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Department of Medicine

Department of Medicine

  Division of General Internal Medicine

Section of Palliative Care and Medical Ethics


Section of Palliative Care and Medical Ethics


Palliative Care Research at the University of Pittsburgh

Asking empiric questions, exploring ethical dilemmas, and building the evidence base in palliative care.

Director: Yael Schenker, MD, MAS
Division of General Internal Medicine
Section of Palliative Care and Medical Ethics
University of Pittsburgh
schenkery@upmc.edu

Areas of Inquiry

Models of Care

What are the barriers to providing palliative care services, and how can we overcome them? Researchers at the University of Pittsburgh are investigating these questions. Their work examines how palliative care services are viewed by patients with serious illness, oncologists, and cardiologists. And, they are developing new models of "primary" or basic palliative care that do not require specialty referral. Given the acute shortage of palliative care specialists, this work is timely and important. The CONNECT intervention, developed by Yael Schenker, MD, MAS, and collaborators, is an oncology nurse-led care management approach to improving provision of palliative care in cancer clinics.

Grief and Bereavement

One out of five Americans dies in an Intensive Care Unit (ICU). Their family members face difficult decisions about life support and suffer from high rates of post-traumatic stress disorder, depression, anxiety and complicated grief afterwards. Can storytelling help families heal after participating in a decision to limit life support? An interdisciplinary team of investigators from the University of Pittsburgh including Amber Barnato, MD, MPH, MS; Yael Schenker, MD, MAS; Charles Reynolds, MD; Mary Amanda Dew, PhD; and Robert Arnold, MD, developed a storytelling intervention for families of ICU patients in the acute bereavement period. This innovative work, funded by the National Palliative Care Research Center, led to the creation of ICU Storyweb, an online space for people to share stories about making medical decisions for loved ones in the intensive care unit (ICU)..

Decision Making

How can we help patients and families make informed decisions about their medical care? How can we ensure that these decisions reflect patient values and preferences? How can we support meaningful discussions about goals of care? Researchers at the University of Pittsburgh are investigating these questions from multiple angles. Dr. Schenker and colleagues examine tensions experienced by surrogate (family) decision makers in the intensive care unit (ICU). Douglas White, MD, MAS, and collaborators conduct randomized trials of interventions to improve the quality of surrogate (family) ICU decision making. Winifred Teuteberg, MD, and colleagues are developing and evaluating eRECORD changes to support discussions about goals of care. Drs. Arnold and White are examining the impact of changing the default in advance directives. Dr. Schenker; Daniel Hall, MD, MDiv, MHSc; and Alan Meisel, JD, are exploring ways to improve the process of informed consent.

Clinician-Patient Communication

How can we teach clinicians the communication skills they need to deliver bad news, provide emotional support, elicit values, manage conflict, and engage patients and families in discussions about goals of care? An internationally-recognized leader in communication research, Dr. Robert Arnold, MD has been developing, evaluating, and implementing communication training programs across multiple health care settings for more than 15 years. This work, including VitalTalk, OncoTalk, and PalliTalk, has led to collaborations with faculty, fellows, and students from around the world with an interest in improving the quality of clinician-patient communication. In the last five years, along with colleagues Jane Schell, MD, they have developed NephroTalk; with Lillian Emlett, MD, MS, IntensiveTalk; and with Winifred Teuteberg, MD, Eva Reitschuler-Cross, MD, and Kathryn Berlacher, MD, CardioTalk. In the School of Nursing, Margaret Rosenzweig, PhD, CRNP-C has developed OncPower, an electronic curriculum, supported through an R25 mechanism of the National Cancer Institute, that teaches practice and communication skills to nurse practitioners new to oncology.

Symptom Management

How can we alleviate symptoms and improve quality of life for patients with serious illness? Investigators from the School of Nursing, including Margaret Rosenzweig, PhD, CRNP-C; Annette De Vito Dabbs, PhD, RN; Heidi Donovan, PhD, RN; and Paula Sherwood, PhD, RN, are developing and testing theoretically-guided, patient and family-centered interventions to improve outcomes for patients with serious illness and their caregivers. Their research focuses on patients with neurologic conditions, lung transplant patients, patients with advanced cancer, and family caregivers.

Health Care Advertising

What are health care institutions advertising to the public? What are the ethical implications of these advertising campaigns? And what is their impact? Investigators from the University of Pittsburgh are exploring these questions. Their work, published to date in the Annals of Internal Medicine, JAMA Internal Medicine, and the American Journal of Bioethics, has generated significant debate among experts in bioethics and health policy.

National Recommendations

Who We Are

Our palliative care research program includes collaborators from diverse disciplines across the University of Pittsburgh and the University of Pittsburgh Medical Center.

  • Robert Arnold, MD, Professor of Medicine and Chief, Section of Palliative Care and Medical Ethics, and Medical Director, UPMC Palliative and Supportive Institute
  • Edward Chu, MD, Professor of Medicine and Chief, Division of Hematology-Oncology
  • Annette De Vito Dabbs, PhD, RN, FAAN, Professor and Chair, Acute and Tertiary Care, School of Nursing
  • Howard Degenholtz, PhD, Associate Professor, Department of Health Policy and Management, Graduate School of Public Health
  • Mary Amanda Dew, PhD, Professor of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science
  • Julie Donohue, PhD, Associate Professor of Health Policy and Management, Graduate School of Public Health
  • Heidi Donovan, PhD, RN, Associate Professor, Acute and Tertiary Care, School of Nursing
  • Daniel Hall, MD, MDiv, MHSc, Assistant Professor of Surgery, and Core Investigator, VA Center for Health Equity Research and Promotion
  • Dio Kavalieratos, PhD, Assistant Professor of Medicine, Section of Palliative Care and Medical Ethics
  • Alan Meisel, JD, Dickie, McCamey, and Chilcote Professor of Bioethics, Professor of Law and Psychiatry, and Director, Center for Bioethics and Health Law
  • Charles Reynolds, III, MD, UPMC Endowed Professor in Geriatric Psychiatry and Director, Aging Institute, collaboration between UPMC Senior Services and the University of Pittsburgh
  • Margaret Rosenzweig, PhD, CRNP-C, AOCN, FAAN, Associate Professor, Acute and Tertiary Care, School of Nursing
  • Jane Schell, MD, Assistant Professor of Medicine, Section of Palliative Care and Medical Ethics
  • Yael Schenker, MD, MAS, Assistant Professor, Section of Palliative Care and Medical Ethics and Director, Palliative Care Research
  • Paula Sherwood, PhD, RN, CNRN, FAAN, Professor and Vice Chair of Research, Acute and Tertiary Care, School of Nursing
  • Winifred Teuteberg, MD, Associate Professor of Medicine, Section of Palliative Care and Medical Ethics
  • Steven Weisbord, MD, MSc, Associate Professor of Medicine and Clinical and Translational Science, Renal-Electrolyte Division, and Core Investigator, VA Center for Health Equity Research and Promotion
  • Douglas White, MD, MAS, Associate Professor, Critical Care Medicine, and Director, Program on Ethics and Decision Making in Critical Illness

Grants, Honors, News

Grants

  • American Cancer Society (Yael Schenker, MD, MAS, PI)
    1/1/2017 - 12/31/2018
    Primary palliative care for patients with advanced hematologic malignancies
    This objective of this proposal is to develop and pilot test a nurse-led primary palliative care intervention for patients with advanced hematologic malignancies.

  • Genentech Corporation (Margaret Rosenzweig, PhD, FNP-BC, AOCNP,FAAN, PI)
    2017 - 2018
    The Breast Cancer Treatment Symptom Experience, Management and Outcomes According to Race (SEMOARS) Study.

  • National Heart, Lung, and Blood Institute (Dio Kavalieratos, PhD, PI)
    8/2016 - 7/2020
    Integrating Palliative Care with Disease Management to Improve Outcomes among Patients with Advanced Heart Failure: Interventional Research Career Development (K0101HL133466);
    This career development award will provide Dr. Kavalieratos the resources and support to develop and pilot test a novel primary palliative care/disease management intervention for patients with advanced heart failure. This research is innovative given its delivery in community cardiology clinics and by cardiology nurses, thereby increasing the scalability and generalizability of palliative intervention for individuals with HF.

  • The Patrick and Catherine Weldon Donaghue Medical Research Foundation (Jane Schell, MD, MHS, Clinical Site PI (Study PI: Dale Lupu, PhD, George Washington University))
    11/1/2016 – 10/31/2018
    MY WAY Project: Multi-center advance care planning intervention for older patients with kidney disease a using nurse coach.

  • National Institutes of Health/National Cancer Institute (Yael Schenker, MD, MAS, PI)
    6/1/2016 – 5/31/2021
    A cluster randomized trial of a primary palliative care intervention (CONNECT) for patients with advanced cancer (R01CA197103);
    The objective of this proposal is to conduct a cluster randomized trial among 672 patients with advanced cancer and their caregivers receiving care at 16 community oncology clinics, assessing the impact of the CONNECT intervention on patient and caregiver 3-month outcomes and health care utilization.

  • Center for Medicare and Medicaid Services (Charles Reynolds, III, MD, PI)
    3/21/2016 – 10/23/2020
    Phase Two-RAVEN: Reduce Preventable Hospitalizations among Nursing Facility Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents Payment Reform.
    This is a CMS Award Cooperative Agreement.

  • Milbank Foundation (Robert Arnold, MD, Co-Investigator)
    05/01/2015 – 04/30/2017
    Primary Palliative Care Training
    Three related initiatives of this project include: (1) training clinicians providing palliative care consults at six community or rural hospitals, (2) training hospitalists to provide primary palliative care at our six largest hospitals, and (3) evaluating these models of palliative care.

  • National Institute for Nursing Research (Douglas White, MD, MAS, PI)
    9/1/2014 - 8/31/2019
    Stepped Wedge Trial of an Intervention to Support Proxy Decision Makers in ICUs (R01NR014663);
    The objective of this proposal is to conduct a randomized stepped wedge trial in 1000 patients at five centers assessing the impact of the PARTNER intervention on patients' 6-month outcomes and health care utilization and surrogate decision-makers' psychological outcomes.

  • Cystic Fibrosis Foundation (Dio Kavalieratos, PhD, PI)
    01/12/2014 – 11/1/2017
    Developing an Embedded Palliative Care Program for Cystic Fibrosis
    This three-year grant will enable the University of Pittsburgh Medical Center to implement a rapid learning health care system within its Cystic Fibrosis Program. This system will identify and use specialist palliative care resources to respond to patients with cystic fibrosis who have unmet supportive care needs. We will design and execute a pilot randomized controlled trial to test the feasibility and acceptability of a nurse-practitioner–led specialist palliative care intervention.

  • National Institute of Mental Health (Charles Reynolds, III, MD, PI)
    9/24/2013 - 7/31/2017
    Prevention of Depression and Associated Anxiety Disorders in Low and Middle Income Countries (R34MH096997);
    To develop and pilot test in Goa, India an LHC-led depression and anxiety disorder prevention strategy ("MANAS/DP"), building upon the experience of the MANAS treatment trial ("MANAS/RX") 1.

  • National Institute on Aging (Douglas White, MD, MAS, PI)
    9/1/2013 - 5/31/2018
    A Trial to Improve Surrogate Decision-Making for Critically Ill Older Adults (R01AG045176);
    This project will conduct a multi-center efficacy of the Four Supports Intervention among 400 critically ill older adults. The central hypothesis is that by intensively supporting surrogates in this highly stressful circumstance, the Four Supports Intervention will improve key elements of decision making, decrease long-term psychological distress among surrogates, and achieve more patient-centered care near the end of life.

  • National Institute of Mental Health (Charles Reynolds, III, MD, PI)
    7/1/2011 - 4/30/2017
    ACISR for Late-Life Depression Prevention (Operations Core) (P30MH090333);
    To provide organizational support/infrastructure and financial oversight of all Center activities, to ensure mission-relevance to research in late-life depression prevention.

  • National Institute of Mental Health (Charles Reynolds, III, MD, PI)
    7/1/2011 - 4/30/2017
    ACISR for Late-Life Depression Prevention (Principal Research Core) (T32MH019986);
    This core will develop and test selective and indicated prevention strategies across multiple domains of vulnerability of major depression in later life.

Awards and Honors

  • In 2017, Dr. Edward Chu received a Doctor Honoris Causa (Honorary Doctoral Degree) from Athens National University and University of Athens Medical School.
  • In 2017, Dr. Margaret Rosenzweig received the PNC/Komen Pittsburgh Community Caring Award.
  • In 2017, Dr. Yael Schenker received the Society of General Internal Medicine Early Career Investigator Award.
  • In 2016, Dr. Edward Chu received the Chinese American Hematology-Oncology Network (CAHON) Lifetime Achievement Award.
  • Dr. Robert Arnold was appointed as a Distinguished Service Professor of Medicine in 2016.
  • Drs. Robert Arnold, Yael Schenker, and Douglas White were appointed as members of the Carnegie Mellon University Center for Ethics and Policy.
  • Dr. Yael Schenker was awarded the American Academy of Hospice and Palliative Medicine Early Career Investigator Award in 2016.
  • Dr. Charles Reynolds was appointed as a Distinguished Professor of Psychiatry in 2016.
  • Dr. Charles Reynolds was awarded the Pardes Humanitarian Award from the Brain and Behavior Research Foundation in June, 2016.
  • Dio Kavalieratos, PhD, received the 2015 Outstanding Paper Award from the American Academy of Hospice and Palliative Medicine (AAHPM) for his paper titled "Managing Symptoms When 'the First Step or Two Isn’t Working': Provider and Patient Perceptions of the Role of Specialty Palliative Care in Symptom Management in Gynecologic Oncology," which was published in the Journal of Pain and Symptom Management. This award recognizes the top 5% of papers, as determined by the AAHPM Scientific Subcommittee.
  • Both Robert Arnold, MD, and Douglas White, MD, received the 2015 ICRE Distinguished Mentor Award from the University of Pittsburgh’s Institute for Clinical Research Education. This award recognizes their dedication to their mentees, significant contribution to their mentees’ career development, and investment in their mentees’ independent success. Drs. Arnold and White continuously provide constructive feedback and create opportunities for their mentees to enhance their careers, and we appreciate all they do.
  • Heidi S. Donovan, PhD, RN, was recently appointed to Associate Professor and Vice Chair for Research, Health and Community Systems; and Director, Office of Community Partnerships, School of Nursing, University of Pittsburgh. Dr. Donovan is also a new member of the Committee on the State of Science in Ovarian Cancer Research, Institute of Medicine.

In The News

Resources for Palliative Care Researchers

Palliative Care Organizations

Training Opportunities

Palliative Care Conferences

The Annual Assembly of the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA)
This annual three-day meeting brings together nearly 3,000 physicians, nurses, and other health care providers in the field of hospice and palliative care to share research, clinical best practices, and practice-related guidance to advance the specialty and improve patient care.

Palliative Care in Oncology Symposium
Co-sponsored by AAHPM, the American Society of Clinical Oncology (ASCO), and the Multinational Association of Supportive care in Cancer (MASCC), the goal of the Palliative Care in Oncology Symposium is to promote discussion and integration of palliative care from the time that patients are diagnosed with cancer, include supportive care into survivorship plans that address late effects of cancer treatment, and increase the use of palliative care at the end of life.

Funding Organizations and Research Cooperative Groups

Palliative Care Research Cooperative Group (PCRC)
PCRC was established in 2010 to create a network for academic community palliative care providers to engage in research opportunities. They work to develop scientifically based methods that lead to meaningful evidence for decreasing the suffering of patients with advanced or potentially life-limiting illnesses and their caregivers, including family members and providers of care.

National Palliative Care Research Center (NPCRC)
NPCRC is committed to stimulating, developing, and funding research directed at improving care for seriously ill patients and their families.

American Cancer Society (ACS)
As the nation's largest private, not-for-profit source of funds for scientists studying cancer, the ACS focuses its funding on investigator-initiated, peer-reviewed proposals. This process ensures that researchers propose projects that they believe are ready to be tackled with the available knowledge and techniques and encourages discovery in areas that scientists believe are most likely to solve the problems of cancer. ACS also offers grants that support the clinical and/or research training of health professionals (i.e., nurses, physicians, social workers). These Health Professional Training Grants promote excellence in cancer prevention and control by providing incentive and support for highly qualified individuals in outstanding training programs or responsible for training.

Cambia Health Foundation (CHF)
Based in Portland, CHF awards grants based on three program areas: transforming health care, children’s health, and palliative and end-of-life care. The Sojourn’s Scholar Leadership Program seeks to support outstanding nurse and physician emerging leaders in palliative care by investing in their professional development.

National Institute of Nursing Research (NINR)
NINR supports research to develop improved, personalized strategies to treat and prevent the adverse symptoms of illness across diverse populations and settings.

National Institute on Aging (NIA)
The National Institute on Aging leads the federal government in conducting and supporting research on aging and the health and well-being of older people. The Institute seeks to understand the nature of aging and the aging process, and diseases and conditions associated with growing older, in order to extend the healthy, active years of life.

National Cancer Institute (NCI)
NCI is the Federal Government's principal agency for cancer research and training.

Research Priorities in Palliative Care

Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life by the Institutes of Medicine (IOM) Committee on Approaching Death: Addressing Key End-of-Life Issues. National Academy of Sciences, 2014.

Building Momentum: The Science of End-of-Life and Palliative Care. A Review of Research Trends and Funding, 1997-2010. The National Institutes of Health, the National Institute of Nursing Research, 2013.

Improving Health Care and Palliative Care for Advanced and Serious Illness. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.

Research Priorities in Geriatric Palliative Care. A Series of Reports by the National Palliative Care Research Center, beginning July 2013.

Journals that Publish Palliative Care Research

Palliative Care Newsletters and Blogs

Investigators from the University of Pittsburgh have been involved in the following national recommendations shaping the future of palliative care:

GeriPal - A Geriatrics and Palliative Care Blog
GeriPal is a forum for discourse, recent news and research, and freethinking commentary. GeriPal welcomes the perspectives of generalists, specialists, gerontologists, palliative care clinicians, and anyone else interested in care of the elderly or palliative care.

PALLIMED – A Hospice & Palliative Medicine Blog

Hospice and Palliative Medicine SmartBrief
The Hospice and Palliative Medicine SmartBrief is a daily targeted newsletter with articles for hospice and palliative medicine.

PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care)
PC-FACS is an electronic publication that provides concise summaries of the most important findings from more than 100 medical and scientific journals.

Palliative Care JournalClub
Palliative Care JournalClub is an electronic listing of palliative care articles. Readers can register to receive a weekly e-mail of selected titles.

Get Palliative Care Blog & Resources
Get Palliative Care provides information for family caregivers, clinicians, and policy makers about what palliative care is, who it’s right for, and how to get it, as well as an extensive resource list.

Measurement Tools

Coming soon!


Contact Us

If you have questions or need information about our services or research, please call 412-692-4758 or click here to send us an email.

Support Palliative Care Research

The Section of Palliative Care and Medical Ethics was established in 1997. Since its founding, researchers have received funding from the National Palliative Care Research Center, the National Cancer Institute, the National Institute of Nursing Research, the National Heart Lung and Blood Institute, and the American Cancer Society.

If you are an individual or group with an interest in supporting palliative care research at the University of Pittsburgh or learning more about any of our ongoing projects, please call us at 412-692-4758 or click here to send us an email.