A5048661722- Palliative Care and End-of-Life Issues
- Grief, Bereavement, and Mental Health
- Geriatric Care and Nursing Homes
- Family and Patient Care in Intensive Care Units
- Childhood Cancer Survivors' Quality of Life
- Religion, Spirituality, and Psychology
- Patient-Provider Communication in Healthcare
- Cultural Competency in Health Care
- Patient Dignity and Privacy
- Child and Adolescent Psychosocial and Emotional Development
- Global Health Workforce Issues
- Diversity and Career in Medicine
- Frailty in Older Adults
- Heart Failure Treatment and Management
- Ethics in medical practice
- Migration, Health and Trauma
- Patient Satisfaction in Healthcare
- Healthcare Policy and Management
- Chronic Disease Management Strategies
- Trauma and Emergency Care Studies
- Diabetes Management and Education
- Emergency and Acute Care Studies
- Intensive Care Unit Cognitive Disorders
- Cancer survivorship and care
- Family and Disability Support Research
Duke University
2016-2025
Geriatric Research Education and Clinical Center
2012-2025
National League for Nursing
2025
National Institute for Occupational Safety and Health
2025
Salem State University
2025
University of Colorado Denver
2025
Durham VA Health Care System
2020-2024
Icahn School of Medicine at Mount Sinai
2024
University of Lausanne
2024
Levine Cancer Institute
2024
Racial and ethnic disparities in health care access quality are well documented for some minority groups. However, compared to other areas of care, such as disease prevention, early detection, curative research palliative is limited. Given the rapidly growing population older adults, many whom will face advanced serious illness, availability high-quality that meets varied needs adults all races ethnicities a priority. This paper reviews existing data on racial use outlines priorities future research.
Cultural beliefs and values are thought to account for differences between African Americans whites in the use of advance directives about hospice care, but few data clarify which explain these differences. Two hundred five adults aged 65 older who received primary care Duke University Health System were surveyed. The survey included scales: Hospice Beliefs Attitudes, Preferences Care, Spirituality, Healthcare Distrust, About Dying Advance Care Planning. less likely than white subjects have...
By 2030 more people in the United States will be older than age sixty-five younger five. Our health care system is unprepared for complexity of caring a heterogenous population adults—a problem that has been magnified by coronavirus disease 2019 (COVID-19) pandemic. Here, as part National Academy Medicine’s Vital Directions Health and Care: Priorities 2021 initiative, we identify six vital directions to improve quality life all Americans. The next administration must create an adequately...
OBJECTIVES: To determine whether frail older adults, based on a deficit accumulation index (DAI), are at greater risk of adverse outcomes after discharge from the emergency department (ED). DESIGN AND SETTING: Secondary analysis data Medicare Current Beneficiary Survey. PARTICIPANTS: One thousand eight hundred fifty‐one community‐dwelling fee‐for‐service enrollees, aged 65 and who were discharged ED between January 2000 September 2002. MEASUREMENTS: The primary dependent variable was time to...
Objectives To define multimorbidity “classes” empirically based on patterns of disease co‐occurrence in older Americans and to examine how class membership predicts healthcare use. Design Retrospective cohort study. Setting Nationally representative sample Medicare beneficiaries file years 1999–2007. Participants Individuals aged 65 the Beneficiary Survey who had data available for at least 1 year after index interview (N = 14,052). Measurements Surveys (self‐report) were used assess chronic...
Presently a median of 37.5% the U.S. skilled nursing facility (SNF) workforce has been vaccinated for COVID-19. It is essential to understand vaccine hesitancy among SNF workers inform campaigns going forward. To describe concerns raised healthcare and staff from SNFs during town hall meetings. Sixty-three four corporations were invited send Opinion Leaders, outspoken nursing, nurse aid, dietary, housekeeping or recreational therapy, attend 1-h virtual meeting. Meetings used similar format...
Importance Shared decision-making is the preferred method for evaluating complex tradeoffs in care of patients with critical illness. However, it remains unknown whether clinicians engage diverse and caregivers equitably shared decision-making. Objective To compare clinicians' approaches to recorded conversations Black White Design, Setting, Participants This thematic analysis consisted unstructured clinician-caregiver meetings audio-recorded during a randomized clinical trial decision aid...
Importance Unmet and racially disparate palliative care needs are common in intensive unit (ICU) settings. Objective To test the effect of a primary intervention vs usual control both overall by family member race. Design, Setting, Participants This cluster randomized clinical trial was conducted at 6 adult medical surgical ICUs 2 academic community hospitals North Carolina between April 2019 May 2022 with physician-level randomization sequential clusters Black patient–family dyads White...
Objectives To compare the prevalence and predictors of caregiver esteem burden during two different stages care recipients' illnesses—advanced chronic illness last year life. Design Longitudinal, observational cohort study. Setting Community sample recruited from outpatient clinics at Duke University Durham Veterans Affairs Medical Centers. Participants Individuals with advanced cancer, congestive heart failure, or obstructive pulmonary disease their primary caregiver, retrospectively coded...
Communication between cardiologists and patients can significantly affect patient comprehension, adherence, satisfaction. To our knowledge, a coaching intervention to improve cardiologist communication has not been tested.
Background: Hospice provides supportive care to terminally ill patients at the end of life.However, some enrollees leave hospice before death in search therapies that may prolong survival.Because a greater preference for life-sustaining life, African American be more likely than white withdraw from seek life-prolonging therapies.Methods: In secondary data analysis and discharged VITAS programs between January 1, 1999, December 31, 2003, we used logistic regression examine association race...
Background: Previous research suggests that lack of knowledge hospice is a barrier to the use care by African Americans. However, there little data examining racial differences in exposure information. Objectives: Examine self-reported information and determine how this impacts beliefs about care. Methods: We surveyed 200 community-dwelling older adults (65 or older). used Spearman's correlations examine relationship between responses individual items on Hospice Beliefs Attitudes Scale...
Terminally ill patients with lower incomes are less likely to die at home, even hospice care.To examine the relationship between income and transfer from home before death interaction level of care as a predictor in admitted routine care.We matched zip codes US census tracts generate median annual household divided measure into $10,000 increments (≤$20,000 >$50,000). We abstracted data central administrative clinical database provider. analyzed using logistic regression adjusted for...
Abstract Objective We aimed to explore multiple perspectives regarding barriers and facilitators of advance care planning (ACP) among African Americans identify similarities or differences that might have clinical implications. Method Qualitative study with health disparities experts ( n = 5), community members 9), seriously ill American patients caregivers 11). Using template analysis, interviews were coded intrapersonal, interpersonal, systems-level themes in accordance a social ecological...
<h3>Importance</h3> Palliative care consultations in intensive units (ICUs) are increasingly prompted by clinical characteristics associated with mortality or resource utilization. However, it is not known whether these triggers reflect actual palliative needs. <h3>Objective</h3> To compare unmet needs trigger status (present vs absent). <h3>Design, Setting, and Participants</h3> This prospective cohort study was conducted 6 adult medical surgical ICUs academic community hospitals North...
Seriously ill patients rely on spiritual and existential beliefs to support coping approach crucial treatment healthcare decisions. Yet, we lack gold standard, validated approaches gathering information those beliefs. Therefore, developed I-SPIRIT, a needs inventory for with serious illness (IIR-10-050).
Nursing students exposed to bullying behaviors are at risk for making medication errors. For a quasi-experimental study, 15 prelicensure nursing Midwestern university were simulated or common distractions while administering medications in laboratory setting. Data analyzed using Kruskal-Wallis tests. There was no significant difference administration rubric score (H[2] = 1.489, p .475) time spent room 1.778, .411) between groups. Bullying and other interruptions distracted from successfully...