A5007482727- Palliative Care and End-of-Life Issues
- Childhood Cancer Survivors' Quality of Life
- Patient Dignity and Privacy
- Grief, Bereavement, and Mental Health
- Patient-Provider Communication in Healthcare
- Ethics in medical practice
- Family and Patient Care in Intensive Care Units
- Innovations in Medical Education
- Family Support in Illness
- Cancer survivorship and care
- Empathy and Medical Education
- Religion, Spirituality, and Psychology
- Health Systems, Economic Evaluations, Quality of Life
- Pain Management and Opioid Use
- Emergency and Acute Care Studies
- Medical Education and Admissions
- Migration, Health and Trauma
- Global Health Workforce Issues
- Healthcare professionals’ stress and burnout
- Diversity and Career in Medicine
- Geriatric Care and Nursing Homes
- Ethics and Legal Issues in Pediatric Healthcare
- Primary Care and Health Outcomes
- Optimism, Hope, and Well-being
- Interprofessional Education and Collaboration
Harvard University
2016-2025
Dana-Farber Cancer Institute
2016-2025
Boston University
2012-2025
Brigham and Women's Hospital
2014-2024
Dana-Farber Brigham Cancer Center
2011-2024
Ariadne Diagnostics (United States)
2015-2023
Clatterbridge Cancer Centre NHS Foundation Trust
2018
Marie Curie
2018
Boston Children's Hospital
2018
Harvard University Press
2005-2014
Bereavement is a universal experience, and its association with excess morbidity mortality well established. Nevertheless, grief becomes serious health concern for relative few. For such individuals, intense persists, distressing disabling, may meet criteria as distinct mental disorder. At present, not recognized disorder in the DSM-IV or ICD-10. The goal of this study was to determine psychometric validity prolonged (PGD) enhance detection potential treatment bereaved individuals at...
To characterize the aggressiveness of end-of-life cancer treatment for older adults on Medicare, and its relationship to availability healthcare resources.We analyzed Medicare claims 28,777 patients 65 years who died within 1 year a diagnosis lung, breast, colorectal, or other gastrointestinal between 1993 1996 while living in one 11 US regions monitored by Surveillance, Epidemiology, End Results Program.Rates with chemotherapy increased from 27.9% 29.5% (P =.02). Among those received...
Religion and spirituality play a role in coping with illness for many cancer patients. This study examined religiousness spiritual support advanced patients of diverse racial/ethnic backgrounds associations quality life (QOL), treatment preferences, advance care planning.The Coping With Cancer is federally funded, multi-institutional investigation examining factors associated patient caregiver well-being. Patients an diagnosis failure first-line chemotherapy were interviewed at baseline...
<h3>Background</h3> Life-sustaining medical care of patients with advanced cancer at the end life (EOL) is costly. Patient-physician discussions about EOL wishes are associated lower rates intensive interventions. <h3>Methods</h3> Funded by National Institute Mental Health and Cancer Institute, Coping With a longitudinal multi-institutional study 627 cancer. Patients were interviewed baseline followed up through death. Costs for unit hospital stays, hospice care, life-sustaining procedures...
Purpose Physicians have an ethical obligation to honor patients' values for care, including at the end of life (EOL). We sought evaluate factors that help patients receive care consistent with their preferences. Methods This was a longitudinal multi-institutional cohort study. measured baseline preferences life-extending versus symptom-directed and actual EOL received in 325 advanced cancer. also associated sociodemographic, health, communication characteristics, discussions between...
To determine whether the place of death for patients with cancer is associated patients' quality life (QoL) at end (EOL) and psychiatric disorders in bereaved caregivers.Prospective, longitudinal, multisite study advanced their caregivers (n = 342 dyads). Patients were followed from enrollment to death, a median 4.5 months later. Patients' QoL EOL was assessed by caregiver report within 2 weeks death. Bereaved caregivers' mental health baseline 6 after loss Structured Clinical Interview...
The stage theory of grief remains a widely accepted model bereavement adjustment still taught in medical schools, espoused by physicians, and applied diverse contexts. Nevertheless, the has previously not been tested empirically.To examine relative magnitudes patterns change over time postloss 5 indicators for consistency with grief.Longitudinal cohort study (Yale Bereavement Study) 233 bereaved individuals living Connecticut, data collected between January 2000 2003.Five rater-administered...
Purpose To determine whether spiritual care from the medical team impacts received and quality of life (QoL) at end (EoL) to examine these relationships according patient religious coping. Patients Methods Prospective, multisite study patients with advanced cancer September 2002 through August 2008. We interviewed 343 baseline observed them (median, 116 days) until death. Spiritual was defined by patient-rated support needs receipt pastoral services. The Brief Religious Coping Scale (RCOPE)...
Introduction Ensuring that patients receive care is consistent with their goals and values a critical component of high-quality care. This article describes the protocol for cluster randomised controlled trial multicomponent, structured communication intervention. Methods analysis Patients advanced, incurable cancer life expectancy <12 months will participate together surrogate. Clinicians are enrolled either to usual or The Serious Illness Care Program intervention designed identify...
To evaluate measures that could use existing administrative data to assess the intensity of end-of-life cancer care.Benchmarking standards and statistical variation were evaluated using Medicare claims 48,906 patients who died from 1991 through 1996 in 11 regions United States. We assessed accuracy by comparing 150 medical records one hospital affiliated treatment center.Systems not providing overly aggressive care near end life would be ones which less than 10% receive chemotherapy last 14...
BACKGROUND: Although spiritual care is associated with less aggressive medical at the end of life (EOL), it remains infrequent. It unclear if omission impacts EOL costs. METHODS: A prospective, multisite study 339 advanced cancer patients accrued subjects from September 2002 to August 2007 an outpatient setting and followed them until death. Spiritual was measured by patients' reports that health team supported their religious/spiritual needs. costs in last week were compared among reporting...
High-quality conversations between clinicians and seriously ill patients about values goals are associated with improved outcomes but occur infrequently.To examine feasibility, acceptability, effect of a communication quality-improvement intervention (Serious Illness Care Program) on patient outcomes.A cluster randomized clinical trial the Serious Program in an outpatient oncology setting was conducted. Patients advanced cancer (n = 278) 91) participated September 1, 2012, June 30, 2016....
Earlier clinician-patient conversations about patients' values, goals, and preferences in serious illness (ie, conversations) are associated with better outcomes but occur inconsistently cancer care.To evaluate the efficacy of a communication quality-improvement intervention improving occurrence, timing, quality, accessibility documented between oncology clinicians patients advanced cancer.This cluster randomized clinical trial outpatient was conducted at Dana-Farber Cancer Institute...
<h3>Importance</h3> More patients with cancer use hospice currently than ever before, but there are indications that care intensity outside of is increasing, and length stay decreasing. Uncertainties regarding how affects health utilization costs have hampered efforts to promote it. <h3>Objective</h3> To compare for poor-prognosis cancers enrolled in vs similar without care. <h3>Design, Setting, Participants</h3> Matched cohort study nonhospice using a nationally representative 20% sample...
National palliative care guidelines outline spiritual as a domain of care, yet patients' religiousness and/or spirituality (R/S) are underappreciated in the oncology setting. Among patients with advanced cancer receiving radiation therapy (RT), this study aims to characterize patient spirituality, religiousness, and religious coping; examine relationships these variables quality life (QOL); assess perceptions
Psychological distress often causes suffering in terminally ill patients and their families poses challenges diagnosis treatment. Increased attention to treatment of depression can improve the coping mechanisms families. This paper reviews clinical characteristics normal grief explains strategies for differential diagnosis. Although some literature discusses psychological issues facing elderly with cancer, less is known about end-stage pulmonary, cardiac, renal, neurologic disease. Data on...
Abstract BACKGROUND Psychological morbidity has been proposed as a source of distress in cancer patients. This study aimed to: 1) determine the prevalence diagnosable psychiatric illnesses, and 2) describe mental health services received predictors service utilization patients with advanced cancer. METHODS was cross‐sectional, multi‐institutional 251 eligible Eligibility included: distant metastases, primary therapy failure, nonpaid caregiver, age ≥20 years, stamina for interview, English or...
Purpose Despite well-documented racial and ethnic differences in advance care planning (ACP), we know little about why these exist. This study tested proposed mediators of racial/ethnic ACP. Patients Methods We studied 312 non-Hispanic white, 83 black, 73 Hispanic patients with advanced cancer the Coping Cancer study, a federally funded multisite prospective cohort designed to examine disparities ACP end-of-life care. assessed impact terminal illness acknowledgment, religiousness, treatment...
This study sought to inductively derive core themes of religion and/or spirituality (R/S) active in patients' experiences advanced cancer inform the development spiritual care interventions terminally ill setting.This is a multisite, cross-sectional, mixed-methods randomly-selected patients with (n = 68). Scripted interviews assessed role R/S and concerns encountered experience. Qualitative quantitative data were analyzed. Theme extraction was performed interdisciplinary input (sociology...