A5008460966- Palliative Care and End-of-Life Issues
- Family and Patient Care in Intensive Care Units
- Patient-Provider Communication in Healthcare
- Patient Dignity and Privacy
- Childhood Cancer Survivors' Quality of Life
- Geriatric Care and Nursing Homes
- Grief, Bereavement, and Mental Health
- Substance Abuse Treatment and Outcomes
- Complementary and Alternative Medicine Studies
- Adolescent Sexual and Reproductive Health
- Ethics in medical practice
- HIV/AIDS Research and Interventions
- LGBTQ Health, Identity, and Policy
- Intensive Care Unit Cognitive Disorders
- Cancer survivorship and care
- Emergency and Acute Care Studies
- Health Policy Implementation Science
- Health Systems, Economic Evaluations, Quality of Life
- Healthcare Policy and Management
- Patient Satisfaction in Healthcare
- Community Health and Development
- Advanced Causal Inference Techniques
- Adolescent and Pediatric Healthcare
- Reproductive tract infections research
- Optimism, Hope, and Well-being
Harborview Medical Center
2015-2025
University of Washington
2015-2024
Seattle University
2016-2019
National Institute of Nursing Research
2006
Kingston General Hospital
2006
Queen's University
2006
Seattle Indian Health Board
1995-2003
Minnesota Project
2000
Neurological Surgery
1995
Indiana University Bloomington
1980
Communication about end-of-life care is a core clinical skill. Simulation-based training improves skill acquisition, but effects on patient-reported outcomes are unknown.To assess the of communication skills intervention for internal medicine and nurse practitioner trainees patient- family-reported outcomes.Randomized trial conducted with 391 81 between 2007 2013 at University Washington Medical South Carolina.Participants were randomized to an 8-session, simulation-based, (N = 232) or usual...
Clinician communication about goals of care is associated with improved patient outcomes and reduced intensity end-of-life care, but it unclear whether interventions can improve this communication.
Importance Discussions about goals of care are important for high-quality palliative yet often lacking hospitalized older patients with serious illness. Objective To evaluate a communication-priming intervention to promote goals-of-care discussions between clinicians and Design, Setting, Participants A pragmatic, randomized clinical trial clinician-facing vs usual was conducted at 3 US hospitals within 1 health system, including university, county, community hospital. Eligible were aged 55...
Objectives: To refine the Family Satisfaction in Intensive Care Unit (FS-ICU) survey and develop a validated method for scoring instrument. Design: Instrument development study, using data from two prospective cohort studies. Setting: care units seven university-affiliated hospitals (six Canadian, one United States). Subjects: members of ICU patients. Interventions: Based on priori criteria, items were tagged potential removal discussed with FS-ICU developers. Factor analysis was used to...
This study compared characteristics of patients who had herpes simplex virus (HSV) type 1 with HSV-2, by use data from a cross-sectional analysis. Data were collected in an urban sexually transmitted diseases clinic positive genital HSV cultures. Overall, 17.1% (95% confidence interval [CI], 14.9%–19.3%) 1145 isolates obtained during 1993–1997 HSV-1. The proportion HSV-1 among initial infections was higher men sex (46.9%) than women (21.4%) and lowest heterosexual (14.6%). White race (odds...
Because of high mortality, end-of-life care is an important component intensive care.We evaluated the effectiveness a quality-improvement intervention to improve unit (ICU) conducted cluster-randomized trial randomizing 12 hospitals. The targeted clinicians with five components: clinician education, local champions, academic detailing, feedback quality data, and system supports. Outcomes were assessed for patients dying in ICU or within 30 hours discharge using surveys medical record review....
Palliative care in the intensive unit (ICU) is an important focus for quality improvement.To evaluate effectiveness of a multi-faceted improvement intervention to improve palliative ICU.We performed single-hospital, before-after study quality-improvement ICU. The consisted clinician education, local champions, academic detailing, feedback clinicians, and system support. Consecutive patients who died ICU were identified pre- (n = 253) postintervention 337). Families completed Family...
The importance of good clinician–patient communication to quality end-of-life care has been well documented yet there are no validated measures that allow patients assess the this communication. Using a sample hospice (n = 83) and with chronic obstructive pulmonary disease (COPD) 113), we evaluated psychometric characteristics 13-item patient-centered, patient-report questionnaire about (QOC). Our purpose was explore measurement structure QOC items ascertain if represent unitary or...
Background: Communication with patients and families is an essential component of high-quality care in serious illness. Small-group skills training can result new communication behaviors, but past studies have used facilitators extensive experience, raising concerns this not scalable. Objective: The objective was to investigate the effect experiential building workshop (Codetalk), led by newly trained facilitators, on internal medicine trainees' nurse practitioner students' ability...
✓ Several significant diagnostic and therapeutic advances in the management of subarachnoid hemorrhage have emerged during last 10 years. The present study was undertaken to determine whether these improved overall outcome patients low surgical risk what factors predict outcome. authors retrospectively reviewed good-grade seen at Harborview Medical Center University Washington, who suffered ruptured anterior circulation aneurysms between 1983 1993. results this series demonstrate that...
Rationale: We investigated whether proposed "quality markers" within the medical record are associated with family assessment of quality dying and death in intensive care unit (ICU). Objective: To identify chart-based markers that could be used as measures for improving end-of-life care. Design: A multicenter study conducting standardized chart abstraction surveying families patients who died ICU or 24 hrs being transferred from an ICU. Setting: ICUs at ten hospitals northwest United States....
Although racial/ethnic minorities receive more intense, nonbeneficial healthcare at the end of life, role race/ethnicity independent other social determinants health is not well understood.Examine association between race/ethnicity, key health, and intensity in last 30 days life for those with chronic, life-limiting illness.We identified 22,068 decedents chronic illness cared a single system Washington State who died 2010 2015 linked electronic records to death certificate data.Binomial...
Little is known about the experience of financial stress for patients who survive critical illness or their families. Our objective was to describe prevalence among critically ill and families, identify clinical demographic characteristics associated with this stress, explore associations between psychologic distress.Secondary analysis a randomized trial comparing coping skills training program an education surviving acute respiratory failure families.Five geographically diverse...
Background: As our population ages and the burden of chronic illness rises, there is increasing need to implement quality metrics that measure benchmark care seriously ill, including delivery both primary specialty palliative care. Such can be used drive improvement, value-based payment, accountability for population-based outcomes. Methods: In this article, we examine use electronic health record (EHR) as a tool assess serious through narrative review description program in large healthcare...
Although studies have shown regional and interhospital variability in the intensity of end-of-life care, few data are available assessing specific aspects palliative care ICU across hospitals or family nurse ratings this care. Recently, relatively high satisfaction with has prompted speculation that improved over time, but temporal trends not been documented.Retrospective cohort study consecutive patients dying 13 Seattle-Tacoma-area between 2003 2008.We examined time among quality assessed...
Aims . To evaluate the effectiveness of a motivational intervention to reduce attrition from waiting list for substance abusers seeking publicly funded treatment. Design Randomized clinical trial comparing an "attrition prevention" condition standard care while awaiting treatment admission. Setting A centralized abuse assessment and referral center in Seattle, Washington. Participants Substance (n = 654) eligible drug Measurements Alcohol use, substance‐related negative consequences, areas...
Improving patient–clinician communication about end-of-life care is important in order to enhance quality of for patients with chronic obstructive pulmonary disease (COPD). Our objective was compare care, and endorsement barriers facilitators this the Netherlands USA. The present study an analysis survey data from 122 Dutch 391 US outpatients COPD. We compared (Quality Communication questionnaire) (Barriers Facilitators Questionnaire) between USA, controlling patients’ demographic illness...
Background: Communication about religious and spiritual issues is fundamental to palliative care, yet little empirical data exist guide curricula in this area. The goal of study was develop an improved understanding physicians' perspectives on their communication competence issues. Methods: We examined surveys physician trainees (n=297) enrolled ongoing skills at two medical centers the northwestern southeastern United States. Our primary outcome self-assessed discussing religion...
Effective physician communication at the end-of-life is a cornerstone to providing patient-centered palliative care. Educational programs in often rely on self-assessments of knowledge and attitudes seldom provide patients' reports. Thus, it unclear whether are associated with patient perspectives.
<h3>Importance</h3> High-quality goals-of-care communication is critical to delivering goal-concordant, patient-centered care hospitalized patients with chronic life-limiting illness. However, implementation and documentation of discussions remain important shortcomings in many health systems. <h3>Objective</h3> To evaluate the efficacy, feasibility, acceptability a patient-facing clinician-facing communication-priming intervention promote for serious <h3>Design, Setting, Participants</h3>...