Office Hours with Andrea Darzi

As a medical student in Lebanon, Andrea Darzi noticed a common trend that raised questions.

When discussing patient cases, treatment plans were based on clinical practice guidelines. However, there wasn’t enough evaluation of how reliable these guidelines were or if they took important local factors into account.

This observation, and a few barriers that turned into blessings, set her on a path to become an assistant professor at McMaster University in the Department of Anesthesia and Department of Health Research Methods, Evidence and Impact (HEI). It’s here at McMaster where Darzi contributes to optimizing pain management care through the development and mobilization of evidence-based guidelines and advancement of their methodologies.

When one door closes, another one opens

Darzi was born in Australia and moved to Lebanon, where she pursued her undergraduate degree in biology and then medical school. After three months of elective courses in the United States, she secured a paid post-doctoral fellowship which would have her stay there – but her plans were foiled by immigration red tape.

“For the next six months, I had every possible problem with my VISA being issued,” she says. “It felt like it just wasn’t meant to be, and no matter how much I pushed, it seemed like it was not the track I was meant to take.”

She returned to Lebanon where she did a master’s in public health at the American University of Beirut (AUB). From her medical training, Darzi had one-on-one health care experience, but wanted to better understand the health care continuum, including community-level needs and how policy and public health interfaced.

“I noticed that a lot of physicians were trained in research – they were pursuing their master’s degrees, their PhD’s. They noted that being involved in research made them better physicians which in turn, supported their clinical journey with patients.”

While completing her master’s, she was exposed to guideline work and simultaneously co-founded a not-for-profit organization that aimed to work with structurally marginalized populations to increase public health awareness and provide access to health care. Through this work, she continued to witness the disconnect that often occurs between evidence and practice. Those experiences further clarified her desire to pursue a career path in health research methodology and focus on the development, contextualization and mobilization of health guidelines.

The support of mentors along the way

“I have been very privileged – I ended up crossing paths with incredible mentors and supervisors who have supported me and have helped me grow,” Darzi says.

The first of those mentors was Elie Akl, a part-time professor at McMaster and a full-time professor at AUB. Akl introduced Darzi to evidence-based guidelines and to the importance of contextualizing guidelines to different settings prior to their use. Darzi largely credits where she is today to her work with Akl and the foundation she built learning from him. During her time working with him she held the role of assistant director of the AUB GRADE center, where they aimed to educate, use and support the advancement of the GRADE approach that guides users in rating the certainty of evidence and strength of recommendations.

“We worked on adapting international evidence-based guidelines to different contexts, accounting for factors such as values and preferences, cost, equity, feasibility, and acceptability. This allowed for better uptake and impact of the guidelines in their relevant context.”

Through her work with Akl and the GRADE center, Darzi was introduced to Holger Schünemann, who was chair of the Clinical Epidemiology graduate program at McMaster. She came to Hamilton where she completed a three-year PhD and worked part-time as a research assistant.

“My PhD experience shaped me to be stronger, to keep the big picture in mind, and to be more understanding and prepared for the responsibility of pursuing a faculty position. Holger really played a key role in my career, and I am better for it.”

After her PhD, Darzi completed a postdoc with Jason Busse, and worked with him and Gordon Guyatt on several pain guidelines and projects.

“Busse and Guyatt helped me cultivate and refine my skill set and supported my ambition to join as a faculty member and establish my own research path,” she says.

Through her work with them, she recognized that health care professionals are faced with an increasing number of clinical practice guidelines developed using varying methodologies and of varying quality, and are often faced with inconsistent recommendations. Her current focus is on solving this – with the support of her mentors, Darzi was successfully awarded a CIHR grant to develop a freely accessible e-Chronic Pain Recommendation Map.

“I’m so privileged to work with them and be able to provide, through this effort, structured access to high quality trustworthy guidance in the field of chronic pain and a platform to support shared decision-making,” she says.

“Many ways to help people”

As a guideline methodologist with a focus on chronic pain, Darzi’s goal is to be able to contribute to and influence evidence-based policy and practice, and to support optimizing patient care.

“Chronic pain is tough to manage. We have found that most interventions work a little for some people. Twenty per cent of people live with chronic pain, and that includes children. It breaks my heart,” Darzi adds.

Though her ambitions were originally to be a practicing clinician, Darzi believes that the work she does can be just as impactful, where she can focus on long-term goals, publishing high-quality work and optimizing care through the development of trustworthy guidelines, informing policy and practice and increasing trust in science.

“I believe there are many ways to help people. Practicing medicine is just one way. I have found another way to make a difference and  do my part to help the most that I can – and life has blessed me this way,” she says.