Palliative Medicine Research Program

Development of a dementia specific portal based ACP tool by engaging end users
PI: Gabbard, J
Brief description: we will engage PLWD, those with CF, and their caregivers in an iterative process of user-centered design to develop a dementia-specific patient portal-based ACP tool to ultimately improve engagement and adoption among PLWD and in those with CF.

Barriers and enablers to recruitment, retention, and engagement for advance care planning among vulnerable older adults utilizing the Theoretical Domain Framework
PI: Gabbard, J
Brief description: We will conduct structured interviews with patients (n=15): five patients who participated in the IMPACT study, five passive patient decliners (those who initially agreed but did not show up to their provider ACP visit) and five active patient decliners (patients who refused to participate)

Impact of advance care planning on health-related outcome measures in patients admitted for COVID-19
PI: Gabbard, J and Silla,L (med student)  CoI: Amy Cowles, Tiffany Statler
Brief description: The goal of this study is to assess whether having documented ACP prior to admission for COVID19 affects health related outcomes (i.e. length of stay, ICU admission, in-hospital mortality, in-hospital CPR, mechanical ventilation, and discharge location).

A Telehealth ACP Intervention in those with Unrecognized Dementia or Mild Cognitive Impairment and their Caregivers
PI:  Gabbard, J   CoI: Gretchen Brenes, Ajay Dharod, Richa Bundy, Adam Moses, Nick P
Brief description: The purpose of this study is to pilot-test and evaluate a pragmatic telehealth ACP intervention among patients with either unrecognized dementia or with the diagnosis of mild cognitive impairment.  
 
Telehealth utilization and satisfaction in oncology patients followed by palliative care during the COVID19 pandemic
PI: Gabbard, J and  Weimer,A (med student)
Brief description: The goal of this study is to access acceptability and satisfaction of telehealth among oncological patients followed in the supportive care oncology clinic during COVID19 pandemic.

Quality Improvement of the Management of End of Life Care
PI: Rebecca Omlor          
Brief description: We are looking to see if the new comfort care order set changes the prescribing/ordering practices of providers on the resident run ward services.  We also did pre- and post-surveys on perceptions and knowledge related to end of life care and the order set.

Evaluation of Aggressive Treatment Administered at End-of-Life in Oncology Patients
PI: Brandy Snyder (Tiffany Statler)
Brief description: The research’s objective is to evaluate the use of aggressive cancer treatment during the last 30 days of life in oncology patients within a specific time frame to identify trends and opportunities to enhance value and quality of care for patients.  An observational, single-center, retrospective chart review, IRB approved. Cancer Center registry generated a report to identify deceased oncology patients treated at the institution from, July 1st, 2017 to July 1st, 2019.

Analysis of the Electronic Frailty Index (eFI) in Relation to COVID-19 Infection Outcomes in Hospitalized Older Adults in a Southeastern US Health Care
PI: Brooten,J                  CoIs: Gabbard, J, Grey,C, & Cline, D
Brief description: The goal is to assess the association between the eFI and health-related outcomes in patients sixty-five and older with COVID-19 infection to see if this an independent predictor of poor outcomes

Use of machine learning to develop a risk predictor for early mortality in inter-hospital transfer patients.
PI: Brooten,J                   CoIs: Gabbard, J, Grey,C, & Cline, D
Brief description: The goal of this study is to use machine learning to identify markers within the EHR associated with early mortality (defined as death within 72 hours of transfer) in patients who were transferred to a tertiary medical center. 

Layers of Loss: A Scoping Review of Huntington’s Disease Caregivers’ Spiritual Distress and Coping Strategies
PI: Marterre, B and Bethany Leidl
Brief description: Scope of review on caregiver spiritual distress and coping scoping in  Huntington's disease. 

Cryocompression for Bortezomib-induced Peripheral Neuropathy among Multiple Myeloma Patients
PI: Strowd, R     CoI; Tiffany Statler
Brief Description: The primary objective of this two-arm, open label pilot study is to evaluate the feasibility of daily, 30-minute cryocompression treatments over an 8-week period in multiple myeloma patients.

Comparative Effectiveness of Early Integrated Telehealth versus In-Person Palliative Care for Patients with Advanced Lung Cancer (REACH PC)
PI: Temel, Site PI: Grey

Brief Description: to compare the effect of telehealth vs in-person palliative care for patients with advance lung cancer.

Improving Transitions of Care after discharge from SNF
Aim 1: To arrange PCP follow up before SNF discharge and examine the impact on the days to PCP follow up as documented via encounters in the EHR.
Aim 2: To examine number of patients arriving to PCP follow up appointments after SNF discharge and describe the association with 30-day hospital/SNF readmission rates.

Steffen,L; Cheavens,J; Vowles,K; Gabbard,J; Nguyen, H; Gan,G; Martin,E; Smith,B. Hope-related Goal Cognitions and Daily Experiences of Fatigue, Pain, and Functional Concern among Lung Cancer Patients. Supportive Care in Cancer. Support Care Cancer. 2019 Jun 01. PMID: 31152302.

Gabbard J, Jordan A, Mitchell J, Corbett M, White P, Childers J. Dying on Hospice in the Midst of an Opioid Crisis: What Should We Do Now? The American journal of hospice & palliative care. 2018:1049909118806664.

Mogul AS, Cline DM, Gabbard J, Bryant C. Missed Opportunities: Integrating Palliative Care into the Emergency Department for Older Adults Presenting as Level I Triage Priority from Long-Term Care Facilities. The Journal of emergency medicine. 2018. 

Gabbard, J., Sieber, F., & Oh, E. (2019). Postoperative Delirium. In R. Eckenhoff & N. Terrando (Eds.), The Perioperative Neurocognitive Disorders (pp. 11-23). Cambridge: Cambridge University Press. doi:10.1017/9781316402504.003 (ISBM: 9781316402504). 

Gabbard,J; McNabney,M. “End-of-Life Care for Dementia Patients in the Program of All-inclusive Care for the Elderly (PACE) - A Quality of Care Assessment”. Remedy Open Access. 2016. Volume 1. Article 1016. Page 1-5. 

Gabbard J, McNabney M. The Case for Dual Training in Geriatric Medicine and Palliative Care: The Time is Now. Am J Hosp Palliat Care. 2018 Feb;35(2):364-370. doi: 10.1177/1049909117696251. Epub 2017 Mar 1. PubMed PMID: 28273760.

Gabbard, J., Pajewski, N. M., Callahan, K. E., Dharod, A., Foley, K., Ferris, K., Williamson, J. (2019). Advance care planning for vulnerable older adults within an Accountable Care Organization: study protocol for the IMPACT randomised controlled trial. BMJ Open, 9(12). doi:ARTN e032732

Moses, A., Dharod, A., Williamson, J., Pajewski, N. M., Tuerff, D., Guo, J., & Gabbard, J. (2020). Considerations for Integrating Advance Care Planning Into the Electronic Health Record: A Primer for Clinicians. American Journal of Hospice & Palliative Medicine. doi:Artn 1049909120909303

McLouth, L. E. S., Lycan, T. W., Levine, B. J., Gabbard, J., Ruiz, J., Farris, M., . . . Petty, W. J. (2020). Patient-Reported Outcomes From Patients Receiving Immunotherapy or Chemoimmunotherapy for Metastatic Non-Small-Cell Lung Cancer in Clinical Practice. Clinical Lung Cancer, 21(3), 255-+. doi:10.1016/j.cllc.2019.11.015

Gabbard, J.; Johnson,D*; Russel, G; Spencer, S; Williamson, J; McLouth,L; Ferris,K; Sink,K; Brenes,G; Yang, M. "Prognostic Awareness, Disease and Palliative Understanding Among Caregivers of Patients With Dementia." American Journal of Hospice and Palliative Medicine®: 2019. PMID 31854201

Sheehan OC, Kharrazi H, Carl KJ, Leff B, Wolff JL, Roth DL, Gabbard J, Boyd CM. Helping Older Adults Improve Their Medication Experience (HOME) by Addressing Medication Regimen Complexity in Home Healthcare. Home Healthc Now. 2018 Jan/Feb;36(1):10-19. doi: 10.1097/NHH.0000000000000632. PubMed PMID: 29298192

Sheehan OC, Graham-Phillips AL, Wilson JD, Crews DC, Holt CL, Gabbard J, Smith KC, Wolff JL, Roth DL. Non-spouse companions accompanying older adults to medical visits: a qualitative analysis. BMC Geriatr. 2019 Mar 15;19(1):84. PubMed PMID: 30876388

Marterre B. Bruno's Score. J Pain Symptom Manage. 2018.

Gabbard, J; Breznau, C*; Marterre, B. Palliative Management Pearls for Post-Bariatric Surgery Patients. Journal of Palliative Medicine. 2019. 

Marterre B and K Clayville. Navigating the Murky Waters of Hope, Fear and Spiritual Suffering: An Expert Co-Captain’s Guide. Surgical Clinics of North America (in press), 2019.

Omlor, Rebecca. To Resuscitate or Not to Resuscitate. Pallimed Glob. August 2018.

Brooten, J. K., Buckenheimer, A. S., Hallmark, J. K., Grey, C. R., Cline, D. M., Breznau, C. J., . . . Gabbard, J. L. (2020). Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions. Western Journal of Emergency Medicine, 21(4), 935-942. doi:10.5811/westjem.2020.5.46067

Isaac Chua, MD, Finly Zachariah, MD et al.  Early Integrated Telehealth versus In-Person Palliative Care for Patients with Advanced Lung Cancer:A Study Protocol. JPSM. Accepted as of July 2, 2019

Kurowski-Burt A, Sedney C, Smith M, Dekeseredy P, Grey C, Boo S. Therapeutic nihilism of neurological diseases: A comparative qualitative study. Jour of Clin Neuroscience. Accepted Aug 5, 2019

Buckenheimer A, Dothard A, Russell G, Grey C, Petty WJ, Lycan TW. “End-of-life care in the immune checkpoint inhibitor era.” Accepted for online presentation at the Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, abstract number e24003, scheduled for May 29th, 2020.

Roberts N, Buckenheimer A, Dothard A, Grey C, Petty WJ, Lycan TW.  Lazarus effect? A retrospective case series of NSCLC patients previously on hospice care who later received immunotherapy. Poster accepted for presentation at American College of Physicians, North Carolina chapter (NC-ACP) annual scientific session; Greensboro, NC, ‪Feb 28, 2020‬.‬‬‬‬‬‬‬‬

Mogul,A; Bryant,C; Gabbard,J; Cline, D. “Missed Opportunities: Integrating Palliative Care into the Emergency Department for Older Adults Presenting as Level 1 Triage Priority from Long-Term Care Facilities”.  American College of Emergency Physicians Conference 2018

Gabbard,J; Johnson, D; Spencer,S; Sink,K; Yang,M. Prognostic Awareness and Palliative Understanding Among Caregivers of Patients with Dementia. AGS National Meeting 2019

Brooten,J*; McQueen,T; Breznau,C; Omlor,R; Cleveland,M; Yang,M; Gabbard,J. “Improving Home-based Primary Care Communications with Patients and Caregivers”. Wake Forest Quality Improvement Symposium 2019

Brooten,J*; Sarwal,A; Grey,C; Gabbard,J: “Tertiary Care Transfer, Early Mortality and Goals of Care Discussions in Patients with Acute Neurological Conditions”. Neurocritical Care Society (NCS) Annual meeting October 2019

Brooten,J*; Buckenheimer,A, Breznau,C; McQueen,T; Welsh,D; Hallmark, J; Williamson,J; Grey,C; Cline,DM, Gabbard,J. “Risk factors associated with early mortality and hospital transfer along with rates of goals of care discussions”. Wake Forest Research Symposium 2019 and Academy of Emergency Medicine Conference 2020 

Guo, J., Pajewski,N; Callahan,K; Dharod,A; Foley,K; Ferris,K; Moses, A; Willard, J.; Williamson,J; Gabbard,J. (2020). "ACPSmart Tool: A tool for clinical decision support for advance care planning in an outpatient primary care setting”. AGS 2020

Gabbard,J;  McLouth, C; Brenes, G, Claudel,S*; Ongchuan, S*; Burkart, J; Pajewski, NM; Callahan, K; Williamson,J; Murea, M (2020). "Rapid Electronic Capturing of Patient-Reported Outcome Measures in Older Adults with End-Stage Renal Disease: A Feasibility Study." AGS 2020

Implementing Predictive Modeling to Increase Advance Care Planning Completion in Outpatient IM Resident Clinics. Life Care Forum; User Group Meeting, Epic National Convention. User Group Meeting. Presented by S. Allan Petty. Contributors Adam Moses, Carl Grey, Ajay Dharod. Verona, WI, August 2020.  

Implementing Predictive Modeling to Increase Advance Care Planning Completion in Outpatient IM Resident Clinics. American Medical Informatics Association 2020 Meeting. Presented by S. Allan Petty. Contributors Adam Moses, CF Morris, Richa Bundy, Carl Grey, Ajay Dharod. November 2020.

Implementing Predictive Modeling to Increase Advance Care Planning Completion in Outpatient IM Resident Clinics. North Carolina User Group Meeting. Presented by S. Allan Petty. Contributors Adam Moses, Carl Grey, Ajay Dharod. Greensboro, NC. March 2020.