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.

Leidl BF, Fox-Davis D, Walker FO, Gabbard J, Marterre B. Layers of loss: A scoping review and taxonomy of HD caregivers’ spiritual suffering, grief/loss and coping strategies. J Pain Symptom Manage. 2023;65(1):e29-e50.

• This is the first comprehensive organization of spiritual suffering, grief / loss and coping mechanisms that caregivers experience / use in the world’s literature. Huntington’s Disease is an incurable, multi-generational, autosomal dominant disorder that plays out over decades, creating unique challenges and a myriad of spiritually-related stressors in those affected and their familial caregivers.

Cannon ST, Gabbard J, Walsh RC, Statler TM, Browne JD, Marterre B. Concordant palliative care delivery in advanced head and neck cancer. Am J Otolaryngol. 2023;44(1):103675.

• Although small (10), we described the world’s first consecutive series of patients with advanced head and neck cancer who had received palliative care (PC) consults. Although PC consultation in this series was commonly late (on average, on hospital day 9), significant suffering was mitigated following most consults.

Spencer AL, Nunn AM, Miller PR, Russell GB, Carmichael SP, Neri KE, Marterre B. The value of compassion: healthcare savings of palliative care consults in trauma. Injury. 2023;54(1):249-255.

• 140 trauma patients who received palliative care (PC) consults were matched to 140 who did not. Average time to PC consult was 7 days, and yet hospital cost savings in the PC group averaged over $30,000 for the entire hospitalization and over $14,000 per hospital day. Patients were more likely to discharge to hospice if they received a PC consult (33.6 vs 2.1%). The derived in-hospital death plus discharge to hospice rate was 61.4% for the PC cohort vs. 16.4% for the control population.

Spencer AL, Miller PR, Russell GB, Cornea I, Marterre B. Timing is everything: early versus late palliative care consults in trauma. J Trauma Acute Care Surg. 2023

• 154 trauma patients who received palliative care (PC) consults were analyzed based on whether PC was consulted EARLY (within 3 days) or LATE. Patients in the LATE group had significantly longer length of stays (17.5 vs 7.0 days) and higher hospital costs ($53,165 vs $17,654), more days on the ventilator (7.0 vs. 2.4) and higher rates of tracheostomies and surgical feeding tubes (11.7 vs 1.7%). In-hospital mortality and derived in-hospital death plus discharge to hospice rates were not significantly different between the EARLY and LATE PC consult groups (about 29% and 63%, respectively).

Miller P, Hoffman MR, Marterre B. Founding the Surgical Palliative Care Society. Am Surg. 2023

• This article describes the history of the surgical palliative care movement, from cancer surgeon Balfour Mount’s relationships with Elisabeth Kubler-Ross and Dame Cicely Saunders at London’s St Christopher’s Hospice in the early 1970s to the founding of the Surgical Palliative Care Society in 2021 by the three authors.

Marterre B, Hinshaw DB, Shinall MC. Spirituality in surgery—a double-edged scalpel. Am Surg. 2023; Published on-line ahead of print.

• This literature-based essay explains how investigating, respecting, and working with surgical patients’ spiritualities is as critical a skill as the proficient technical performance of operations. It also addresses how when spirituality is ignored, sacred patient values remain undiscovered, authentic trust is hindered, and healthy shared decision-making processes suffer. Many practical applications for overcoming these pitfalls are offered.

Robertson, M, Gabbard, J, David, S, et al. Implementing a multidimensional perioperative delirium curriculum for surgical residents. J Am Geriatr Soc. 2023;.

• Delirium, an acute disorder of attention and cognition, is a frequent and often preventable clinical syndrome that commonly occurs after surgery. This article discusses a curriculum we developed to help surgeon better recognize, prevent, and treat delirium.

McLouth LE, Gabbard J, Levine BJ, Golden SL, Lycan TW, Petty WJ, & Weaver KE. Prognostic Awareness, Palliative Care Use, and Barriers to Palliative Care in Patients Undergoing Immunotherapy or Chemo-immunotherapy for Metastatic Lung Cancer. J Palliat Med., 2023

• Communicating prognosis and integrating palliative care (PC) are challenging yet vital aspects of quality care for patients with metastatic non-small cell lung cancer (NSCLC). Many patients receiving immunotherapy for stage IV NSCLC expected curative treatment even when they were not actually responding or had poor performance status & only 17% were seeing PC. Efforts to improve palliative care literacy and use in this population is greatly needed.

Statler TM, Hsu FC, Silla L, Sheehan KN, Cowles A, Brooten JK, Omlor RL, Gabbard J. Occurrence of Advance Care Planning and Hospital Course in Patients Admitted for Coronavirus Disease 2019 (COVID-19) During the Pandemic. Am J Hosp Palliat Care. 2022

• The Coronavirus Disease 2019 (COVID-19) pandemic highlighted the importance of understanding patients' goals, values, and medical care preferences given the high morbidity and mortality. This study found low advance care planning (ACP) and palliative care consultation (PCC) in patients admitted for COVID-19. PCC and completion of ACP was associated with higher rates of care de-escalation.

Gabbard J, Strahley AE, Pajewski NM, Callahan KE, Foley KL, Brown A, Moses A, Kirkendall E, Williamson JD, Brooten J, Marterre B, Sutfin EL. Development of an Advance Care Planning Portal-Based Tool for Community-Dwelling Persons Living With Cognitive Impairment: The ACPVoice Tool. Am J Hosp Palliat Care. 2022 Oct

• Patient portals can be an innovative and efficient way to engage patients in advance care planning (ACP). Though 2 rounds of cognitive interviews, we developed a new ACP tool for persons living with cognitive impairment that can be used to improve engagement in ACP.

Omlor,R; Cleveland,J; Brooten,J; Frechman,E; Gabbard,J. Anticipatory Guidance in Dementia Across the Stages. Fast Fact #455 Journal of Palliative Medicine. Pending Publication. 2023

• This Fast Fact reviews the trajectory of dementia, the prognosis, and anticipatory guidance needs at each stage of dementia

Hilton, R; Hayes, M; Somers, E; Brooten,J; Gabbard,J.Use of anticoagulation for non-valvular diseases in patients with limited prognosis Fast Fact #461 Journal of Palliative Medicine. Pending Publication. 2023

• This Fast Fact reviews factors that important to consider when trying to make the decision whether to continue or discontinue anticoagulation in patients with limited prognosis (<6 months).

Wang DH, Breyre AM, Brooten JK, Hanson KC. Top Ten Tips Palliative Care Clinicians Should Know About Improving Partnerships with Emergency Medical Services. J Palliat Med. 2023

• Emergency medical services (EMS) clinicians increasingly encounter seriously ill patients and their caregivers in times of distress. This article describes unmet needs at the EMS-palliative interface, challenges with collaboration, and where directional progress exists.

Frechman E, Dietrich MS, Buck HG, Rhoten BA, Davis, A, Maxwell CA. A Qualitative study exploring older adults’ perceptions, facilitators, and barriers in planning for aging and frailty. J Ageing and Longevity. 2023

• This article shares the results of a qualitative study amplifying the voices of older adults on their perceptions of the planning for aging and frailty concept, and what may promote or hinder this process.

Frechman E, Dietrich MS, Buck HG, Rhoten BA, Maxwell CA. Readiness to Plan for Aging and Frailty: Examining Contextual Factors. J Gerontol Nurs. 2023

• This article examines how contextual factors (functional status, frailty, health status, and social support) are associated with planning for aging and frailty.

Frechman E, Wright PM. Nurse Burnout in Hospice and Palliative Care: A Scoping Review. Illness, Crisis, & Loss. 2023

• For 21 years in a row, the Gallup poll ranks nursing is rated the most trusted profession. This article focuses on burnout in hospice and palliative care nurses and ways that individuals and organizations can promote well-being.

Frechman E, Buck HG, Dietrich MS, Maxwell CA. Development of a Planning for Aging and Frailty Questionnaire. Res Gerontol Nurs. 2022

• This article describes how an instrument used to measure planning for aging and frailty was developed and then pilot tested.

Coogan A, Kimpel C, Jones AC, Barroso J, Frechman E, Maxwell CA. Perspectives on Aging and End of Life Among Lower Socioeconomic Status (SES) Older Adults. J Appl Gerontol. 2022

• This article showcases the voices of older adults of lower socio-economic status related to their planning for aging and end-of-life.

Whitehead P, Frechman E, Johnstone-Petty M, Kates J, Tay DL, DeSanto K, Fink RM. A scoping review of nurse-led advance care planning. Nurs Outlook. 2022

• This article focuses on nurse-led advance care planning models and the importance of nurses to bridge communication between patients and care providers.

Frechman E, Dietrich MS, Buck HG, Rhoten BA, Maxwell CA. PLAN: Preparing and Living for Aging Now; A descriptive study investigating older adults' readiness to plan for aging and frailty. Geriatr Nurs. 2022

• This article describes the concept of planning for aging and frailty which is a comprehensive approach to assess adults’ readiness to plan for their aging process within 5 domains (communication/socialization, environmental, financial, physical care, cognitive status).This article reveals the results of the study examining 252 older adult participants.

Vickey T, Frechman E. Continuation of Hemodialysis in a Patient With Global Hypoxic Brain Injury: Ethical Considerations and Factors That May Influence Decision Making. J Hosp Palliat Nurs. 2022

• This article is a case study portraying a palliative care patient and the multiple domains of care (physical, social, spiritual, psychological, emotional, ethical) that palliative care nurses must consider in caring for patients with serious illness.

Famouri, M. L., Hernandez, S., Omlor, R. L., Lane-Brown, M., Evans, S. M., McIntosh, D., & Denizard-Thompson, N. (2023). Active Bystander Training: Using Standardized Patient Methodology to Teach Residents to Navigate Microaggressions in Patient Encounters. MedEdPORTAL, 19, 11298.

• Studies show that physicians and medical trainees who identify as underrepresented in medicine or as women experience higher rates of microaggressions during patient encounters. We designed, implemented, and evaluated an active bystander training workshop focused on mitigating microaggressions using standardized patient (SP) methodology

Marterre B. Surgeon-patient cross~talk: how it happens, how to fix it. Am Surg. 2023; Published on-line ahead of print.

• This literature-based essay explains how the difficulties in surgeon-patient communication stem from different world views promoted by the reliance on different cerebral hemispheres. It explicates the extreme emotional and psychosociospiritual distress that family members experience and how a palliative triangle—surgeon, patient, family—should be established and executed preoperatively in all high-stakes surgical scenarios.

Statler, T. M., Dressler, E. V. M., Klepin, H. D., Weaver, K. E., & Gabbard, J..”Does baseline patient-reported pain level predict overall survival among newly diagnosed older adults receiving cancer chemotherapy?” 2023 AGS.

Frechman, Erica; Pajewski, Nicholas; Callahan, Kathryn; Dharod, Ajay; Foley, Kristie; Williamson, Jeff; Brenes, Gretchen; and Gabbard, Jennifer. “Implementation of a serious illness conversation telehealth intervention among persons living with cognitive impairment: outcomes of the process evaluation of an embedded pragmatic clinical trial in outpatient primary care.” AAHPM 2023

Gabbard,J et al. “Promoting Serious Illness Conversations through Telehealth among Persons Living with Cognitive Impairment: an Embedded Pragmatic Clinical Trial in Outpatient Primary Care.” AAHPM 2023

Mahmond,S; Gabbard,J; Moses,A; Sheehan,K; Dharod,A; Palakshappa,J.(2023) “Improving Goals of Care Discussion Documentation in the Medical ICU: A QI project. 2023. ATS.

Brooten,J; Little, T; Pajewski,N; Gabbard,J; and Cline, D. “Correlation Between the Electronic Frailty Index and Hospitalization Mortality in Older Adults Infected with SARS-CoV-2.” ACEP Oct 2022

Brooten, J., Turner, A., Speiser, J., Gabbard, J., & Cline, D. “Early Mortality Risk Assessment Modeling by Random Forest Analysis of Patients Presenting to a Tertiary Medical Center Emergency Department.” ACEP Oct 2022

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.