Hodder Arnold (pp.100-107).

Book Chapter in Press:

n/a

PUBLISHED ABSTRACTS:

Nesbitt, J., McClement, S.E., Edwards, M., & Harlos, M.S. (2011). End of life care following acute stroke: The nurse’s perspective. Canadian Journal of Neuroscience Nursing 33 (1), p 17.

McClement, S.E., Lobchuk, M., Chochinov HM, & Dean R. (2011). ‘Broken covenant’: Healthcare aides’ experience of the ethical in caring for dying seniors in a personal care home. Canadian Bioethics Society 22nd Annual Conference-Book of Conference Abstracts. St. John, New Brunswick.

Edwards, M., & McClement, S.E. (2011). Palliative home care, and the notion of “if the client wants it, its right”. Canadian Bioethics Society 22nd Annual Conference-Book of Conference Abstracts. St. John, New Brunswick.

Sadeh, E., Moffatt, M., McClement, S.E., & Metge, C. (2011). Consolidation of Acute Care Surgical Services: Learning from Patient Experiences. Canadian Association for Health Services & Policy Research Conference, Halifax, Nova Scotia.

Nesbitt, J., McClement, S.E., Edwards, M., & Harlos, M. (2011). End of life care following an acute stroke: The nurses perspective. Canadian Association of Neuroscience Nurses, Toronto, Ontario

McClement, S., Fallis, W., & Pereira, A. (2010). Family Presence During Resuscitation (FPDR) in the Emergency Room and Intensive Care Unit: Family Members’ Perspectives. Abstract D08-A: Journal of Palliative Care, 26(3), p.216.

Hack, T., McClement, S., Chochinov, H., Cann, B., Hassard, T., Kristjanson, L., & Harlos, M. (2010). What Can We Learn From Cancer Patients’ Reflections on Life as Death Approaches? Analysis of Dignity Therapy Transcripts. Abstract G08-C: Journal of Palliative Care, 26(3), p. 223.

Edwards, M., Webster, G., Murphy, P, & McClement, S.E. (2010). Moral Distress – Seeking Greater Clarity to Restore Moral Meaning. Conference Book of Abstracts. 21st Annual Canadian Bioethics Society Conference, Kelowna, B.C. (p 6).

Hack, T., McClement, S., Chochinov, H., Cann, B., Hassard, T., Kristjanson, L., Harlos, M. (2010). What can we learn from cancer patients’ reflections on life as death approaches? Analysis of dignity therapy transcripts.. Journal of Palliative Care, 26, 223.

Hack, T.F., McClement, S.E., Chochinov, H.M., Cann, B., Hassard, T., Kristjanson, L., Harlos, M. (2010). What can we learn from cancer patients’ reflections on life as death approaches? Analysis of dignity therapy transcripts. . Psycho-Oncology, 19 (Suppl. 2): S182.

McClement, S.E., Wowchuk, S., & Klaasen, K. (2009). Health Care Aides’ Perspectives about Expert Care of the Dying Resident in a Personal Care Home. Conference Book of Abstracts-Making Moments Matter: 15th National Conference on Gerontological Nursing (p.100).

Edwards, M., McClement, S.E., & Briscoe, W. (2009). Moral Distress and Moral Courage: Working Together in Moments that Matter. Conference Book of Abstracts–Making Moments Matter: 15th National Conference on Gerontological Nursing.

McClement, S.E., Chochinov H.M., & Dean, R. Lobchuk, M.M (2009). Health Care Aides ‘Experience of the Ethical’ in Caring for Dying Seniors in a Personal Care Home Book of Abstracts: 3rd International In Sickness and in Health Conference: Government of the Self in the Clinic and the Community (Abstract A2-p.23).

Fallis, W, & McClement, S.E. (2008). Family Presence during Resuscitation: A Survey of Canadian Critical Care Nurses’ Practices and Perceptions. Dynamics National Critical Care Conference Book of Abstracts, p.18.

McClement, S.E. (2006). Do you see what I see? Body image issues in end of life care.
Book of Abstracts-16th Annual Provincial Hospice Palliative Care Conference, Winnipeg, Manitoba, p. 69.

McClement, S.E. (2006). Wisdom from the trenches: Health care aide perspectives on how to provide excellent care for dying residents in personal care home settings. Book of Abstracts-16th Annual Provincial Hospice Palliative Care Conference, Winnipeg, Manitoba, p. 81.

Lobchuk, M.M., McClement, S.E., Daeninck, P.J., & Elands, H. (2006). What do informal caregivers think and feel when they are induced to perspective on cancer patients’ symptom experiences? 4th International Conference on Cancer Nursing, International Society of Nurses in Cancer Care/Canadian Association of Nurses in Oncology, September 27 to October 1, 2006 Toronto, Ontario.

Woodgate, R., McClement, S.E., Beaune, L., West, C., Drouin, D., Stutzer, C., Widger, K. (2005). Families’ Perspectives about the Transition Experience and Nature of Care through Childhood Cancer and Bereavement. Book of Conference proceedings, International World Gathering on Bereavement. Vancouver, B.C.

McClement, S.E. (2005). Ethical issues in the provision of home-based palliative care: Do Nurses and Physicians See things differently? Abstract P267, page 60. In Canadian Association of Psychosocial Oncology [CAPO] 2005 Mind/Body Medicine and Spirituality: New Horizons in Cancer Care Book of Abstracts, Victoria, B.C.

McClement, S.E., Woodgate, R.L. (2004). Calming the waters of our souls: A nursing perspective on caring for palliative cancer patients experiencing delirium. Abstract 1.2, page 17. International Palliative Care Nursing Research Conference, Prato Italy.

McClement, S.E. (2004). Involuntary weight loss in advanced cancer: a grounded theory study of patient and family member perspectives. Plenary Paper Abstract, page 46. International Palliative Care Nursing Research Conference, Prato Italy.

McClement, S.E. (2004). Family beliefs regarding the nutritional care of a terminally ill relative: a qualitative study. Abstract 4.2, page 53. International Palliative Care Nursing Research Conference, Prato Italy.

McMillan D.E., Sloan, J.A., Richardson, J., Frost, M., McClement, S.E., Morre W., Novotny, P.J., Painter, V., & Read, L. (2003). Linking clinical significance to a sleep intervention model. Clinical Therapeutics: Quality of Life III: Translating the Science of Quality of Life Assessment into Clinical Practice: An Example Drive approach for Practising Clinicians and Clinical Researchers. (vol. 24-Suppl 4). Pages D45-47.

McClement, S.E. (2002). A grounded theory study of family member perspectives regarding the nutritional care in advanced cancer. Journal of Palliative Care, 18(3), 216.

McClement, S.E. (2001). To feed or not to feed? Factors influencing family member perceptions regarding the nutritional care of a terminally ill relative. Journal of Palliative Care, 17(3), 199.

Dean, M., Bond, J., & McClement, S.E. (2001). Losing an adult child to cancer. Journal of Palliative Care, 17(3), 219.

Chochinov HM, Hack T, McClement S.E., Kristjanson L, (2000). The Palliative Care Dignity Inventory. Psychosomatics, 41:160

Chochinov, H.M., Hack, T., McClement, S.E., Kristjanson, L., & Harlos, M. (2000). Dignity in the Terminally Ill. Book of Abstracts, Conference Proceedings: Psychosocial Oncology 2000-and Beyond–Future Directions. Vancouver, B.C.

McClement, S.E. (1999). Nutritional care in advanced cancer: A preliminary analysis of patients, family, and health care provider experiences. Journal of Palliative Medicine, 2(1), 129.

Chochinov, H.M., Hack, T.F., Kristjanson, L.J., Harlos, M.S. & McClement, S.E. (1998). Explicating the Construct of Dignity in Palliative Cancer Patients. 4th International Qualitative Health Research Conference (PC8, p.116). Vancouver, B.C.

McClement, S.E. (1998). Expert nursing behaviors in care of the dying adult in the intensive care unit. 1st International Research Utilization Conference. Conference Proceedings, p.36. Toronto, ON.

TRANSLATED WORKS

McClement, S.E. (2000). Nurse-physician collaboration in palliative care research. Pflegewissenschaft im Kontext der Meizin: Symposium vom Samstag. UniversitatsSpital, Zurich.

COMMISSIONED WORKS

McClement, S. E., & Hack, T. F. (1997). The impact of providing patients with
audiotapes of initial oncology treatment consultation on information recall, anxiety, and satisfaction with communication. Commissioned by Dr. T Hack: Funded by the National Cancer Institute of Canada (NCIC)/ Sociobehavioral Cancer Research Network (SCRN).

McClement, S. E. (1994). Cancer support groups: A review of the literature. Commissioned by the Canadian Cancer Society Emotional Support Group Sub-Committee Task Force: Funded by the Canadian Cancer Society.

NON-REFEREED PUBLICATIONS

McClement, S. (2008). Nutritional care of the dying: Family members’ concerns. The Forum: Association for Death Education and Counseling, 34(4), 5-6.

McClement, S.E.,& Yates, R. (2004). Guidelines for talking with children. Hospice Companion 15(3); 6.

McClement, S.E. (2001). Nutritional care in advanced cancer: The experiences of patients, families, and health care providers. Nurse Scene, 26, (2): 24.

McClement, S.E. (2000). Nutritional care at the end of life: Food for thought. Hospice
Companion, 11(1), 4-5.

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June 2009 – Canadian Association of Critical Care Nurses Editorial Award for the article, “Family presence during resuscitation: A survey of Canadian critical care nurses’ practices and perceptions.” (2008). Dynamics: The Official Journal of the Canadian Association of Critical Care Nurses, 19(3), 22-28. Shared with lead author Dr. Wendy Fallis and co-author Asha Pereira

June 2009 – University of Manitoba Merit Award

June 2009 – Honorary Nursing Diploma, Saskatchewan Institute for Applied Science and Technology,Regina Saskatchewan

April 2009 – University of Manitoba Students’ Teacher Recognition Award

May 2008 – University of Manitoba Graduate Students’ Association Teaching Award

March 2007 – Certificate of Excellence in Leadership Saskatchewan Institute for Science & Applied Technology [SIAST] Nursing Division, Saskatoon, SK

2005 – College of Registered Nurses of Manitoba Excellence in Professional Nursing Award

May 2005 – Favourite Faculty Teaching Award (Palliative Care Nursing) Baccalaureate Program for Registered Nurses (BPRN) Faculty of Nursing, University of Manitoba

April 2002 – Centre for Applied Ethics Fellowship University of Manitoba

April 2001 – Favourite Faculty Teaching Award (Palliative Care Nursing) Baccalaureate Nursing Graduating Class, University of Manitoba

April 1999 – Favourite Faculty Teaching Award (Palliative Care Nursing) Baccalaureate Nursing Graduating Class, University of Manitoba

April 1999 – Best Oral Paper Presentation: “Nutritional Care in Advanced Cancer”. Humber College Palliative Care Conference Toronto, Ontario

1995 – 1998 – National Cancer Institute of Canada (NCIC) Doctoral Studentship for Sociobehavioral Research ($18,500 per annum)

1994 – Manitoba Health Research Council (MHRC) Doctoral Studentship ($12,500 p.a.)

1991 – Manitoba Health Research Council Master’s Studentship ($12,500 p.a.)

1991 – University of Manitoba Graduate Fellowship (Declined in lieu of MHRC studentship)

1986 – University of Victoria Award for Academic Excellence

1979 – Grace Hospital School of Nursing Award for General Proficiency

1979 – Grace Hospital School of Nursing Award for Personal and Professional Qualities

Grants and Contracts (Currently Funded):

Thompson, G., Chochinov, H.M., Hack, T.F., McClement, S., Rogers, K., & St. John, P.
Developing a question prompt sheet for family caregivers of older adults with dementia in long
term care. Manitoba Health Research Council. July, 2011- August, 2013. Total: $152,054.

Chochinov, H.M., McClement, S., Hassard, T., Hack, T.F., Harlos, M., Thompson, G. The
Patient Dignity Question (PDQ): A novel approach to enhancing care for patients near the end
of-life. Canadian Cancer Society Research Institute. July 1, 2010 – June 30, 2013.
Total: $137,000.

Chochinov, H., McClement, S., Hack, T., Harlos, M., Hassard, T., Enns, M., Zacharias, J.,
Ramsey, C., Richman-Eisenstat, J., Strang, D., Johnson, W., Davison, S., Damant, R. Dignity
and distress across end-of-life populations. Canadian Institutes of Health Research. April 1,
2009 – March, 2012. Total: $606,000.

The patient dignity question (PDQ): a novel approach to enhancing care for patients near the end-of-life Principal Applicant: Dr. Harvey Chochinov Co-applicants: Drs. Kristjanson, Hack, McClement, Hassard, & Harlos. Granting Agency: National Cancer Institute of Canada. 2010/2011 : $36,756 -2011/2012 – $52,584 – 2012/2013 – $47,268. Total: $136,608.

Grants and Contracts (Past):

Building on Our Success with KT: The 2nd Annual Dignity Therapy Educational Workshop
Principal Applicant: Dr. Susan McClement, Co-Applicant: Dr. Harvey Chochinov. Granting Agency: Canadian Institutes for Health Research Meetings, Planning and Dissemination Grant: Dissemination Events Funds awarded: $20,000 (June 1, 2011)

McClement, S., Chochinov, H., Hack, T., Harlos, M., Hassard, T., Thompson, G., Hagen, N.,
Sinclair, S., & Murray, A. Assessing the relevance of the Patient Dignity Inventory (PDI) in
identifying distress and influencing clinical care in palliative care. Canadian Institutes of
Health Research. September 1, 2009 – August 30, 2010. Total: $100,000. In addition, Manitoba
Health Research Council Regional Partnership Program. Total: $55,908. Grand Total: $155,908.

Development of a Question Prompt Sheet for Family Caregivers of Older Adults with Dementia Living in Long-term Care
Principal Applicant: Dr. Genevieve Thompson Co-Applicants: Drs. Harvey Chochinov, Susan McClement, & Tom Hack. Granting Agency: Manitoba Health Research Council (MHRC) Operating Grants competition. Funds Awarded: $152,054.00

Developing an Expert Model of Palliative Care for Older Adults with Dementia
Principal Applicant: Dr. Genevieve Thompson Co-Applicants: Dr. Susan McClement & Kathleen Klaasen. Granting Agency: CIHR Catalyst Grant: Pilot Projects in Aging ($34,687)

Ethics and the Interface Between Long-term Care and Emergency Settings
Principal Applicant: Dr. Marie Edwards, Co-Applicant: Dr. Susan McClement. Granting Agency: Canadian Institutes for Health Research Meetings, Planning and Dissemination Grant: Planning Grants Competition. Funds awarded: $4400

An Educational Workshop on Dignity Therapy
Principal Applicant: Dr. Susan McClement, Co-Applicant: Dr. Harvey Chochinov. Granting Agency: Canadian Institutes of Health Research (CIHR) Knowledge Translation Grant (awarded March 2009). Funds awarded: $15,000

Assessing the Relevance of the Patient Dignity Inventory in Identifying Distress and Influencing Clinical Care in Palliative Care
Principal Investigator: Dr. Susan McClement, Co-Investigators: Drs. Harvey Chochinov; Tom Hack; Mike Harlos; Tom Hassard; Neil Hagen Shane Sinclair & Allison Murray. Granting Agency: Canadian Institutes of Health Research-Institute for Cancer Research (awarded September 2009). Funds Awarded: $100,000, Manitoba Health Research Council: $55,908. Grand Total $155,908.

Internet Support community for Individuals Affected by Lung Cancer: Discussion Content and Implications for Health care Providers
Principal Investigator: Dr. Michelle Lobchuk, Co-Investigator: Dr. Susan McClement. Granting Agency: Lung Association : (awarded August, 2009). Funds Awarded: $15,699.

Exploring Ethical Practice in Palliative Home Care using Appreciative Inquiry
Principal Investigator: Dr. Marie Edwards, Co-Investigators: Drs. Susan McClement, Elizabeth Peter & Kerstin Roger. Granting Agency: Canadian Institutes of Health Research Catalyst Grant Ethics (awarded June 2009) Funds Awarded: $64,802 p.a.

The Moral Work of the Palliative Home Care Team
Principal Investigator: Dr. Marie Edwards, Co-Investigators: Dr. Susan McClement & Dr. Kerstin Roger. Granting Agency: Canadian Institutes of Health Research Catalyst Grant Ethics Competition (awarded June 2009). Funds requested: $38,919 p.a.

Chochinov, H., Gagnon, P., McClement, S., Hack, T., Hassard, T., Harlos, M., Taylor-Brown, J., Barrington, V., Ellwood, A., Manii, D., Marshall, D., Mayer, C., McLeod, D., Morris, J., Sellick, S., Slaven, M., Stiles, C., Turnbull, G., Wainwright, W. National patient dignity inventory study. National Cancer Institute of Canada. July 1, 2008 – June 30, 2011. Total: $446,050.

Palliative Home Care Ethics Research Team
Principal Investigator: Dr. Marie Edwards
Co-Investigator: Dr. Susan McClement, Collaborator: Ms. Lori Embelton Program Director Palliative Care Program Winnipeg Regional Health Authority (WRHA). Granting Agency: Canadian Institutes for Health Research (CIHR) Research Advisory Group (CRAG)-Large Grant Development Fund. Funds Awarded: $2,620.00 (1 year) Jan-June 2008.

Responding to Nurses’ Moral Distress
Co-Principal Investigators: Drs. Marie Edwards and Susan McClement. Granting Agency: Canadian Institutes of Health Research Seed Grant: Ethics Competition Funds Awarded: $38,918 (1 year) June 2007-June 2008.

A Phenomenological Analysis of Health Care Aides’ ‘Experience of the Ethical’ in Caring for Dying Patients in a Personal Care Home
Principal Investigator: Dr. S.E. McClement
Co-Investigators: Drs. Michelle Lobchuk and Harvey Chochinov
Granting Agency: Canadian Institutes of Health Research (CIHR) Special RFA in Ethics competition (June 1, 2006)
Funds Awarded: 39,538.

Family Presence During Resuscitation
Principal Investigator: Dr. Wendy Fallis
Co-Investigators: Dr. S.E. McClement & Dr. R. Strachan
Funding Agency: Manitoba Medical Services Foundation (MSF) Funds Awarded: $20,000 [January 2006-December 2006]

Family Presence During Resuscitation
Principal Investigator: Dr. Wendy Fallis
Co-Investigators: Dr. S.E. McClement & Dr. R. Strachan
Funding Agency: American Association of Critical Care Nurses (AACCN)
Funds Awarded: $15,000 [April 2006-March 2007]

Palliative Care Education and Support Needs of Nurses in Community Based Hospitals: A Pilot Study Principal Investigator: Dr. S.E. McClement
Co-Investigators: Dr. Ruth Dean, G. Thompson, & Dr. D. Barkwell
Funding Agency: University of Manitoba Faculty of Nursing Endowment Fund
Funds Awarded: $2295.00 [Sept 05 – August 06]

Reliance on Tube-Feeding: A Grounded Theory Study of Dysphagic Head and Neck Cancer Patients’ Experience
Principal Investigator: Dr. S.E. McClement
Co-Investigators: Candace Myers SLP-C, & Dr. H.M. Chochinov
Funding Agency: CancerCare Foundation
Funds Awarded: $13,500 [Sept 05 – August 07]

Expert Care of the Dying in the Personal Care Home Setting: Health Care Aide Perspectives Principal Investigator: Dr. S.E. McClement
Co-Investigators: Suzanne Wowchuk & Kathleen Klaasen
Funding Agency: Canadian Legion Poppy Fund
Funds Awarded: $2250.00 [August 05-July 06]

The Experience of Involuntary Weight Loss in Advanced Cancer: Patient and Family Perspectives
Principal Investigator: Dr. S.E. McClement
Co-Investigators: Drs. Roberta Woodgate & Harvey Chochinov
Funding Agency: CancerCare Manitoba Intramural Grants Competition, April 2004.
Funds awarded: $12,888.00 ( July 04- Dec. 05)

What do Informal Caregivers Think and Feel When Induced to Perspective-take on Cancer Patients’ Symptom Experiences?
Principal Investigator: Dr. Michelle Lobchuk
Co-Investigators: Drs. Susan McClement & Paul Daeninck
Funding Agency: Canadian Institutes of Health Research (CIHR) [Palliative and End of Life Care Pilot projects competition]
Funds held: $35,515.00
Time frame: March 2002-2003 (1 year)

End of Life Care and Vulnerable Populations
Principal Investigator: Dr. Harvey Chochinov
Co-Investigators: Drs. D. Steinstra, J. Kaufert, & Z. Lutfyyia
Collaborators: Drs. E. Bruera, L., Kristjanson, I. Higginson, S. McClement, T. Hack, J. Taylor-Brown, M. Harlos, N. Hansen, & Librach, L.
Funding Agency: Canadian Institutes of Health Research (CIHR) End of Life Care New Emerging Team Grant
Funds held: $279,000
Time frame: 5 years (awarded July 2004)

New Emerging Teams in Palliative Care: Cancer-associated Cachexia-Anorexia Syndrome
Principal Investigator: Dr. Vickie Baracos, U of Alberta
Co-Investigators: Clandinin M, MacDonald N, Marliss E
Collaborators: McClement SE, Wismer W
Funding Agency: Canadian Institutes of Health Research (CIHR) End of Life Care New Emerging Team Grant
Funds held: $259,000 p.a.
Time frame: 5 years (awarded July 2004)

Nurses’ and Physicians’ Perceptions of Ethical Problems in the Provision of Home-Based Palliative Cancer Care.
Principal Investigator: Dr. Susan McClement
Funding Agency: Sociobehavioral Cancer Research Network (SCRN)
Funds held: $8,000.00
Time Frame: Sept. 2002-2004

Quality of Life for Individuals at the End of Life
Principal Investigator: Dr. H. Chochinov
Co-Investigators: Dr.W. Breitbart Dr. T Hack, Dr. S.E. McClement, Dr. L. Kristjanson, Dr. M. Harlos, & Dr. T. Hassard
Funding Agency: National Institutes of Health (NIH) (USA)
Funds held: $1,964,814.00 (2004-2008)

Lung Cancer Stigma: Attributional effects on informal caregiver perspective-taking and accuracy outcomes on symptom experiences
Principal Investigator: Dr. Michelle Lobchuk
Co-Investigators: Drs. Chris McPherson, & S.E. McClement.
Funding Agency: National Cancer Institute of Canada (NCIC)
Funds held: $220,000 (July 05 – June 08)

Funding held in the past 5 years

Delay in Cancer Diagnosis and the Doctor-Patient Relationship. Principal Investigator: Dr. Jeffrey Sisler
Co-Investigators: Telisha Smith-Gorvie, B.Sc. Med Student; Candace Meyers, Speech Pathologist; Dr. Susan McClement
Funding Body: Janus Research Grant, College of Family Physicians of Canada ($4700) (07/01 2002 – 08/01/2003)

Losing an Adult Child to Cancer
Principal Investigator: Dr. Mervyn Dean
Co-Investigators: Dr. John Bond; Dr. Paul Daeninck & Dr. Susan McClement
Funding Body: St. Boniface Research Foundation ($4,000)
(07/01 2002 – 08/01/2003)

Dignity Psychotherapy: An Intervention for Suffering in the Terminally Ill. Principal Investigator: Dr H.M. Chochinov
Co-Investigators: Dr. T Hack, Dr. L. Kristjanson, Dr. S.E. McClement, Dr. M. Harlos, & Dr. T. Hassard
Funding Agency: American Foundation for Suicide Prevention
Funds held: $100,000

Developing the Palliative Care Dignity Inventory
Principal Investigator: Chochinov, H.M.
Co-Investigators: Hack, T.F., Kristjanson, L.J., McClement, S.E., & Harlos, M.S.
Funding Body: National Cancer Institute of Canada (2000-2001 = $61,103) (2001-2002 = $59, 963) (2002-2003 = $13, 284)

The Effect of a Palliative Care Nursing Course on Nurses’ Knowledge and Attitudes about Cancer Pain Management, and Attitudes toward Care of the Dying.
Principal Investigator: McClement, S.E.
Co-Investigators: Dr. Dean Care, & Dr. Ruth Dean.
Funding Body: University of Manitoba Faculty of Nursing Endowment Fund ($2295.00) (06/01/2000 – 07/01/2002)

Caring for Palliative Cancer Patients Experiencing Delirium: A Nursing Perspective
Co-Principal Investigators: McClement, S.E. & Woodgate, R.L.
Co-Investigators: Dean, R.A., & Slobozian, B.
Funding Body: Riverview Health Centre Millennium Research Fund ($7500.00) (06/01/2000 – 07/01/2002

Operating Grants Received

April 2001 – University of Manitoba “Teaching with Technology Grant” for Designing and Evaluating a Palliative Care Nursing Course for Web-Based Delivery. Co-applicant Dr. Dean Care ($3000.50).

January 2000 – University of Manitoba Summer Session Innovation Fund for the development of a course in palliative care for registered nurses. Co-applicant Dr. Dean Care. ($2500)

June 1997 – Nutritional care in advanced cancer: The experiences of patients, families, and health care providers. Funded by the Manitoba Association of Registered Nurses ($3500.00)