PI: Reed Bratches, PhD

Dr. Bratches’ joint-funded ICAR/CPSC award will be used to fund a mixed-method explanatory sequential study to understand family caregiver strategies to manage medication refusals for persons living with dementia. Medication refusals are a distressing aspect of care-resistant behavior that contributes to negative outcomes for persons living with dementia and their caregivers, but little is known about the strategies used by family caregivers to effectively manage medication refusals, especially by caregivers of historically marginalized groups. This study will seek to classify caregiver strategies to manage medication refusals and identify strategic components for future targeted intervention.

PI: Kimberly Kopecky, MD, MSCI

As a palliative-trained surgical oncologist, Dr. Kopecky performs high-risk abdominal surgery for cancer. For her study, she plans to characterize the cognitive aspects of patient and caregiver expectation development in order to better understand the ways in which expectations influence decision-making. This work will also investigate ways in which surgeons currently elicit, address, and manage the expectations of patients and caregivers before and after high-risk abdominal surgery for cancer. She hopes that the findings from this study will enable her toward designing an intervention aimed at optimizing expectation management in the peri-operative setting.

PI: Rushil Patel, MD

Dr. Wall’s study objective is to investigate, for the first time, specialty palliative care referral timing, reasons and barriers in women with cervical cancer. Trends in referral patterns will be analyzed over a 5 year period and they will conduct semi-structured interviews with patients with newly diagnosed cervical cancer. To assess patient needs tailored to specialty palliative care and to identify critical intervention components with concurrent administration of a validated quality of life measure. They will look to determine the specialized palliative care needs of racial minority groups increasingly burdened with cervical cancer in the Southeast United States and to develop guidelines for a consistently implemented early specialty palliative care program.

PI: Alexandra Evancho, PT, DPT

Dr. Evancho’s study addresses the issue of fatigue, anxiety, and depression as a common conditions in breast cancer and how it parallels with insomnia and sleep disturbance, exacerbating one another and decreasing quality of life (QOL). In a study of patients with cancer experiencing insomnia, 87% cited the stress surrounding their cancer diagnosis as a major reason for sleep difficulties. Benzodiazepines (BZDs) are the most commonly prescribed pharmacotherapy intervention for insomnia, however BZDs are associated with negative side effects including risks of misuse and addiction.

PI: Richard Taylor, PhD, DNP, CRNP, ANP-BC

Dr. Taylor's study will aim to examine the relationship between biopsychosocial factors and life-space mobility (LSM), LSM trajectory patterns, older colorectal cancer (CRC) survivors’ lived LSM experiences, and survivors’ LSM intervention design suggestions.

PI: Jacyln Wall, MD

Dr. Wall’s study objective is to investigate, for the first time, specialty palliative care referral timing, reasons and barriers in women with cervical cancer. Trends in referral patterns will be analyzed over a 5 year period and they will conduct semi-structured interviews with patients with newly diagnosed cervical cancer. To assess patient needs tailored to specialty palliative care and to identify critical intervention components with concurrent administration of a validated quality of life measure. They will look to determine the specialized palliative care needs of racial minority groups increasingly burdened with cervical cancer in the Southeast United States and to develop guidelines for a consistently implemented early specialty palliative care program.

The aim of this study is to determine relationships between stressors, stress moderators, and daily depression-related symptoms and to determine relationships between depression symptom trajectories, resilience, frailty, and QoL. The results of this study will identify modifiable targets to inform interventions that improve resilience and QoL among SGM cancer survivors and their intimate partners. The proposed work will serve as the first step towards a dynamic SGM mental health framework in cancer to improve the quality of palliative and EOL care for this underserved population.

Thematic area of research: Addressing Culture, Lived Experiences and Racism; Towards Health Equity

As a group, LGBT older adults are affected disproportionately by poverty and poor health due to a lifetime of stressors and discrimination, particularly for LGBTs persons of color. Lack of trust and legal protections may cause older LGBT adults to be less open about their sexuality, further hampering a focus on their unique health care needs.

The specific aim of this study is to gain an understanding of the cultural values and preferences for care and communication among African American and White GB men, aged 50 years or older, with a serious illness and/or their partners/caregivers.

Thematic area of research: Addressing Culture, Lived Experiences and Racism; Towards Health Equity

The purpose of this research is to fill a knowledge gap regarding whether the kidney transplant center is an appropriate space for conversations about palliative care and ACP for patients with advanced kidney disease.

Thematic area of research: Increasing Access to Palliative and Supportive Care

Using the gender minority stress and resilience theory as a conceptual framework and Community-Based Participatory Research as our approach, we aim to inform the development of a PC Conversation guide for TGD people aged 55+ with serious illness and their partners. We aim to identify 1) the cultural values and preferences for clinician communication and PC care, 2) the minority stress experiences faced in healthcare settings, and 3) racial differences in these values, preferences, and experiences.

Thematic area of research: Address Palliative Care Cultural Considerations and Disparities

To understand the values and preferences, goals of medical care, and other preferences including clinician communication, of a sub-culture of lesbian and bisexual women with serious illness and their partners who live in an urban southern city.

Thematic area of research: Address Palliative Care Cultural Considerations and Disparities

In this study, we begin to explore how and if oncologists’ recommendation leads to healthy behavior improvement by examining if it affects engagement in a web-based diet program, diet self-efficacy and diet quality. The study design will be guided by formative research findings and Bandura’s Social-Cognitive Theory (SCT) behavior change model that proposes that effective health promotion interventions are based on SCT constructs.

Thematic area of research: Enhance Communication Skills Among Patients, Caregivers, and Clinicians

The goal of this proposal is to gather qualitative data to identify key dose and content components for a highly innovative optimization trial pilot of the ENABLE CHF-PC intervention.

Thematic area of research: Increasing Access to Palliative and Supportive Care

The purpose of this study is to better understand end-of-life (EOL) care for children with AHD by determining disparities in EOL care and if those patterns and disparities reflect bereaved patient priorities.

Thematic area of research: Improve Caregivers Support & Bereavement Care

The goal of the proposed research is to explore the communication about patient preferences by both patients and their oncologists related to decision-making in metastatic breast cancer, an incurable illness with limited life expectancy.

Thematic area of research: Enhance Communication Skills Among Patients, Caregivers, and Clinicians

The overall goal of this pilot study is to determine the feasibility of administering a tele-based palliative care consult to “short-stay” (<90 days)patients in a SNF; including assessing its acceptability to the SNF facility, clinicians, and patients, and to assess short-term effectiveness of care on patient outcome.

Thematic area of research: Increasing Access to Palliative and Supportive Care