Research and Scholarship

Improving Decision-Making about Feeding Options in Dementia
A Decision Aid about Goals of Care for Patients with Dementia
PEACE Hospice and Palliative Care Quality Measures

UNC investigators lead numerous observational studies, quality improvement projects and clinical trials for people with serious illness and their families.  We are a founding member organization and host the Measurement Core for the Palliative Care Research Cooperative group – a nationwide interdisciplinary research network funded by NIH-NINR to advance palliative care science and improve care for people with serious illness.

Research and quality improvement projects are facilitated by collaboration and support across the UNC Health Affairs campus, including the North Carolina Translational and Clinical Sciences Institute, the Cecil G. Sheps Center for Health Services Research, UNC Center for Aging and Health, and the Lineberger Comprehensive Cancer Center.

Selected recent scientific publications by UNC Palliative Care Program faculty

Palliative care for seriously ill older adults, including those living with Alzheimer’s disease and related dementias

• Hanson LC, Kistler CE, Lavin K, Gabriel SL, Ernecoff NC, Lin FC, Sachs GA, Mitchell SL. Triggered Palliative Care for Late-stage Dementia: a Pilot Randomized Trial. J Pain Symptom Manage. 2019; 57(1): 10-19
• Toles M, Song MK, Lin FC, Hanson LC. Perceptions of Family Decision-makers of Nursing Home Residents With Advanced Dementia Regarding the Quality of Communication Around End-of-Life Care. J Am Med Dir Assoc. 2018;19(10):879-883.
• Ernecoff NC, Zimmerman S, Mitchell SL, Song MK, Lin FC, Wessell KL, Hanson LC. Concordance between Goals of Care and Treatment Decisions for Persons with Dementia. J Palliat Med. 2018;21(10):1442-1447.

Palliative and supportive care for persons living with cystic fibrosis

• Kavalieratos D, Georgiopoulos AM, Dhingra L, Basile MJ, Rabinowitz E, Hempstead SE, Faro A, Dellon EP. Models of Palliative Care Delivery for Individuals with Cystic Fibrosis: Cystic Fibrosis Foundation Evidence-Informed Consensus Guidelines. J Palliat Med. 2021;24(1):18-30.
• Dellon EP, Basile M, Hobler MR, Georgiopoulos AM, Chen E, Goggin J, Goss CH, Hempstead SE, Faro A, Kavalieratos D. Palliative Care Needs of Individuals with Cystic Fibrosis: Perspectives of Multiple Stakeholders. J Palliat Med. 2020;23(7):957-963.
• Dellon EP, Helms SW, Hailey CE, Shay R, Carney SD, Schmidt HJ, Brown DE, Prieur MG. Exploring knowledge and perceptions of palliative care to inform integration of palliative care education into cystic fibrosis care. Pediatric pulmonology. 2018;53(9):1218-1224.

Innovative models for palliative care in cancer

• Hong S, Zimmerman PE, Rao V, Markwalter DW. Buprenorphine-Naloxone in the Setting of Kratom Withdrawal, Opioid Use Disorder, and Stage IV Lung Adenocarcinoma. J Palliat Med. 2022 [Epub ahead of print]
• Hanson LC, Wessell KL, Hanspal J, Lin FC, Collichio FA, DeWalt D, Milowsky MI, Rosenstein DL, Winzelberg GS, Wood WA, Ernecoff NC. Pre-Post Evaluation of Collaborative Oncology Palliative Care for Patients With Stage IV Cancer. J Pain Symptom Manage. 2021 [Epub ahead of print]
• DiMartino LD, Weiner BJ, Hanson LC, Weinberger M, Birken SA, Reeder-Hayes K, Trogdon JG. Inpatient Palliative Care Consultation and 30-Day Readmissions in Oncology. J Palliat Med. 2018;21(1):62-68.
• Hanson LC, Collichio F, Bernard SA, Wood WA, Milowsky M, Burgess E, Creedle CJ, Cheek S, Chang L, Chera B, Fox A. Integrating Palliative and Oncology Care for Patients with Advanced Cancer: A Quality Improvement Intervention. J Palliat Med. 2017;20(12):1366-1371.

Measurement science in hospice and palliative care:  

• Ernecoff NC, Wessell KL, Bennett AV, Hanson LC. Measuring Goal-Concordant Care in Palliative Care Research. J Pain Symptom Manage. 2021 [Epub ahead of print]
• Dolin R, Silberman P, Kirk DA, Stearns SC, Hanson LC, Taylor DH Jr, Holmes GM. Do Live Discharge Rates Increase as Hospices Approach Their Medicare Aggregate Payment Caps? J Pain Symptom Manage. 2018;55(3):775-784.
• Zheng NT, Li Q, Hanson LC, Wessell KL, Chong N, Sherif N, Broyles IH, Frank J, Kirk MA, Schwartz CR, Levitt AF. Nationwide Quality of Hospice Care: Findings From the Centers for Medicare & Medicaid Services Hospice Quality Reporting Program. J Pain Symptom Manage. 2018;55(2):427-432 e421.

Communication and decision-making

• Ernecoff NC, Wessell KL, Wood WA, Winzelberg GS, Collichio FA, Hanson LC. How well do documented goals-of-care discussions for patients with stage IV cancer reflect communication best practices? BMC Palliat Care. 2021;20(1):41.
• Kistler CE, Beeber AS, Winzelberg GS, Gabriel SL, Wretman CJ, Hanson LC. Evaluation of a Training Toolkit to Improve Clinicians’ Skills for Dementia Advance Care Planning. J Palliat Med. 2021;24(8):1183-1190.
• Li L, Nelson JE, Hanson LC, Cox CE, Carson SS, Chai EJ, Keller KL, Tulsky JA, Danis M. How Surrogate Decision-Makers for Patients With Chronic Critical Illness Perceive and Carry Out Their Role. Crit Care Med. 2018;46(5):699-704.

Impact of cancer on parenting 

• Hailey CE, Yopp JM, Deal AM, Mayer DK, Reeder-Hayes KE, Hanson LC, Grunfeld G, Rosenstein DL, Park EM. Communication with children and psychological distress in parents with advanced cancer: a mixed-methods study. Supportive Care in Cancer, 2018; 26:287-295.
• Rosenstein, D. L., & Yopp, J. M. (2018). The Group: Seven Widowed Fathers Reimagine Life: Oxford University Press.
• Park EM, Check DK, Song MK, Reeder-Hayes KE, Hanson LC, Yopp JM, Rosenstein DL, Mayer DK. Parenting while living with advanced cancer: A qualitative study. Palliat Med. 2017;31(3):231-238.

Other palliative care research

• Casey MF, Price L, Markwalter D, Bohrmann T, Moraes Tsujimoto T, Lavin K, Hanson LC, Lin FC, Platts-Mills TF. Advance Care Planning for Emergency Department Patients With COVID-19 Infection: An Assessment of a Physician Training Program. Am J Hosp Palliat Care. 2022;39(11):1358-1363.
• Casey MF, Markwalter DW. Incorporating End-of-Life Care into the Management of Dead on Arrival Patients in the Emergency Department: Invited Commentary. J Emerg Nurs. 2021;47(4):521-523.
• Markwalter DW, Murphy MA, Turnbull JM, Fanning JB. Framing the future: Family preparedness for care transitions of critically ill children. Fam Syst Health. 2019;37(3):212-223.

UNC Palliative Care providers are also involved in a number of quality improvement and educational projects, including:

• System-wide ACP Task Force
  • UNCHS ACP Organizational goal to increase ACP
  • Respecting Choices SDMSI training
  • Tailored core ACP training for diverse audiences
  • CAPC on-line modules
  • QI coaching
  • Epic optimization
• Triggered consults for advanced congestive heart failure / LVAD and late-stage chronic kidney disease (CKD)
• Enhanced PC and ACP in the SICU
• Early Oncology Palliative Care for persons with advanced cancer
• Dignity therapy program