Research in Palliative Care

The UNC-CH Divisions of Geriatric Medicine and Hematology-Oncology collaborate in the Palliative Care Program, an interdisciplinary program with clinical, educational, and research initiatives. The Palliative Care Program is co-directed by Laura Hanson, MD, MPH (Geriatric Medicine) and Stephen Bernard, MD (Hematology-Oncology).

• Medical Co-Director – Laura Hanson, MD, MPH is an associate professor in the Division of Geriatric Medicine. She is board-certified in Internal Medicine, Geriatric Medicine and Palliative Medicine. Dr. Hanson's research focuses on health care decisions and quality of care near the end of life for older and chronically ill patients. She has led numerous original investigations of care at the end of life. Dr. Hanson serves as course director for the core research training curriculum of the K30 Program. Her research support has included a Soros Foundation Project on Death in American Scholar award, in addition to other foundation and NIH grants.
• Medical Co-Director – Stephen Bernard, MD is a professor in the Division of Hematology-Oncology. He is board-certified in Internal Medicine, Medical Oncology, and Palliative Medicine. In 1998 he completed a sabbatical in Palliative Care with Dr. Eduardo Bruera at the University of Alberta. Dr. Bernard developed and directs the UNC-CH SOM course in Palliative Medicine. Dr. Bernard’s research experience includes Phase I, II, and III drug trials in cancer medicine, and a prospective validation study of the Palliative Performance Scale.

Current Research Initiatives

UNC Palliative Care Clinical Research Database

To facilitate research and clinical quality monitoring, the UNC-CH Palliative Care Program includes a clinical research database. The database includes demographic and clinical characteristics, information on end-of-life treatment decisions, and validated measures of performance status and symptom scores. Patients or their families are asked to consent to use of their de-identified data to improve future palliative care. Of the 395 patients seen between July 1, 2002 and June 30, 2005, 304 gave consent. The research database is also used to facilitate other externally funded studies.

Hospice and Palliative Care Quality Measures

Working collaboratively with the Carolinas Center for Medical Excellence, Dr. Hanson is the clinical investigator for a CMS contract to develop quality measures for hospice and palliative care. The purpose of this special study is to develop a set of hospice and palliative care quality measurement tools and associated procedures that will enable hospice and palliative care programs to assess quality, target actionable shortcomings, and monitor improvements.

On Our Terms: A Lay Health Advisor Pilot Study

Compared to whites, African-Americans with cancer are less likely to receive effective treatment for pain, less likely to communicate with health care providers about life-sustaining treatment choices, and less likely to use palliative care services. This NIH-funded study examines the feasibility of training lay health advisors to improve palliative care knowledge for African-American cancer patients and their families.This study is a collaboration with the UNC-Shaw Partnership to Eliminate Health Disparities, an NIH-funded consortium of multiple investigators at both institutions.

Improving Decision Making About Tube Feeding

Tube feeding in advanced dementia is increasing despite limited medical benefits. Led by Dr. Hanson, this NIH-funded study is a randomized controlled trial to test the impact of a decision aid on quality of decision-making and on treatments used for nursing home residents with advanced dementia.

Spiritual Care at the End of Life

The primary aim of this study is to describe the structure, process, and outcome of spiritual care delivered to dying patients and their families, using structured interviews with 150 patients and family caregivers served by the UNC-CH Palliative Care Program and the Family Medicine and Internal Medicine inpatient services. The research is funded by the Fetzer Foundation, and Dr. Tim Daaleman and Dr. Hanson are lead investigators.

Validation of the Palliative Performance Scale in the Acute Tertiary Care Hospital

This study used data on n=277 patients from the UNC-CH Palliative Care Clinical Research Database to validate the Palliative Performance Scale as a predictor of survival. Research has led to a collaborative international meta-analysis with investigators at the University of British Colombia on the predictive validity of the Palliative Performance Scale, which is complete and submitted for publication.

Last updated 7/12/2007.