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Johnson, Kimberly Sherell

Positions:

Associate Professor of Medicine

Medicine, Geriatrics
School of Medicine

Senior Fellow in the Center for the Study of Aging and Human Development

Center for the Study of Aging and Human Development
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1997

M.D. — Johns Hopkins University

Medical Resident, Me Dicine

Duke University

Chief Medical Resident Ambulatory Services, Medicine

Duke University

Fellow In Geriatrics, Medicine

Duke University

News:

Grants:

Duke Health Disparities Research Center

Administered By
Medicine, Geriatrics
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 25, 2017
End Date
June 30, 2022

Bridging the Gap to Enhance Clinical Research Program (BIGGER)

Administered By
Medicine, Infectious Diseases
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
December 15, 2016
End Date
November 30, 2021

Behavioral and Physiology in Aging

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
September 01, 2015
End Date
August 31, 2020

Implementing Best Practice in Palliative Care

Administered By
Center for the Study of Aging and Human Development
AwardedBy
Agency for Healthcare Research and Quality
Role
Principal Investigator
Start Date
September 30, 2013
End Date
September 29, 2018

Duke CTSA (UL1)

Administered By
Institutes and Centers
AwardedBy
National Institutes of Health
Role
Associate Director
Start Date
September 26, 2013
End Date
April 30, 2018

Toward Policies that Accommodate the Concerns of African Americans' in Resolving Disputes about the Use of Life Sustaini

Administered By
Center for the Study of Aging and Human Development
AwardedBy
Greenwall Foundation
Role
Principal Investigator
Start Date
March 01, 2015
End Date
December 31, 2017

Palliative Care in Heart Failure (PAL-HF)

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 27, 2011
End Date
July 31, 2016

Behavior And Physiology In Aging

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
July 01, 1999
End Date
August 31, 2015

Increasing Access to Hospice Care for Older African Americans: A National Study

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
June 01, 2012
End Date
May 31, 2015

IPA - Kimberly Johnson

Administered By
Medicine, Geriatrics
AwardedBy
Durham Veterans Affairs Medical Center
Role
Investigator
Start Date
October 01, 2013
End Date
September 30, 2014

IPA - Kimberly Johnson

Administered By
Medicine, Geriatrics
AwardedBy
Durham Veterans Affairs Medical Center
Role
Investigator
Start Date
October 01, 2011
End Date
September 30, 2013

Organizational Variability and Racial Disparities in Hospice Use

Administered By
Center for the Study of Aging and Human Development
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 01, 2007
End Date
May 31, 2013
Show More

Publications:

Acute Leukemia Patients' Needs: Qualitative Findings and Opportunities for Early Palliative Care.

Patients with acute leukemias likely have needs that palliative care can respond to, yet little is known about specific challenges they face, particularly during active treatment. We examined acute myeloid leukemia (AML) patients' expressed challenges and supports following intensive induction chemotherapy. We aimed to understand opportunities for palliative care interventions in this population.A qualitative study of AML patients with high-risk disease at Duke University Hospital, Durham, NC. Patients were interviewed about care experiences approximately 3 months after treatment initiation. Multiple coders used descriptive content analysis to identify common and recurrent themes.We analyzed 22 patient transcripts. Sample demographics included: 10 (45.5%) females, 12 (54.5%) males, mean age 62 (SD 10.9), 19 (86.4%) non-Hispanic white, and 3 (13.6%) non-white/non-Hispanic. All had high-risk disease, by age, relapse status, or molecular markers. We identified 4 themes in our analysis: physical symptoms, psychological issues, uncertainty regarding prognosis, and patients' sources of support. Specific challenges noted by patients included feelings of helplessness/hopelessness, activity restriction, fatigue, fevers, caregiver stress and lack of clarity regarding treatment decision-making.AML patients face substantial challenges regarding physical symptoms, psychological distress, and uncertainty regarding prognosis. These challenges signal needs for which palliative care in high-risk AML patients may help.These findings highlight opportunities to develop targeted palliative care interventions addressing needs in AML patients.

Authors
Boucher, NA; Johnson, KS; LeBlanc, TW
MLA Citation
Boucher, NA, Johnson, KS, and LeBlanc, TW. "Acute Leukemia Patients' Needs: Qualitative Findings and Opportunities for Early Palliative Care." Journal of pain and symptom management (September 18, 2017).
PMID
28935132
Source
epmc
Published In
Journal of Pain and Symptom Management
Publish Date
2017
DOI
10.1016/j.jpainsymman.2017.09.014

State of the Science of Spirituality and Palliative Care Research Part II: Screening, Assessment, and Interventions.

The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part II of the SOS-SPC report addresses the state of extant research and identifies critical research priorities pertaining to the following questions: 1) How do we assess spirituality? 2) How do we intervene on spirituality in palliative care? And 3) How do we train health professionals to address spirituality in palliative care? Findings from this report point to the need for screening and assessment tools that are rigorously developed, clinically relevant, and adapted to a diversity of clinical and cultural settings. Chaplaincy research is needed to form professional spiritual care provision in a variety of settings, and outcomes assessed to ascertain impact on key patient, family, and clinical staff outcomes. Intervention research requires rigorous conceptualization and assessments. Intervention development must be attentive to clinical feasibility, incorporate perspectives and needs of patients, families, and clinicians, and be targeted to diverse populations with spiritual needs. Finally, spiritual care competencies for various clinical care team members should be refined. Reflecting those competencies, training curricula and evaluation tools should be developed, and the impact of education on patient, family, and clinician outcomes should be systematically assessed.

Authors
Balboni, TA; Fitchett, G; Handzo, GF; Johnson, KS; Koenig, HG; Pargament, KI; Puchalski, CM; Sinclair, S; Taylor, EJ; Steinhauser, KE
MLA Citation
Balboni, TA, Fitchett, G, Handzo, GF, Johnson, KS, Koenig, HG, Pargament, KI, Puchalski, CM, Sinclair, S, Taylor, EJ, and Steinhauser, KE. "State of the Science of Spirituality and Palliative Care Research Part II: Screening, Assessment, and Interventions." Journal of pain and symptom management 54.3 (September 2017): 441-453.
PMID
28734881
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
54
Issue
3
Publish Date
2017
Start Page
441
End Page
453
DOI
10.1016/j.jpainsymman.2017.07.029

State of the Science of Spirituality and Palliative Care Research Part I: Definitions, Measurement, and Outcomes.

The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part I of the SOS-SPC two-part series focuses on questions of 1) What is spirituality? 2) What methodological and measurement issues are most salient for research in palliative care? And 3) What is the evidence relating spirituality and health outcomes? After describing current evidence we make recommendations for future research in each of the three areas of focus. Results show wide variance in the ways spirituality is operationalized and the need for definition and conceptual clarity in research in spirituality. Furthermore, the field would benefit from hypothesis-driven outcomes research based on a priori specification of the spiritual dimensions under investigation and their longitudinal relationship with key palliative outcomes, the use of validated measures of predictors and outcomes, and rigorous assessment of potential confounding variables. Finally, results highlight the need for research in more diverse populations.

Authors
Steinhauser, KE; Fitchett, G; Handzo, GF; Johnson, KS; Koenig, HG; Pargament, KI; Puchalski, CM; Sinclair, S; Taylor, EJ; Balboni, TA
MLA Citation
Steinhauser, KE, Fitchett, G, Handzo, GF, Johnson, KS, Koenig, HG, Pargament, KI, Puchalski, CM, Sinclair, S, Taylor, EJ, and Balboni, TA. "State of the Science of Spirituality and Palliative Care Research Part I: Definitions, Measurement, and Outcomes." Journal of pain and symptom management 54.3 (September 2017): 428-440.
PMID
28733252
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
54
Issue
3
Publish Date
2017
Start Page
428
End Page
440
DOI
10.1016/j.jpainsymman.2017.07.028

Design and Evaluation of an Interdisciplinary Health Disparities Research Curriculum

Authors
Johnson, KS; Thomas, KL; Pinheiro, SO; Svetkey, LP
MLA Citation
Johnson, KS, Thomas, KL, Pinheiro, SO, and Svetkey, LP. "Design and Evaluation of an Interdisciplinary Health Disparities Research Curriculum." Journal of the National Medical Association (August 2017).
Source
crossref
Published In
Journal of the National Medical Association
Publish Date
2017
DOI
10.1016/j.jnma.2017.06.005

Palliative Care in Heart Failure The PAL-HF Randomized, Controlled Clinical Trial

Authors
Rogers, JG; Patel, CB; Mentz, RJ; Granger, BB; Steinhauser, KE; Fiuzat, M; Adams, PA; Speck, A; Johnson, KS; Krishnamoorthy, A; Yang, H; Anstrom, KJ; Dodson, GC; Jr, TDH; Kirchner, JL; Mark, DB; O'Connor, CM; Tulsky, JA
MLA Citation
Rogers, JG, Patel, CB, Mentz, RJ, Granger, BB, Steinhauser, KE, Fiuzat, M, Adams, PA, Speck, A, Johnson, KS, Krishnamoorthy, A, Yang, H, Anstrom, KJ, Dodson, GC, Jr, TDH, Kirchner, JL, Mark, DB, O'Connor, CM, and Tulsky, JA. "Palliative Care in Heart Failure The PAL-HF Randomized, Controlled Clinical Trial." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 70.3 (July 18, 2017): 332-341.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
70
Issue
3
Publish Date
2017
Start Page
332
End Page
341

Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial.

Advanced heart failure (HF) is characterized by high morbidity and mortality. Conventional therapy may not sufficiently reduce patient suffering and maximize quality of life.The authors investigated whether an interdisciplinary palliative care intervention in addition to evidence-based HF care improves certain outcomes.The authors randomized 150 patients with advanced HF between August 15, 2012, and June 25, 2015, to usual care (UC) (n = 75) or UC plus a palliative care intervention (UC + PAL) (n = 75) at a single center. Primary endpoints were 2 quality-of-life measurements, the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary and the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (FACIT-Pal), assessed at 6 months. Secondary endpoints included assessments of depression and anxiety (measured via the Hospital Anxiety and Depression Scale [HADS]), spiritual well-being (measured via the FACIT-Spiritual Well-Being scale [FACIT-Sp]), hospitalizations, and mortality.Patients randomized to UC + PAL versus UC alone had clinically significant incremental improvement in KCCQ and FACIT-Pal scores from randomization to 6 months (KCCQ difference = 9.49 points, 95% confidence interval [CI]: 0.94 to 18.05, p = 0.030; FACIT-Pal difference = 11.77 points, 95% CI: 0.84 to 22.71, p = 0.035). Depression improved in UC + PAL patients (HADS-depression difference = -1.94 points; p = 0.020) versus UC-alone patients, with similar findings for anxiety (HADS-anxiety difference = -1.83 points; p = 0.048). Spiritual well-being was improved in UC + PAL versus UC-alone patients (FACIT-Sp difference = 3.98 points; p = 0.027). Randomization to UC + PAL did not affect rehospitalization or mortality.An interdisciplinary palliative care intervention in advanced HF patients showed consistently greater benefits in quality of life, anxiety, depression, and spiritual well-being compared with UC alone. (Palliative Care in Heart Failure [PAL-HF]; NCT01589601).

Authors
Rogers, JG; Patel, CB; Mentz, RJ; Granger, BB; Steinhauser, KE; Fiuzat, M; Adams, PA; Speck, A; Johnson, KS; Krishnamoorthy, A; Yang, H; Anstrom, KJ; Dodson, GC; Taylor, DH; Kirchner, JL; Mark, DB; O'Connor, CM; Tulsky, JA
MLA Citation
Rogers, JG, Patel, CB, Mentz, RJ, Granger, BB, Steinhauser, KE, Fiuzat, M, Adams, PA, Speck, A, Johnson, KS, Krishnamoorthy, A, Yang, H, Anstrom, KJ, Dodson, GC, Taylor, DH, Kirchner, JL, Mark, DB, O'Connor, CM, and Tulsky, JA. "Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial." Journal of the American College of Cardiology 70.3 (July 2017): 331-341.
PMID
28705314
Source
epmc
Published In
JACC - Journal of the American College of Cardiology
Volume
70
Issue
3
Publish Date
2017
Start Page
331
End Page
341
DOI
10.1016/j.jacc.2017.05.030

Unmet Needs of African Americans and Whites at the Time of Palliative Care Consultation.

Differences among patient populations that present to consultative palliative care are not known. Such an appreciation would inform health-care delivery tailored to unique populations.We aimed to compare characteristics and palliative care needs of African Americans (AAs) and whites during initial palliative care consultation.We analyzed patient-reported, clinician-entered clinical encounter data from a large, multisite community-based, nonhospice palliative care collaborative. We included first specialty palliative care consultations from January 1, 2014, to July 2, 2015, across 15 sites within the Global Palliative Care Quality Alliance registry. Demographics, disease, performance status, advance care planning, and symptom prevalence/severity were compared.Of 775 patients, 12.9% (N = 100) were AA. African Americans were younger (63 vs 75.4 years, P < .0001). A larger proportion of AAs had a diagnosis of cancer (45.0% vs 36.3%, P = .09) and in the hospital (71% vs 61.8%, P = .07). African Americans were more likely to have a Palliative Performance Score of 0 to 30 (35.6% vs 23.7%, P = .049). Around 50% in both racial groups were full code; slightly more than 40% had an advance directive. Nearly two-thirds in both racial groups reported 3 or more symptoms of any severity; one-third reported 3 or more moderate or severe symptoms. A larger proportion of Africans than whites reported pain of any severity (66.0% vs 56.1%, P = .06).All patients present to palliative care consultations with significant symptom and advance care planning needs. Further research is needed to identify how to deliver palliative care: earlier, in noncancer conditions, and improve pain management in AA populations.

Authors
Kamal, AH; Bull, J; Wolf, SP; Portman, D; Strand, J; Johnson, KS
MLA Citation
Kamal, AH, Bull, J, Wolf, SP, Portman, D, Strand, J, and Johnson, KS. "Unmet Needs of African Americans and Whites at the Time of Palliative Care Consultation." The American journal of hospice & palliative care 34.5 (June 2017): 461-465.
PMID
26888883
Source
epmc
Published In
American Journal of Hospice & Palliative Medicine
Volume
34
Issue
5
Publish Date
2017
Start Page
461
End Page
465
DOI
10.1177/1049909116632508

Meeting Basic Needs: Social Supports and Services Provided by Hospice.

Describe social goods and services for which hospices assist patients and families and the resources hospices use to do so.Basic social supports and services not routinely covered by insurers may be needed by terminally ill patients and their families. Little is known about hospices' provision of such social supports and services.A 2014-2015 cross-sectional survey of hospices nationwide. Participating hospices had been in operation for at least 3 years and were located in any of the 50 states or District of Columbia. Hospices were surveyed about availability and sources of internal funds and referral to obtain basic social supports for patients. Descriptive statistics, bivariate analysis, and categorization were used to describe hospice practices. Measures included frequency and nature of goods and services provision in the prior year; and extent to which hospices used internal funds or community referral for goods and services.Over 80% (n = 203) reported internal funds covered services not reimbursed by insurers; 78% used funds in last year. Hospices used internal funds for food (81.7%), shelter (57.8%), utility bills (73.5%), and funeral costs (50%). Hospices referred patients/families to community organizations to obtain a similar range of services, including transportation, clothing, linens/towels, furniture/appliances, home repairs, and caregiver support.Hospices are using internal resources and accessing community resources to provide patients with basic social needs not routinely covered by insurance.

Authors
Boucher, NA; Kuchibhatla, M; Johnson, KS
MLA Citation
Boucher, NA, Kuchibhatla, M, and Johnson, KS. "Meeting Basic Needs: Social Supports and Services Provided by Hospice." Journal of palliative medicine 20.6 (June 2017): 642-646.
PMID
28186839
Source
epmc
Published In
Journal of Palliative Medicine
Volume
20
Issue
6
Publish Date
2017
Start Page
642
End Page
646
DOI
10.1089/jpm.2016.0459

Comparing the Palliative Care Needs of Those With Cancer to Those With Common Non-Cancer Serious Illness.

Historically, palliative care has been focused on those with cancer. Although these ties persist, palliative care is rapidly integrating into the care of patients with common, non-cancer serious illnesses. Despite this, the bulk of literature informing palliative care practices stems from the care of cancer patients.We compared functionality, advanced care planning, hospital admissions, prognosis, quality of life, pain, dyspnea, fatigue, and depression between patients with cancer and three non-cancer diagnoses-end-stage renal disease (ESRD), heart failure (HF), and chronic obstructive pulmonary disease (COPD).We conducted a cross-sectional, retrospective analysis of the characteristics and symptoms of patient's with ESRD, HF, COPD, and cancer at time of first specialty palliative care referral. Using a web-based point of care quality assessment and reporting tool, Quality Data and Collection Tool-Palliative care, this analysis evaluated all eligible patients who received a palliative care consultation between October 1, 2012 and November 25, 2014. Data were obtained from 13 participating sites. The primary outcome for the study was functionality using the palliative performance scale. Hospital admission in the last 30 days, prognosis, patient's understanding of prognosis, advanced care planning including code status and appointed decision maker, pain, fatigue, depression, and dyspnea were also evaluated as secondary outcomes. We tested for an association between our outcomes with disease type (cancer vs. non-cancer) fitting multivariable logistic regression models.We found that the patients with primary diagnoses other than cancer were less functional at time of referral (odds ratio: 1.6; 95% CI: 1.1, 2.3; P < 0.05).Patients with COPD, ESRD, and HF were less functional and more likely to be hospitalized at time of referral to palliative care than cancer patients. These findings may be reflective of the slower and more varied trajectory of non-cancer serious illness. One aim of palliative care for those with non-cancer severe illness should be directed toward improving and assisting with functionality and decreasing frequency of hospital admissions. These interventions could take place in the palliative care office, but could also be integrated into hospital discharge plans.

Authors
Bostwick, D; Wolf, S; Samsa, G; Bull, J; Taylor, DH; Johnson, KS; Kamal, AH
MLA Citation
Bostwick, D, Wolf, S, Samsa, G, Bull, J, Taylor, DH, Johnson, KS, and Kamal, AH. "Comparing the Palliative Care Needs of Those With Cancer to Those With Common Non-Cancer Serious Illness." Journal of pain and symptom management 53.6 (June 2017): 1079-1084.e1.
PMID
28457746
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
53
Issue
6
Publish Date
2017
Start Page
1079
End Page
1084.e1
DOI
10.1016/j.jpainsymman.2017.02.014

Hospice Access for Undocumented Immigrants.

Authors
Gray, NA; Boucher, NA; Kuchibhatla, M; Johnson, KS
MLA Citation
Gray, NA, Boucher, NA, Kuchibhatla, M, and Johnson, KS. "Hospice Access for Undocumented Immigrants." JAMA internal medicine 177.4 (April 2017): 579-580.
PMID
28166315
Source
epmc
Published In
JAMA Internal Medicine
Volume
177
Issue
4
Publish Date
2017
Start Page
579
End Page
580
DOI
10.1001/jamainternmed.2016.8870

Adherence to Measuring What Matters Items When Caring for Patients With Hematologic Malignancies Versus Solid Tumors.

Measuring What Matters (MWM) prioritizes quality measures in palliative care practice. Hematologic malignancy patients are less likely to access palliative care, yet little is known about their unique needs. Differences in MWM adherence may highlight opportunities to improve palliative care in hematology.To assess adherence to MWM measures by palliative care clinicians caring for patients with hematologic malignancies, compared to those with solid tumors.We used the Quality Data Collection Tool to assess completion of MWM measures across nine sites.We included data from 678 patients' first visits and various care settings; 64 (9.4%) had a hematologic malignancy, whereas 614 (90.6%) had a solid tumor. Hematology patients were more likely to be seen in a hospital (52 or 81.3% vs. 420 or 68%), whereas solid tumor patients were more frequently seen at home or in clinics (160 or 26% vs. 7 or 10.9%). Of the nine MWM measures we assessed, high adherence (>90%) was seen regardless of tumor type in measures #3 (Pain Treatment), #7 (Spiritual Concerns), #8 (Treatment Preferences), and #9 (Care Consistent With Preferences). Clinicians seeing hematology patients were significantly less likely to meet measures #2 (Screening for Physical Symptoms; 57.8% vs. 84.2%, P < 0.001), and #5 (Discussion of Emotional Needs; 56.3% vs. 70.0%, P = 0.03).MWM adherence regarding symptom assessment and meeting emotional needs was lower for patients with hematologic malignancies compared to those with solid tumors. This finding suggests two key areas for quality improvement initiatives in palliative care for patients with hematologic malignancies.

Authors
LeBlanc, TW; Ritchie, CS; Friedman, F; Bull, J; Kutner, JS; Johnson, KS; Kamal, AH; AAHPM Research Committee Writing Group,
MLA Citation
LeBlanc, TW, Ritchie, CS, Friedman, F, Bull, J, Kutner, JS, Johnson, KS, Kamal, AH, and AAHPM Research Committee Writing Group, . "Adherence to Measuring What Matters Items When Caring for Patients With Hematologic Malignancies Versus Solid Tumors." Journal of pain and symptom management 52.6 (December 2016): 775-782.
PMID
27810570
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
52
Issue
6
Publish Date
2016
Start Page
775
End Page
782
DOI
10.1016/j.jpainsymman.2016.09.004

Palliative Care in Heart Failure: Results of a Randomized, Controlled Clinical Trial

Authors
Rogers, JG; Patel, CB; Mentz, RI; Steinhauser, KE; Granger, BB; Fiuzat, M; Adams, PA; Speck, A; Johnson, KS; Krishnamoorthy, A; Yang, H; Anstrom, KJ; Dodson, GC; O'Connor, CM; Tulsky, JA
MLA Citation
Rogers, JG, Patel, CB, Mentz, RI, Steinhauser, KE, Granger, BB, Fiuzat, M, Adams, PA, Speck, A, Johnson, KS, Krishnamoorthy, A, Yang, H, Anstrom, KJ, Dodson, GC, O'Connor, CM, and Tulsky, JA. "Palliative Care in Heart Failure: Results of a Randomized, Controlled Clinical Trial." JOURNAL OF CARDIAC FAILURE 22.11 (November 2016): 940-940.
Source
wos-lite
Published In
Journal of Cardiac Failure
Volume
22
Issue
11
Publish Date
2016
Start Page
940
End Page
940

The feasibility and acceptability of a chaplain-led intervention for caregivers of seriously ill patients: A Caregiver Outlook pilot study.

When caring for a loved one with a life-limiting illness, a caregiver's own physical, emotional, and spiritual suffering can be profound. While many interventions focus on physical and emotional well-being, few caregiver interventions address existential and spiritual needs and the meaning that caregivers ascribe to their role. To evaluate the feasibility and acceptability of the process and content of Caregiver Outlook, we employed a manualized chaplain-led intervention to improve well-being by exploring role-related meaning among caregivers of patients with a life-limiting illness.We conducted a single-arm pre-post pilot evaluation among caregivers of patients with advanced cancer or amyotrophic lateral sclerosis (ALS). Caregivers completed three chaplain-led intervention sessions focusing on (1) a relationship review, (2) forgiveness, and (3) legacy. Outcomes administered at baseline and at 1 and 2 weeks after the intervention included quality of life, anxiety, depression, spiritual well-being, religious coping, caregiver burden, and grief.The sample (N = 31) included a range of socioeconomic status groups, and the average age was approximately 60 years. A third of them worked full-time. Some 74% of our participants cared for a spouse or partner, and the other quarter of the sample cared for a parent (13%), child (10%), or other close family member (3%). At baseline, participants did not demonstrate clinical threshold levels of anxiety, depression, or other indicators of distress. Outcomes were stable over time. The qualitative results showed the ways in which Caregiver Outlook was assistive: stepping back from day-to-day tasks, the opportunity to process emotions, reflecting on support received, provoking thoughts and emotions between sessions, discussing role changes, stimulating communication with others, and the anonymity of a phone conversation. Both religious and nonreligious participants were pleased with administration of the chaplain intervention.The acceptability and feasibility of Caregiver Outlook were demonstrated among caregivers of patients with an advanced illness. Our pilot findings suggest minor modifications to study participant screening, interventionist guidance, and the study measures.

Authors
Steinhauser, KE; Olsen, A; Johnson, KS; Sanders, LL; Olsen, M; Ammarell, N; Grossoehme, D
MLA Citation
Steinhauser, KE, Olsen, A, Johnson, KS, Sanders, LL, Olsen, M, Ammarell, N, and Grossoehme, D. "The feasibility and acceptability of a chaplain-led intervention for caregivers of seriously ill patients: A Caregiver Outlook pilot study." Palliative & supportive care 14.5 (October 2016): 456-467.
PMID
26513022
Source
epmc
Published In
Palliative & Supportive Care
Volume
14
Issue
5
Publish Date
2016
Start Page
456
End Page
467
DOI
10.1017/s1478951515001248

Identifying Patterns of Multimorbidity in Older Americans: Application of Latent Class Analysis.

To define multimorbidity "classes" empirically based on patterns of disease co-occurrence in older Americans and to examine how class membership predicts healthcare use.Retrospective cohort study.Nationally representative sample of Medicare beneficiaries in file years 1999-2007.Individuals aged 65 and older in the Medicare Beneficiary Survey who had data available for at least 1 year after index interview (N = 14,052).Surveys (self-report) were used to assess chronic conditions, and latent class analysis (LCA) was used to define multimorbidity classes based on the presence or absence of 13 conditions. All participants were assigned to a best-fit class. Primary outcomes were hospitalizations and emergency department visits over 1 year.The primary LCA identified six classes. The largest portion of participants (32.7%) was assigned to the minimal disease class, in which most persons had fewer than two of the conditions. The other five classes represented various degrees and patterns of multimorbidity. Usage rates were higher in classes with greater morbidity, but many individuals could not be assigned to a particular class with confidence (sample misclassification error estimate = 0.36). Number of conditions predicted outcomes at least as well as class membership.Although recognition of general patterns of disease co-occurrence is useful for policy planning, the heterogeneity of persons with significant multimorbidity (≥3 conditions) defies neat classification. A simple count of conditions may be preferable for predicting usage.

Authors
Whitson, HE; Johnson, KS; Sloane, R; Cigolle, CT; Pieper, CF; Landerman, L; Hastings, SN
MLA Citation
Whitson, HE, Johnson, KS, Sloane, R, Cigolle, CT, Pieper, CF, Landerman, L, and Hastings, SN. "Identifying Patterns of Multimorbidity in Older Americans: Application of Latent Class Analysis." Journal of the American Geriatrics Society 64.8 (August 2016): 1668-1673.
PMID
27309908
Source
epmc
Published In
Journal of American Geriatrics Society
Volume
64
Issue
8
Publish Date
2016
Start Page
1668
End Page
1673
DOI
10.1111/jgs.14201

Update in Hospice and Palliative Care.

The goal of this update in hospice and palliative care is to summarize and critique research published between January 1 and December 31, 2014 that has a high potential for impact on clinical practice.To identify articles we hand searched 22 leading journals, the Cochrane Database of Systematic Reviews, and Fast Article Critical Summaries for Clinicians in Palliative Care. We also performed a PubMed keyword search using the terms "hospice" and "palliative care."We ranked candidate articles based on study quality, appeal to a breadth of palliative care clinicians, and potential for impact on clinical practice.In this manuscript we have summarized the findings of eight articles with the highest ratings and make recommendations for clinical practice based on the strength of the resulting evidence.

Authors
Gray, NA; Horton, JR; Dionne-Odom, JN; Smith, CB; Johnson, KS
MLA Citation
Gray, NA, Horton, JR, Dionne-Odom, JN, Smith, CB, and Johnson, KS. "Update in Hospice and Palliative Care." Journal of palliative medicine 19.5 (May 2016): 559-565.
PMID
27046735
Source
epmc
Published In
Journal of Palliative Medicine
Volume
19
Issue
5
Publish Date
2016
Start Page
559
End Page
565
DOI
10.1089/jpm.2016.0034

Are Hospice Admission Practices Associated With Hospice Enrollment for Older African Americans and Whites?

Hospices that enroll patients receiving expensive palliative therapies may serve more African Americans because of their greater preferences for aggressive end-of-life care.Examine the association between hospices' admission practices and enrollment of African Americans and whites.This was a cross-sectional study of 61 North and South Carolina hospices. We developed a hospice admission practices scale; higher scores indicate less restrictive practices, that is, greater frequency with which hospices admitted those receiving chemotherapy, inotropes, and so forth. In separate multivariate analyses for each racial group, we examined the relationship between the proportion of decedents (age ≥ 65) served by a hospice in their service area (2008 Medicare Data) and admission practices while controlling for health care resources (e.g., hospital beds) and market concentration in the area, ownership, and budget.Nonprofit hospices and those with larger budgets reported less restrictive admission practices. In bivariate analyses, hospices with less restrictive admission practices served a larger proportion of patients in both racial groups (P < 0.001). However, in the multivariate models, nonprofit ownership and larger budgets but not admission practices predicted the outcome.Hospices with larger budgets served a greater proportion of African Americans and whites in their service area. Although larger hospices reported less restrictive admission practices, they also may have provided other services that may be important to patients regardless of race, such as more in-home support or assistance with nonmedical expenses, and participated in more outreach activities increasing their visibility and referral base. Future research should explore factors that influence decisions about hospice enrollment among racially diverse older adults.

Authors
Johnson, KS; Payne, R; Kuchibhatla, MN; Tulsky, JA
MLA Citation
Johnson, KS, Payne, R, Kuchibhatla, MN, and Tulsky, JA. "Are Hospice Admission Practices Associated With Hospice Enrollment for Older African Americans and Whites?." Journal of pain and symptom management 51.4 (April 2016): 697-705.
PMID
26654945
Source
epmc
Published In
Journal of Pain and Symptom Management
Volume
51
Issue
4
Publish Date
2016
Start Page
697
End Page
705
DOI
10.1016/j.jpainsymman.2015.11.010

Church-Based Health Promotion Focused on Advance Care Planning and End-of-Life Care at Black Baptist Churches: A Cross-Sectional Survey.

African Americans with serious illnesses receive substandard palliative care (PC) and end-of-life care (EOLC) with a disproportionate number having worse symptom-related suffering, poorer health-related communication and knowledge of advance care planning (ACP) wishes, and increased utilization of hospitals and intensive care units at EOL. Previous research emphasizes the importance of spirituality and the church in African American communities. We are pioneering an innovative partnership between two Baptist African American churches and an interdisciplinary research team with a goal of developing and implementing a community-based, church-centered ACP program. We hypothesize that a church-based approach-which embraces and celebrates religion and spirituality as a means to discuss ACP and EOLC-can improve the quality of EOLC.The aim of the study was to determine parishioner experiences and beliefs about EOLC and their potential desire for a church-based program that would address ACP and EOLC.A cross-sectional survey of parishioners at two large black Baptist churches across four weekend services in December 2014 was conducted using a five-question, Likert-scale survey completed on a note card.There were 930 responses submitted. Approximately 70% of parishioners care, or have cared, for someone with multiple medical problems and/or who is dying, and a vast majority (97%) believed that good EOLC is "important" or "very important." Only 60% of respondents noted having spoken with someone who could make decisions for them if they are unable to speak for themselves and that number decreased to 28% of respondents between the ages of 65 and 80. A majority (93%) would welcome church-provided information about EOLC.A majority of parishioners care for someone with multiple health problems and believe that good EOLC is important. However, significantly less had designated a surrogate decision maker, particularly in parishioners over the age of 65. Respondents would welcome a church-based program focused on improving EOLC.

Authors
Hendricks Sloan, D; Peters, T; Johnson, KS; Bowie, JV; Ting, Y; Aslakson, R
MLA Citation
Hendricks Sloan, D, Peters, T, Johnson, KS, Bowie, JV, Ting, Y, and Aslakson, R. "Church-Based Health Promotion Focused on Advance Care Planning and End-of-Life Care at Black Baptist Churches: A Cross-Sectional Survey." Journal of palliative medicine 19.2 (February 2016): 190-194.
PMID
26840855
Source
epmc
Published In
Journal of Palliative Medicine
Volume
19
Issue
2
Publish Date
2016
Start Page
190
End Page
194
DOI
10.1089/jpm.2015.0319

What are Hospice Providers in the Carolinas Doing to Reach African Americans in Their Service Area?

Experts and national organizations recommend that hospices work to increase service to African Americans, a group historically underrepresented in hospice.The study objective was to describe strategies among hospices in North and South Carolina to increase service to African Americans and identify hospice characteristics associated with these efforts.The study was a cross-sectional survey using investigator-developed scales to measure frequency of community education/outreach, directed marketing, efforts to recruit African American staff, cultural sensitivity training, and goals to increase service to African Americans. We used nonparametric Wilcoxon tests to compare mean scale scores by sample characteristics.Of 118 eligible hospices, 79 (67%) completed the survey. Over 80% were at least somewhat concerned about the low proportion of African Americans they served, and 78.5% had set goals to increase service to African Americans. Most were engaged in community education/outreach, with 92.4% reporting outreach to churches, 76.0% to social services organizations, 40.5% to businesses, 35.4% to civic groups, and over half to health care providers; 48.0% reported directed marketing via newspaper and 40.5% via radio. The vast majority reported efforts to recruit African American staff, most often registered nurses (63.75%). Nearly 90% offered cultural sensitivity training to staff. The frequency of strategies to increase service to African Americans did not vary by hospice characteristics, such as profit status, size, or vertical integration, but was greater among hospices that had set goals to increase service to African Americans.Many hospices are engaged in efforts to increase service to African Americans. Future research should determine which strategies are most effective.

Authors
Johnson, KS; Payne, R; Kuchibhatla, MN
MLA Citation
Johnson, KS, Payne, R, and Kuchibhatla, MN. "What are Hospice Providers in the Carolinas Doing to Reach African Americans in Their Service Area?." Journal of palliative medicine 19.2 (February 2016): 183-189.
PMID
26840854
Source
epmc
Published In
Journal of Palliative Medicine
Volume
19
Issue
2
Publish Date
2016
Start Page
183
End Page
189
DOI
10.1089/jpm.2015.0438

Palliative Care in the African American Community #204.

Authors
Boucher, NA; Raghavan, M; Smith, A; Arnold, R; Johnson, KS
MLA Citation
Boucher, NA, Raghavan, M, Smith, A, Arnold, R, and Johnson, KS. "Palliative Care in the African American Community #204." Journal of palliative medicine 19.2 (February 2016): 228-230.
PMID
26840858
Source
epmc
Published In
Journal of Palliative Medicine
Volume
19
Issue
2
Publish Date
2016
Start Page
228
End Page
230
DOI
10.1089/jpm.2015.0523

Update in hospice and palliative care.

Authors
Webb, JA; Horton, JR; Johnson, K
MLA Citation
Webb, JA, Horton, JR, and Johnson, K. "Update in hospice and palliative care." Journal of palliative medicine 18.6 (June 2015): 545-551. (Review)
PMID
25856765
Source
epmc
Published In
Journal of Palliative Medicine
Volume
18
Issue
6
Publish Date
2015
Start Page
545
End Page
551
DOI
10.1089/jpm.2015.0070

State of the Science: Update in Hospice and Palliative Care

Authors
Horton, JR; Johnson, KS; Dionne-Odom, N; Smith, C
MLA Citation
Horton, JR, Johnson, KS, Dionne-Odom, N, and Smith, C. "State of the Science: Update in Hospice and Palliative Care." February 2015.
Source
wos-lite
Published In
Journal of Pain and Symptom Management
Volume
49
Issue
2
Publish Date
2015
Start Page
390
End Page
390

The palliative care in heart failure trial: rationale and design.

The progressive nature of heart failure (HF) coupled with high mortality and poor quality of life mandates greater attention to palliative care as a routine component of advanced HF management. Limited evidence exists from randomized, controlled trials supporting the use of interdisciplinary palliative care in HF.PAL-HF is a prospective, controlled, unblinded, single-center study of an interdisciplinary palliative care intervention in 200 patients with advanced HF estimated to have a high likelihood of mortality or rehospitalization in the ensuing 6 months. The 6-month PAL-HF intervention focuses on physical and psychosocial symptom relief, attention to spiritual concerns, and advanced care planning. The primary end point is health-related quality of life measured by the Kansas City Cardiomyopathy Questionnaire and the Functional Assessment of Chronic Illness Therapy with Palliative Care Subscale score at 6 months. Secondary end points include changes in anxiety/depression, spiritual well-being, caregiver satisfaction, cost and resource utilization, and a composite of death, HF hospitalization, and quality of life.PAL-HF is a randomized, controlled clinical trial that will help evaluate the efficacy and cost effectiveness of palliative care in advanced HF using a patient-centered outcome as well as clinical and economic end points.

Authors
Mentz, RJ; Tulsky, JA; Granger, BB; Anstrom, KJ; Adams, PA; Dodson, GC; Fiuzat, M; Johnson, KS; Patel, CB; Steinhauser, KE; Taylor, DH; O'Connor, CM; Rogers, JG
MLA Citation
Mentz, RJ, Tulsky, JA, Granger, BB, Anstrom, KJ, Adams, PA, Dodson, GC, Fiuzat, M, Johnson, KS, Patel, CB, Steinhauser, KE, Taylor, DH, O'Connor, CM, and Rogers, JG. "The palliative care in heart failure trial: rationale and design." American heart journal 168.5 (November 2014): 645-651.e1.
PMID
25440791
Source
epmc
Published In
American Heart Journal
Volume
168
Issue
5
Publish Date
2014
Start Page
645
End Page
651.e1
DOI
10.1016/j.ahj.2014.07.018

Caregiver experience during advanced chronic illness and last year of life.

To compare the prevalence and predictors of caregiver esteem and burden during two different stages of care recipients' illnesses-advanced chronic illness and the last year of life.Longitudinal, observational cohort study.Community sample recruited from outpatient clinics at Duke University and Durham Veterans Affairs Medical Centers.Individuals with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease and their primary caregiver, retrospectively coded as chronic-illness (n = 62) or end-of-life (EOL; n = 62) care recipient-caregiver dyads.Caregiver experience was measured monthly using the Caregiver Reaction Assessment, which includes caregiver esteem and four domains of burden: schedule, health, family, and finances.During chronic illness and at the end of life, high caregiver esteem was almost universal (95%); more than 25% of the sample reported health, family, and financial burden. Schedule burden was the most prevalent form of burden; EOL caregivers (58%) experienced it more frequently than chronic-illness caregivers (32%). Caregiver esteem and all dimensions of burden were relatively stable over 1 year. Few factors were associated with burden.Caregiver experience is relatively stable over 1 year and similar in caregivers of individuals in the last year of life and those earlier in the course of chronic illness. Schedule burden stands out as most prevalent and variable among dimensions of experience. Because prevalence of burden is not specific to stage of illness and is relatively stable over time, multidisciplinary healthcare teams should assess caregiver burden and refer burdened caregivers to supportive resources early in the course of chronic illness.

Authors
Sautter, JM; Tulsky, JA; Johnson, KS; Olsen, MK; Burton-Chase, AM; Lindquist, JH; Zimmerman, S; Steinhauser, KE
MLA Citation
Sautter, JM, Tulsky, JA, Johnson, KS, Olsen, MK, Burton-Chase, AM, Lindquist, JH, Zimmerman, S, and Steinhauser, KE. "Caregiver experience during advanced chronic illness and last year of life." Journal of the American Geriatrics Society 62.6 (June 2014): 1082-1090.
PMID
24803020
Source
epmc
Published In
Journal of American Geriatrics Society
Volume
62
Issue
6
Publish Date
2014
Start Page
1082
End Page
1090
DOI
10.1111/jgs.12841

The changing face of the hospice industry: what really matters?

Authors
Johnson, KS
MLA Citation
Johnson, KS. "The changing face of the hospice industry: what really matters?." JAMA internal medicine 174.4 (April 2014): 507-508.
PMID
24566818
Source
epmc
Published In
JAMA Internal Medicine
Volume
174
Issue
4
Publish Date
2014
Start Page
507
End Page
508
DOI
10.1001/jamainternmed.2013.13304

Using the past to predict the future: latent class analysis of patterns of health service use of older adults in the emergency department.

To classify older adults in the emergency department (ED) according to healthcare use and to examine associations between group membership and future ED visits and hospital admissions.Secondary analysis.Medicare Current Beneficiary Survey.Adults aged 65 and older with at least one treat-and-release ED visit between January 1, 2000, and September 30, 2007 (N = 4,964).Measures of health service use included primary care visits, treat-and-release ED visits, and hospital days in the 12 months preceding the index ED visit.Five groups of individuals in the ED with distinct patterns of health service use were identified. "Primary Carederly" (39%) had low rates of ED and hospital use and a high mean number of primary care visits. "Wellderly" (34%) had fewer visits of all types than other groups. "Chronically Illderly" (14%) had the highest mean number of primary care visits and hospital days. "Acute Carederly" (9.8%) had lowest mean number of primary care visits but higher ED visits and hospital days than all other groups except the "Sickest Elderly." Sickest Elderly (3.2%) had the highest number of ED visits; mean number of hospital days was more than four times that of any other group. Primary Carederly and Wellderly had a lower risk of hospital admission within 30 days of the index ED visit than the other groups.In older adults released from an ED, group membership was associated with future health services use. Classification of individuals using readily available previous visit data may improve targeting of interventions to improve outcomes.

Authors
Hastings, SN; Whitson, HE; Sloane, R; Landerman, LR; Horney, C; Johnson, KS
MLA Citation
Hastings, SN, Whitson, HE, Sloane, R, Landerman, LR, Horney, C, and Johnson, KS. "Using the past to predict the future: latent class analysis of patterns of health service use of older adults in the emergency department." Journal of the American Geriatrics Society 62.4 (April 2014): 711-715.
PMID
24635112
Source
epmc
Published In
Journal of American Geriatrics Society
Volume
62
Issue
4
Publish Date
2014
Start Page
711
End Page
715
DOI
10.1111/jgs.12746

Update in Hospice and Palliative Care

Authors
Roza, KA; Horton, JR; Johnson, K; Anderson, WG
MLA Citation
Roza, KA, Horton, JR, Johnson, K, and Anderson, WG. "Update in Hospice and Palliative Care." Journal of Palliative Medicine 17.3 (March 2014): 351-357.
Source
crossref
Published In
Journal of Palliative Medicine
Volume
17
Issue
3
Publish Date
2014
Start Page
351
End Page
357
DOI
10.1089/jpm.2013.0577

State of the Science: Update in Hospice and Palliative Care

Authors
Horton, JR; Johnson, KS
MLA Citation
Horton, JR, and Johnson, KS. "State of the Science: Update in Hospice and Palliative Care." February 2014.
Source
wos-lite
Published In
Journal of Pain and Symptom Management
Volume
47
Issue
2
Publish Date
2014
Start Page
446
End Page
446

Using the past to predict the future: Latent class analysis of patterns of health service use of older adults in the emergency department

Objectives To classify older adults in the emergency department (ED) according to healthcare use and to examine associations between group membership and future ED visits and hospital admissions. Design Secondary analysis. Setting Medicare Current Beneficiary Survey. Participants Adults aged 65 and older with at least one treat-and-release ED visit between January 1, 2000, and September 30, 2007 (N = 4,964). Measurements Measures of health service use included primary care visits, treat-and-release ED visits, and hospital days in the 12 months preceding the index ED visit. Results Five groups of individuals in the ED with distinct patterns of health service use were identified. "Primary Carederly" (39%) had low rates of ED and hospital use and a high mean number of primary care visits. "Wellderly" (34%) had fewer visits of all types than other groups. "Chronically Illderly" (14%) had the highest mean number of primary care visits and hospital days. "Acute Carederly" (9.8%) had lowest mean number of primary care visits but higher ED visits and hospital days than all other groups except the "Sickest Elderly." Sickest Elderly (3.2%) had the highest number of ED visits; mean number of hospital days was more than four times that of any other group. Primary Carederly and Wellderly had a lower risk of hospital admission within 30 days of the index ED visit than the other groups. Conclusion In older adults released from an ED, group membership was associated with future health services use. Classification of individuals using readily available previous visit data may improve targeting of interventions to improve outcomes. © Published 2014. This article is a U.S. Government work and is in the public domain in the U.S.A.

Authors
Hastings, SN; Whitson, HE; Sloane, R; Landerman, LR; Horney, C; Johnson, KS
MLA Citation
Hastings, SN, Whitson, HE, Sloane, R, Landerman, LR, Horney, C, and Johnson, KS. "Using the past to predict the future: Latent class analysis of patterns of health service use of older adults in the emergency department." Journal of the American Geriatrics Society 62.4 (January 1, 2014): 711-715.
Source
scopus
Published In
Journal of American Geriatrics Society
Volume
62
Issue
4
Publish Date
2014
Start Page
711
End Page
715
DOI
10.1111/jgs.12746

The palliative care in heart failure trial: Rationale and design

© 2014 Elsevier Inc. All rights reserved. Background: The progressive nature of heart failure (HF) coupled with high mortality and poor quality of life mandates greater attention to palliative care as a routine component of advanced HF management. Limited evidence exists from randomized, controlled trials supporting the use of interdisciplinary palliative care in HF. Methods: PAL-HF is a prospective, controlled, unblinded, single-center study of an interdisciplinary palliative care intervention in 200 patients with advanced HF estimated to have a high likelihood of mortality or rehospitalization in the ensuing 6 months. The 6-month PAL-HF intervention focuses on physical and psychosocial symptom relief, attention to spiritual concerns, and advanced care planning. The primary end point is health-related quality of life measured by the Kansas City Cardiomyopathy Questionnaire and the Functional Assessment of Chronic Illness Therapy with Palliative Care Subscale score at 6 months. Secondary end points include changes in anxiety/depression, spiritual well-being, caregiver satisfaction, cost and resource utilization, and a composite of death, HF hospitalization, and quality of life. Conclusions: PAL-HF is a randomized, controlled clinical trial that will help evaluate the efficacy and cost effectiveness of palliative care in advanced HF using a patient-centered outcome as well as clinical and economic end points.

Authors
Mentz, RJ; Tulsky, JA; Granger, BB; Anstrom, KJ; Adams, PA; Dodson, GC; Fiuzat, M; Johnson, KS; Patel, CB; Steinhauser, KE; Taylor, DH; O'Connor, CM; Rogers, JG
MLA Citation
Mentz, RJ, Tulsky, JA, Granger, BB, Anstrom, KJ, Adams, PA, Dodson, GC, Fiuzat, M, Johnson, KS, Patel, CB, Steinhauser, KE, Taylor, DH, O'Connor, CM, and Rogers, JG. "The palliative care in heart failure trial: Rationale and design." American Heart Journal 168.5 (January 1, 2014): 645-651.e1.
Source
scopus
Published In
American Heart Journal
Volume
168
Issue
5
Publish Date
2014
Start Page
645
End Page
651.e1
DOI
10.1016/j.ahj.2014.07.018

Race and residence: Intercounty variation in black-white differences in hospice use

Context: Although blacks use hospice at lower rates than whites in the U.S., racial differences in hospice use vary by geographic area. Objectives: To describe intercounty variability in black-white differences in hospice use and the association with the supply of health care resources. Methods: Subjects were a retrospective cohort of Medicare beneficiaries in North and South Carolina who died in 2008. Using Wilcoxon tests and logistic regression, we examined the differences in the supply of health care resources (hospital beds and physicians per population age 65 years and older, percentage of generalists, etc.) between counties with and without racial disparity in hospice use. Counties with a racial disparity had significantly (P < 0.05) higher rates of hospice use among whites than blacks. Results: Of 76,283 decedents in 128 counties, 19.78% were black. In the 39 counties (30.47%) with racial disparity in hospice use, the mean proportion of whites who enrolled in hospice was 41.3% vs. 28.66% of blacks (P < 0.0001). Counties with more hospital beds per population age 65 years and older had a higher odds (OR, 1.39; 95% confidence interval [CI] 1.04-1.86) and those with a larger proportion of generalists had a lower odds (OR, 0.01; 95% CI 0.001-0.476) of having a racial disparity in hospice use. Conclusion: In most counties, the rates of hospice use were similar for blacks and whites. In counties with a racial disparity, there were more resources to deliver aggressive care (i.e., hospital beds and specialists). Because of a greater preference for life-sustaining therapies, blacks may be more likely to use acute care services at the end of life when resources for the delivery of these services are readily available. © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Authors
Johnson, KS; Kuchibhatla, M; Payne, R; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, Payne, R, and Tulsky, JA. "Race and residence: Intercounty variation in black-white differences in hospice use." Journal of Pain and Symptom Management 46.5 (November 1, 2013): 681-690.
Source
scopus
Published In
Journal of Pain and Symptom Management
Volume
46
Issue
5
Publish Date
2013
Start Page
681
End Page
690
DOI
10.1016/j.jpainsymman.2012.12.006

Race and residence: intercounty variation in black-white differences in hospice use.

CONTEXT: Although blacks use hospice at lower rates than whites in the U.S., racial differences in hospice use vary by geographic area. OBJECTIVES: To describe intercounty variability in black-white differences in hospice use and the association with the supply of health care resources. METHODS: Subjects were a retrospective cohort of Medicare beneficiaries in North and South Carolina who died in 2008. Using Wilcoxon tests and logistic regression, we examined the differences in the supply of health care resources (hospital beds and physicians per population age 65 years and older, percentage of generalists, etc.) between counties with and without racial disparity in hospice use. Counties with a racial disparity had significantly (P < 0.05) higher rates of hospice use among whites than blacks. RESULTS: Of 76,283 decedents in 128 counties, 19.78% were black. In the 39 counties (30.47%) with racial disparity in hospice use, the mean proportion of whites who enrolled in hospice was 41.3% vs. 28.66% of blacks (P < 0.0001). Counties with more hospital beds per population age 65 years and older had a higher odds (OR, 1.39; 95% confidence interval [CI] 1.04-1.86) and those with a larger proportion of generalists had a lower odds (OR, 0.01; 95% CI 0.001-0.476) of having a racial disparity in hospice use. CONCLUSION: In most counties, the rates of hospice use were similar for blacks and whites. In counties with a racial disparity, there were more resources to deliver aggressive care (i.e., hospital beds and specialists). Because of a greater preference for life-sustaining therapies, blacks may be more likely to use acute care services at the end of life when resources for the delivery of these services are readily available.

Authors
Johnson, KS; Kuchibhatla, M; Payne, R; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, Payne, R, and Tulsky, JA. "Race and residence: intercounty variation in black-white differences in hospice use." J Pain Symptom Manage 46.5 (November 2013): 681-690.
PMID
23522516
Source
pubmed
Published In
Journal of Pain and Symptom Management
Volume
46
Issue
5
Publish Date
2013
Start Page
681
End Page
690
DOI
10.1016/j.jpainsymman.2012.12.006

Racial and ethnic disparities in palliative care.

Racial and ethnic disparities in health care access and quality are well documented for some minority groups. However, compared to other areas of health care, such as disease prevention, early detection, and curative care, research in disparities in palliative care is limited. Given the rapidly growing population of minority older adults, many of whom will face advanced serious illness, the availability of high-quality palliative care that meets the varied needs of older adults of all races and ethnicities is a priority. This paper reviews existing data on racial and ethnic disparities in use of and quality of palliative care and outlines priorities for future research.

Authors
Johnson, KS
MLA Citation
Johnson, KS. "Racial and ethnic disparities in palliative care." J Palliat Med 16.11 (November 2013): 1329-1334.
PMID
24073685
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
16
Issue
11
Publish Date
2013
Start Page
1329
End Page
1334
DOI
10.1089/jpm.2013.9468

Association of hospice patients' income and care level with place of death.

IMPORTANCE: Terminally ill patients with lower incomes are less likely to die at home, even with hospice care. OBJECTIVES: To examine the relationship between income and transfer from home before death and the interaction between income and level of hospice care as a predictor of transfer from home in patients admitted to routine home hospice care. DESIGN: We matched zip codes to US census tracts to generate median annual household incomes and divided the measure into $10,000 increments (≤$20,000 to >$50,000). We abstracted data from the central administrative and clinical database of a hospice care provider. We analyzed the relationship between income and transfer from home before death using logistic regression adjusted for demographics, diagnosis, region, and length of stay. Level of hospice care was examined as any continuous care vs none. Unlike routine care, which includes periodic visits by hospice, continuous care is a higher level of care used for short periods of crisis to keep a patient at home and includes hospice services in the home at least 8 hours in a 24-hour period. SETTING: A for-profit hospice provider, VITAS Healthcare, operating 26 programs in 8 states. PARTICIPANTS: Hospice patients admitted to routine care in a private residence from January 1, 1999, through December 31, 2003. MAIN OUTCOME MEASURE: Transfer from hospice care in a private residence to hospice care in a site outside the home before death. RESULTS: Of the 61,063 enrollees admitted to routine care in a private residence, 13,804 (22.61%) transferred from home to another location (ie, inpatient hospice unit or nursing home) with hospice care before death. Patients who transferred had a lower mean median household income ($42,585 vs $46,777; P < .001) and were less likely to have received any continuous care (49.38% vs 30.61%; P < .001). The median number of days of continuous care was 4. For patients who did not receive continuous care, the odds of transfer from home before death increased with decreasing median annual household incomes (odds ratio range, 1.26-1.76). For patients who received continuous care, income was not a predictor of transfer from home. CONCLUSIONS AND RELEVANCE: Patients with limited resources may be less likely to die at home, especially if they are not able to access needed support beyond what is available with routine hospice care.

Authors
Barclay, JS; Kuchibhatla, M; Tulsky, JA; Johnson, KS
MLA Citation
Barclay, JS, Kuchibhatla, M, Tulsky, JA, and Johnson, KS. "Association of hospice patients' income and care level with place of death." JAMA Intern Med 173.6 (March 25, 2013): 450-456.
PMID
23420383
Source
pubmed
Published In
JAMA Internal Medicine
Volume
173
Issue
6
Publish Date
2013
Start Page
450
End Page
456
DOI
10.1001/jamainternmed.2013.2773

State of the Science: Update in Hospice and Palliative Care

Authors
Anderson, WG; Horton, JR; Johnson, KS
MLA Citation
Anderson, WG, Horton, JR, and Johnson, KS. "State of the Science: Update in Hospice and Palliative Care." February 2013.
Source
wos-lite
Published In
Journal of Pain and Symptom Management
Volume
45
Issue
2
Publish Date
2013
Start Page
390
End Page
391

Update in hospital palliative care

BACKGROUND: Seriously ill patients frequently receive care in hospitals, and palliative care is a core competency for hospitalists. We aimed to summarize and critique recent research that has the potential to impact the clinical practice of palliative care in the hospital. METHODS: We reviewed articles published between January 2012 and May 2013, identified through a hand-search of leading journals and PubMed. The authors collectively selected 9 articles based on their scientific rigor and relevance to hospital practice. We review their findings, strengths, and limitations and make recommendations for practice. RESULTS: Key findings include: indwelling pleural catheters and talc pleurodesis provide similar relief of dyspnea in patients with malignant pleural effusions; oxygen many not be needed to prevent dyspnea in many dying patients; docusate may not be needed in addition to sennosides to treat opioid-induced constipation; atropine is no more effective than placebo in treating respiratory rattles in dying patients; many older adult survivors of in-hospital cardiopulmonary resuscitation (CPR) are alive up to 1 year after discharge; observing CPR may decrease family post-traumatic stress; surrogates of intensive care unit patients often interpret prognostic information optimistically; many patients with metastatic cancer feel that chemotherapy may cure their disease; viewing a goals-of-care video may decrease preference for CPR in patients being admitted to skilled nursing facilities. CONCLUSIONS: Recent research provides important insights into the effectiveness of medications and interventions for symptom management, outcomes of CPR for patients and families, and communication and advance care planning in the hospital. © 2013 Society of Hospital Medicine.

Authors
Anderson, WG; Flint, LA; Horton, JR; Johnson, K; Mourad, M; Sharpe, BA
MLA Citation
Anderson, WG, Flint, LA, Horton, JR, Johnson, K, Mourad, M, and Sharpe, BA. "Update in hospital palliative care." Journal of Hospital Medicine (2013).
PMID
24214838
Source
scival
Published In
Journal of Hospital Medicine
Publish Date
2013
DOI
10.1002/jhm.2110

Update in hospital palliative care

BACKGROUND: Seriously ill patients frequently receive care in hospitals, and palliative care is a core competency for hospitalists. We aimed to summarize and critique recent research that has the potential to impact the clinical practice of palliative care in the hospital. METHODS: We reviewed articles published between January 2012 and May 2013, identified through a hand-search of leading journals and PubMed. The authors collectively selected 9 articles based on their scientific rigor and relevance to hospital practice. We review their findings, strengths, and limitations and make recommendations for practice. RESULTS: Key findings include: indwelling pleural catheters and talc pleurodesis provide similar relief of dyspnea in patients with malignant pleural effusions; oxygen many not be needed to prevent dyspnea in many dying patients; docusate may not be needed in addition to sennosides to treat opioid-induced constipation; atropine is no more effective than placebo in treating respiratory rattles in dying patients; many older adult survivors of in-hospital cardiopulmonary resuscitation (CPR) are alive up to 1 year after discharge; observing CPR may decrease family post-traumatic stress; surrogates of intensive care unit patients often interpret prognostic information optimistically; many patients with metastatic cancer feel that chemotherapy may cure their disease; viewing a goals-of-care video may decrease preference for CPR in patients being admitted to skilled nursing facilities. CONCLUSIONS: Recent research provides important insights into the effectiveness of medications and interventions for symptom management, outcomes of CPR for patients and families, and communication and advance care planning in the hospital. Journal of Hospital Medicine 2013;8:715-720. © 2013 Society of Hospital Medicine.

Authors
Anderson, WG; Flint, LA; Horton, JR; Johnson, K; Mourad, M; Sharpe, BA
MLA Citation
Anderson, WG, Flint, LA, Horton, JR, Johnson, K, Mourad, M, and Sharpe, BA. "Update in hospital palliative care." Journal of Hospital Medicine 8.12 (2013): 715-720.
Source
scival
Published In
Journal of Hospital Medicine
Volume
8
Issue
12
Publish Date
2013
Start Page
715
End Page
720
DOI
10.1002/jhm.2110

Update in hospice and palliative care

Authors
Anderson, WG; Horton, JR; Johnson, K; Goldstein, NE
MLA Citation
Anderson, WG, Horton, JR, Johnson, K, and Goldstein, NE. "Update in hospice and palliative care." Journal of Palliative Medicine 16.3 (2013): 314-319.
Source
scival
Published In
Journal of Palliative Medicine
Volume
16
Issue
3
Publish Date
2013
Start Page
314
End Page
319
DOI
10.1089/jpm.2012.0481

What is your understanding of your illness? A communication tool to explore patients' perspectives of living with advanced illness.

BACKGROUND: Provider communication courses and guidelines stress the use of open-ended questions, such as "what is your understanding of your illness?," to explore patients' perceptions of their illness severity, yet descriptions of patients' responses are largely absent from the current literature. These questions are most often used by clinicians as they deliver bad news to cancer patients or address code status at the end of life, but have not been well studied in other diseases or earlier in the disease course. OBJECTIVES: To explore the responses of patients living with serious illness to the question "what is your understanding of your illness?" and to identify similarities and differences in themes and language used by cancer and non-cancer patients to discuss their illness. DESIGN: We conducted a qualitative analysis of patients' responses to "what is your understanding of your illness?" PARTICIPANTS: Two hundred nine subjects, 69 with cancer, 70 CHF, and 70 COPD, who had an estimated 50 % 2-year survival. Mean age was 66 years. APPROACH: Responses were recorded at the baseline interview of a larger, longitudinal study of patients with advanced life-limiting illness (cancer, CHF, or COPD). After thematic content analysis using open coding, investigators conducted pattern analysis to examine variation associated with diagnosis. RESULTS: We identified five major themes: naming the diagnosis or describing the pathophysiology, illness history, prognosis, symptoms, and causality. Responses varied by diagnosis. Cancer patients' responses more often included specific diagnostic details and prognosis, while non-cancer patients referenced symptoms and causality. CONCLUSIONS: Patients' responses to the open-ended question "what is your understanding of your illness?" can provide the clinician with important information and insight on how they view their illness in a non-acute setting. The identified themes can serve as a foundation for patient-centered communication strategies as we strive to build a mutual understanding of illness with patients.

Authors
Morris, DA; Johnson, KS; Ammarell, N; Arnold, RM; Tulsky, JA; Steinhauser, KE
MLA Citation
Morris, DA, Johnson, KS, Ammarell, N, Arnold, RM, Tulsky, JA, and Steinhauser, KE. "What is your understanding of your illness? A communication tool to explore patients' perspectives of living with advanced illness." J Gen Intern Med 27.11 (November 2012): 1460-1466.
PMID
22638605
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
27
Issue
11
Publish Date
2012
Start Page
1460
End Page
1466
DOI
10.1007/s11606-012-2109-2

Characteristics and outcomes of hospice enrollees with dementia discharged alive.

OBJECTIVES: To examine the characteristics of hospice enrollees with dementia who were discharged alive because their condition stabilized or improved and predictors of death in the year after discharge. DESIGN: Cross-sectional analysis of clinical and administrative data. SETTING: For-profit hospice provider. PARTICIPANTS: Hospice enrollees aged 65 and older with an admission diagnosis of dementia who died or were discharged alive because their condition stabilized or improved between January 1, 1999, and December 31, 2003. MEASUREMENTS: Demographic variables and hospice length of stay; data did not include functional status or comorbidities. RESULTS: Of 24,111 enrollees with dementia, 1,204 (5.0%) were discharged alive because their condition stabilized or improved; the remainder died while receiving hospice. The median length of stay for those who died was 12 versus 236 days for those discharged alive. Those discharged alive were more likely to be female or have a length of stay exceeding 180 days and less likely to be in the oldest age group (≥ 85), be African American, or reside in a nursing home. In a subgroup of 303 patients discharged alive, 75.5% were still alive at 1 year; none of the demographic variables were associated with death after hospice discharge. CONCLUSION: A small proportion of hospice enrollees with dementia was discharged alive. Most died shortly after enrollment. Future research should examine other factors that may predict which hospice enrollees with dementia are likely to be discharged alive and their subsequent trajectory, such as functional status, comorbidities, and preferences for care.

Authors
Johnson, KS; Elbert-Avila, K; Kuchibhatla, M; Tulsky, JA
MLA Citation
Johnson, KS, Elbert-Avila, K, Kuchibhatla, M, and Tulsky, JA. "Characteristics and outcomes of hospice enrollees with dementia discharged alive." J Am Geriatr Soc 60.9 (September 2012): 1638-1644.
PMID
22905714
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
60
Issue
9
Publish Date
2012
Start Page
1638
End Page
1644
DOI
10.1111/j.1532-5415.2012.04117.x

Racial differences in hospice use and patterns of care after enrollment in hospice among Medicare beneficiaries with heart failure.

BACKGROUND: We examined racial differences in patterns of care and resource use among Medicare beneficiaries with heart failure after enrollment in hospice. METHODS: We conducted a retrospective cohort study of a 5% nationally representative sample of Medicare beneficiaries with heart failure who died between 2000 and 2008. Outcomes of interest included adjusted and unadjusted associations of race with hospice enrollment for any diagnosis, disenrollment, and resource use after enrollment. RESULTS: The study population included 219,275 Medicare beneficiaries with heart failure, of whom 31.4% of white patients and 24.3% of nonwhite patients enrolled in hospice in the last 6 months of life (P < .001). Despite increasing rates of hospice use for both white and nonwhite patients, nonwhite patients were 20% less likely to enroll in hospice (adjusted relative risk, 0.80; 95% CI, 0.79-0.82). After enrollment, nonwhite patients were more likely to have an emergency department visit (42.6% vs 33.9%; P<.001), to be hospitalized (46.8% vs 38.5%; P<.001), and to have an intensive care unit stay (16.9% vs 13.3%; P<.001). These differences persisted after adjustment for patient characteristics. Nonwhite patients were also more likely to disenroll from hospice (11.6% vs 7.2%; P<.001). Among patients who remained in hospice until death, nonwhite patients had higher rates of acute care resource use and higher overall costs. CONCLUSION: Rates of hospice use have increased over time for both white and nonwhite patients. Nonwhite patients were less likely than white patients to enroll in hospice and had higher resource use after electing hospice care, regardless of disenrollment status.

Authors
Unroe, KT; Greiner, MA; Johnson, KS; Curtis, LH; Setoguchi, S
MLA Citation
Unroe, KT, Greiner, MA, Johnson, KS, Curtis, LH, and Setoguchi, S. "Racial differences in hospice use and patterns of care after enrollment in hospice among Medicare beneficiaries with heart failure." Am Heart J 163.6 (June 2012): 987-993.e3.
PMID
22709751
Source
pubmed
Published In
American Heart Journal
Volume
163
Issue
6
Publish Date
2012
Start Page
987
End Page
993.e3
DOI
10.1016/j.ahj.2012.03.006

From the Wellderly to the Sickest Elderly: Classifying Older ED Patients According to Patterns of Health Service Use

Authors
Hastings, SN; Johnson, KS; Sloane, R; Landerman, LR; Horney, C; Whitson, HE
MLA Citation
Hastings, SN, Johnson, KS, Sloane, R, Landerman, LR, Horney, C, and Whitson, HE. "From the Wellderly to the Sickest Elderly: Classifying Older ED Patients According to Patterns of Health Service Use." April 2012.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
60
Publish Date
2012
Start Page
S30
End Page
S31

What are Hospice Providers Doing to Reach African Americans ... and what works?

Authors
Johnson, KS; Kuchibhatla, MN; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, MN, and Tulsky, JA. "What are Hospice Providers Doing to Reach African Americans .. and what works?." April 2012.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
60
Publish Date
2012
Start Page
S220
End Page
S220

The Junior Faculty Laboratory: an innovative model of peer mentoring.

Mentoring in academic medicine has been shown to contribute to the success of junior faculty, resulting in increased productivity, career satisfaction, and opportunities for networking. Although traditional dyadic mentoring, involving one senior faculty member and one junior protégé, is the dominant model for mentoring in the academic environment, there is increasing recognition that the sharing of knowledge, skills, and experiences among peers may also contribute to the career development of junior faculty. The authors describe the structure, activities, and outcomes of the Junior Faculty Laboratory (JFL), a self-organized, flexible, and dynamic peer-mentoring model within the Duke University Center for the Study of Aging and Human Development. As an innovative mentoring model, JFL is entirely peer driven, and its activities are determined by the real-time needs of members. In contrast to some other peer-mentoring models, JFL lacks senior faculty input or a structured curriculum, members are multidisciplinary, meeting times are project driven rather than preset, and participation in collaborative projects is optional based on the interests and needs of group members. Additionally, JFL was not formed as a substitute for, but as a complement to, the dyadic mentoring relationships enjoyed by its members. The model, now in its fifth year, has demonstrated success and sustainability. The authors present the JFL as an innovative, mentoring model that can be reproduced by other junior faculty seeking to foster collegial relationships with peers while simultaneously enhancing their career development.

Authors
Johnson, KS; Hastings, SN; Purser, JL; Whitson, HE
MLA Citation
Johnson, KS, Hastings, SN, Purser, JL, and Whitson, HE. "The Junior Faculty Laboratory: an innovative model of peer mentoring." Acad Med 86.12 (December 2011): 1577-1582.
PMID
22030756
Source
pubmed
Published In
Academic Medicine
Volume
86
Issue
12
Publish Date
2011
Start Page
1577
End Page
1582
DOI
10.1097/ACM.0b013e31823595e8

Which domains of spirituality are associated with anxiety and depression in patients with advanced illness?

BACKGROUND: Anxiety and depression are common in seriously ill patients and may be associated with spiritual concerns. Little research has examined how concerns in different domains of spirituality are related to anxiety and depression. OBJECTIVE: To examine the association of spiritual history and current spiritual well-being with symptoms of anxiety and depression in patients with advanced illness. DESIGN: Cross-sectional cohort study PARTICIPANTS: Two hundred and ten patients with advanced illness, of whom 1/3 were diagnosed with cancer, 1/3 COPD, and 1/3 CHF. The mean age of the sample was 66 years, and 91% were Christian. MEASUREMENTS: Outcome measures were the Profile of Mood States' Anxiety Subscale (POMS) and 10-item Center for Epidemiologic Studies Depression Scale (CESD). Predictors were three subscales of the Spiritual History Scale measuring past religious help-seeking and support, past religious participation, and past negative religious experiences and two subscales of the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale measuring the role of faith in illness and meaning, peace, and purpose in life. We conducted multiple regression analyses, controlling for demographics, disease type and severity, self-rated religiousness/spirituality, and frequency of religious attendance and devotion. RESULTS: In adjusted analyses, greater spiritual well-being, including both beliefs about the role of faith in illness and meaning, peace, and purpose in life were associated with fewer symptoms of anxiety (P ≤ 0.001) and depression (P < 0.001). Greater past negative religious experiences were associated with more symptoms of anxiety (P = 0.04) and depression (P = 0.004). No other measures of spiritual history were associated with the outcomes. CONCLUSIONS: In this diverse sample of seriously ill patients, current spiritual well-being and past negative religious experiences were associated with symptoms of anxiety and depression. Healthcare providers should consider asking about current spiritual well-being and past negative religious experiences in their assessment of seriously ill patients with symptoms of anxiety and depression.

Authors
Johnson, KS; Tulsky, JA; Hays, JC; Arnold, RM; Olsen, MK; Lindquist, JH; Steinhauser, KE
MLA Citation
Johnson, KS, Tulsky, JA, Hays, JC, Arnold, RM, Olsen, MK, Lindquist, JH, and Steinhauser, KE. "Which domains of spirituality are associated with anxiety and depression in patients with advanced illness?." J Gen Intern Med 26.7 (July 2011): 751-758.
PMID
21336669
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
26
Issue
7
Publish Date
2011
Start Page
751
End Page
758
DOI
10.1007/s11606-011-1656-2

Black-white disparity in disability: the role of medical conditions.

OBJECTIVES: To describe the independent contributions of selected medical conditions to the disparity between black and white people in disability rates, controlling for demographic and socioeconomic factors. DESIGN: Cross-sectional analysis of a community-based cohort. SETTING: Urban and rural counties of central North Carolina. PARTICIPANTS: Two thousand nine hundred sixty-six adults aged 68 and older participating in the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE). MEASUREMENTS: Self-reported data on sociodemographic characteristics and medical conditions, Short Portable Mental Status Questionnaire, activities of daily living (ADLs). RESULTS: Fifty-five percent of the cohort was black. Blacks were more likely than whites to report disability (odds ratio=1.39, 95% confidence interval= 1.15-1.68). Controlling for age, sex, marital status, and socioeconomic status, blacks were more likely to be obese and have diabetes mellitus, and less likely to report vision problems, fractures, and heart attacks. The higher prevalence of obesity and diabetes mellitus in blacks, after adjustment for sociodemographic factors, accounted for more than 30% of the black-white difference in disability. Conversely, the black-white disability gap would be approximately 45% wider if whites had a lower prevalence of fractures and vision impairment, similar to their black peers. CONCLUSION: Higher rates of obesity and diabetes mellitus in older black Americans account for a large amount of the racial disparity in disability, even after controlling for socioeconomic differences. Culturally appropriate interventions that lower the prevalence or the functional consequences of obesity and diabetes mellitus in blacks could substantially decrease this racial health disparity.

Authors
Whitson, HE; Hastings, SN; Landerman, LR; Fillenbaum, GG; Cohen, HJ; Johnson, KS
MLA Citation
Whitson, HE, Hastings, SN, Landerman, LR, Fillenbaum, GG, Cohen, HJ, and Johnson, KS. "Black-white disparity in disability: the role of medical conditions." J Am Geriatr Soc 59.5 (May 2011): 844-850.
PMID
21568956
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
59
Issue
5
Publish Date
2011
Start Page
844
End Page
850
DOI
10.1111/j.1532-5415.2011.03401.x

Racial differences in location before hospice enrollment and association with hospice length of stay.

African Americans are less likely than Whites to enroll in hospice. In addition, patients are often referred to hospice very close to death, when they may not have time to take advantage of the full range of hospice services. Understanding how race and location before hospice enrollment are related to hospice length of stay (LOS) may inform the development of interventions to increase timely access to hospice care. Using data from a national hospice provider, African Americans and Whites admitted to routine home hospice care in a private residence between January 1, 2000, and December 31, 2003, were identified. Logistic regression was used to examine the association between race and hospice preadmission location (hospital vs other locations) and preadmission location and hospice LOS (≤7 days vs >7 days) after adjusting for demographic and hospice use variables. Of 43,869 enrollees, 15.3% were African American. One to 2 days before hospice enrollment, African Americans were more likely than Whites to be in the hospital than in all other locations (48.6% vs 32.3%, P<.001; adjusted odds ratio=1.83, 95% confidence interval=1.73-1.95). Regardless of race, those whose preadmission location was the hospital were more likely than those from other locations to die 7 days or less after hospice enrollment. Initiatives to improve end-of-life care should focus on increasing timely access to hospice referrals in settings outside of the hospital. Future research should examine whether racial differences in hospice preadmission location reflect differences in preferences for care or disparities in timely access to hospice referrals in non-acute care settings.

Authors
Johnson, KS; Kuchibhatla, M; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, and Tulsky, JA. "Racial differences in location before hospice enrollment and association with hospice length of stay." J Am Geriatr Soc 59.4 (April 2011): 732-737.
PMID
21410443
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
59
Issue
4
Publish Date
2011
Start Page
732
End Page
737
DOI
10.1111/j.1532-5415.2011.03326.x

Racial Differences in Hospice Use and End of Life Care Among Medicare Beneficiaries with Heart Failure

Authors
Unroe, K; Melissa, G; Johnson, KS; Curtis, L; Setoguchi, S
MLA Citation
Unroe, K, Melissa, G, Johnson, KS, Curtis, L, and Setoguchi, S. "Racial Differences in Hospice Use and End of Life Care Among Medicare Beneficiaries with Heart Failure." April 2011.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
59
Publish Date
2011
Start Page
S8
End Page
S9

P24 Encore Presentation Race and Residence: County-level Variation in Black-White Disparities in Hospice Use

Authors
Johnson, KS; Kuchibhatla, M; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, and Tulsky, JA. "P24 Encore Presentation Race and Residence: County-level Variation in Black-White Disparities in Hospice Use." April 2011.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
59
Publish Date
2011
Start Page
S9
End Page
S9

Intercounty Variability in Hospice Use: Does Race Matter?

Authors
Johnson, KS; Kuchibhatla, MN; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, MN, and Tulsky, JA. "Intercounty Variability in Hospice Use: Does Race Matter?." April 2010.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
58
Publish Date
2010
Start Page
106
End Page
106

Racial differences in self-reported exposure to information about hospice care.

BACKGROUND: Previous research suggests that lack of knowledge of hospice is a barrier to the use of hospice care by African Americans. However, there is little data examining racial differences in exposure to hospice information. OBJECTIVES: Examine racial differences in self-reported exposure to hospice information and determine how this exposure impacts beliefs about hospice care. METHODS: We surveyed 200 community-dwelling older adults (65 or older). We used Spearman's correlations to examine the relationship between responses to individual items on the Hospice Beliefs and Attitudes Scale (HBAS) and self-reported exposure to hospice information (never heard of hospice, heard a little, or heard a lot). We used multivariate analyses to examine predictors of exposure to hospice information and beliefs about hospice care (total score on HBAS). RESULTS: Compared to whites (n = 95), African Americans (n = 105) reported significantly less exposure to hospice information (p = 0.0004). Nineteen percent of African Americans and 4% of whites had never heard of hospice; 47.6% of African Americans and 71.6% of whites had heard a lot about hospice. In multivariate analysis controlling for demographics and health status, African Americans had a two times higher odds of reporting that they had never heard of hospice or heard only a little about hospice versus heard a lot about hospice (odds ratio [OR] = 2.24 [1.17, 4.27]. Greater exposure to hospice information was associated with more favorable beliefs about hospice care (outcome: total score on HBAS; parameter estimate 1.34, standard error 0.44, p = 002). CONCLUSIONS: African Americans reported less exposure to information about hospice than whites. Greater exposure to hospice information was associated with more favorable beliefs about some aspects of hospice care. Because knowledge is power, educational programs targeting older African Americans are needed to dispel myths about hospice and to provide minorities with the tools to make informed choices about end-of-life care.

Authors
Johnson, KS; Kuchibhatla, M; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, and Tulsky, JA. "Racial differences in self-reported exposure to information about hospice care." J Palliat Med 12.10 (October 2009): 921-927.
PMID
19807237
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
12
Issue
10
Publish Date
2009
Start Page
921
End Page
927
DOI
10.1089/jpm.2009.0066

Emergency department discharge diagnosis and adverse health outcomes in older adults.

OBJECTIVES: To determine the relationship between the reason for an emergency department (ED) visit and subsequent risk of adverse health outcomes in older adults discharged from the ED. DESIGN: Secondary analysis of data from the Medicare Current Beneficiary Survey. SETTING: ED. PARTICIPANTS: One thousand eight hundred fifty-one community-dwelling Medicare fee-for-service enrollees aged 65 and older discharged from the ED between January 2000 and September 2002. MEASUREMENTS: Independent variables were ED discharge diagnosis groups: injury or musculoskeletal (MSK) (e.g., fracture, open wound), chronic condition (e.g., chronic obstructive pulmonary disorder, heart failure), infection, non-MSK symptom (e.g., chest pain, abdominal pain), and unclassified. Adverse health outcomes were hospitalization or death within 30 days of the index ED visit. RESULTS: Injury or MSK was the largest ED diagnosis group (31.4%), followed by non-MSK symptom (22.2%), chronic condition (20.9%), and infection (7.8%); 338 (17.8%) had ED discharge diagnoses that were unclassified. In adjusted analyses, a discharge diagnosis of injury or MSK condition was associated with lower risk of subsequent adverse health outcomes (hazard ratio (HR)=0.69, 95% confidence interval (CI)=0.50-0.96) than for all other diagnosis groups. Patients seen in the ED for chronic conditions were at greater risk of adverse outcomes (HR=1.86, 95% CI=1.37-2.52) than all others. There were no significant differences in risk between patients with infections, those with non-MSK symptoms, and the unclassified group. CONCLUSION: Adverse health outcomes were common in older patients with an ED discharge diagnosis classified as a chronic condition. ED discharge diagnosis may improve risk assessment and inform the development of targeted interventions to reduce adverse health outcomes in older adults discharged from the ED.

Authors
Hastings, SN; Whitson, HE; Purser, JL; Sloane, RJ; Johnson, KS
MLA Citation
Hastings, SN, Whitson, HE, Purser, JL, Sloane, RJ, and Johnson, KS. "Emergency department discharge diagnosis and adverse health outcomes in older adults." J Am Geriatr Soc 57.10 (October 2009): 1856-1861.
PMID
19694872
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
57
Issue
10
Publish Date
2009
Start Page
1856
End Page
1861
DOI
10.1111/j.1532-5415.2009.02434.x

Variability in Adverse Outcomes According to Emergency Department Discharge Diagnosis

Authors
Hastings, SN; Whitson, HE; Purser, J; Sloane, RJ; Johnson, KS
MLA Citation
Hastings, SN, Whitson, HE, Purser, J, Sloane, RJ, and Johnson, KS. "Variability in Adverse Outcomes According to Emergency Department Discharge Diagnosis." March 2009.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
57
Publish Date
2009
Start Page
S71
End Page
S71

Racial Differences in Self-Reported Exposure to Hospice Information

Authors
Johnson, KS; Kuchibhatla, M; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, and Tulsky, JA. "Racial Differences in Self-Reported Exposure to Hospice Information." JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 57 (March 2009): S90-S91.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
57
Publish Date
2009
Start Page
S90
End Page
S91

What explains racial differences in the use of advance directives and attitudes toward hospice care?

Cultural beliefs and values are thought to account for differences between African Americans and whites in the use of advance directives and beliefs about hospice care, but few data clarify which beliefs and values explain these differences. Two hundred five adults aged 65 and older who received primary care in the Duke University Health System were surveyed. The survey included five scales: Hospice Beliefs and Attitudes, Preferences for Care, Spirituality, Healthcare System Distrust, and Beliefs About Dying and Advance Care Planning. African Americans were less likely than white subjects to have completed an advance directive (35.5% vs 67.4%, P<.001) and had less favorable beliefs about hospice care (Hospice Beliefs and Attitudes Scale score, P<.001). African Americans were more likely to express discomfort discussing death, want aggressive care at the end of life, have spiritual beliefs that conflict with the goals of palliative care, and distrust the healthcare system. In multivariate analyses, none of these factors alone completely explained racial differences in possession of an advance directive or beliefs about hospice care, but when all of these factors were combined, race was no longer a significant predictor of either of the two outcomes. These findings suggest that ethnicity is a marker of common cultural beliefs and values that, in combination, influence decision-making at the end of life. This study has implications for the design of healthcare delivery models and programs that provide culturally sensitive end-of-life care to a growing population of ethnically diverse older adults.

Authors
Johnson, KS; Kuchibhatla, M; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, and Tulsky, JA. "What explains racial differences in the use of advance directives and attitudes toward hospice care?." J Am Geriatr Soc 56.10 (October 2008): 1953-1958.
PMID
18771455
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
56
Issue
10
Publish Date
2008
Start Page
1953
End Page
1958
DOI
10.1111/j.1532-5415.2008.01919.x

Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department.

OBJECTIVES: To determine whether frail older adults, based on a deficit accumulation index (DAI), are at greater risk of adverse outcomes after discharge from the emergency department (ED). DESIGN AND SETTING: Secondary analysis of data from the Medicare Current Beneficiary Survey. PARTICIPANTS: One thousand eight hundred fifty-one community-dwelling Medicare fee-for-service enrollees, aged 65 and older who were discharged from the ED between January 2000 and September 2002. MEASUREMENTS: The primary dependent variable was time to first adverse outcome, defined as repeat outpatient ED visit, hospital admission, nursing home admission, or death, within 30 days of the index ED visit. RESULTS: Time to first adverse outcome was shortest in individuals with the highest number of accumulated deficits. The frailest participants were at greater risk of adverse outcomes after ED discharge than those who were least frail (hazard ratio (HR)=1.44, 95% confidence interval (CI)=1.06-1.96). The frailest individuals were also at higher risk of serious adverse outcomes, defined as hospitalization, nursing home admission, or death (HR=1.98, 95% CI=1.29-3.05). In contrast, no association was detected between degree of frailty and repeat outpatient ED visits within 30 days (HR=1.06, 95% CI=0.73-1.54). CONCLUSION: The DAI as a construct of frailty was a robust predictor of serious adverse outcomes in the first 30 days after ED discharge. Frailty was not found to be a major determinant of repeat outpatient ED visits; therefore, additional study is needed to investigate this particular type of health service use by older adults.

Authors
Hastings, SN; Purser, JL; Johnson, KS; Sloane, RJ; Whitson, HE
MLA Citation
Hastings, SN, Purser, JL, Johnson, KS, Sloane, RJ, and Whitson, HE. "Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department." J Am Geriatr Soc 56.9 (September 2008): 1651-1657.
PMID
18691282
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
56
Issue
9
Publish Date
2008
Start Page
1651
End Page
1657
DOI
10.1111/j.1532-5415.2008.01840.x

A frailty index predicts some but not all subsequent health service use in older adults discharged from the emergency department

Authors
Hastings, SN; Purser, J; Johnson, KS; Sloane, RJ; Whitson, HE
MLA Citation
Hastings, SN, Purser, J, Johnson, KS, Sloane, RJ, and Whitson, HE. "A frailty index predicts some but not all subsequent health service use in older adults discharged from the emergency department." April 2008.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
56
Issue
4
Publish Date
2008
Start Page
S168
End Page
S168

What explains racial differences in the completion of advance directives?

Authors
Johnson, KS; Kuchibhatla, M; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, and Tulsky, JA. "What explains racial differences in the completion of advance directives?." April 2008.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
56
Issue
4
Publish Date
2008
Start Page
S4
End Page
S4

Racial differences in location prior to hospice enrollment and association with hospice length of stay

Authors
Johnson, KS; Kuchibhatla, M; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, and Tulsky, JA. "Racial differences in location prior to hospice enrollment and association with hospice length of stay." March 2008.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
23
Publish Date
2008
Start Page
387
End Page
388

Racial differences in hospice revocation to pursue aggressive care.

BACKGROUND: Hospice provides supportive care to terminally ill patients at the end of life. However, some enrollees leave hospice before death in search of therapies that may prolong survival. Because of a greater preference for life-sustaining therapies at the end of life, African American patients may be more likely than white patients to withdraw from hospice to seek life-prolonging therapies. METHODS: In a secondary data analysis of African American and white patients discharged from VITAS hospice programs between January 1, 1999, and December 31, 2003, we used logistic regression to examine the association between race and discharge disposition defined as hospice revocation to pursue aggressive care (eg, emergency medical care, chemotherapy, or invasive medical intervention) vs all other discharges. We used a Cox proportional hazards model to examine survival at 1 year after hospice revocation in a subgroup of enrollees from Florida hospice programs. RESULTS: Of the 166 197 enrollees, 2.8% revoked hospice to pursue aggressive care, and African American patients were more likely than white patients to do so (4.5% vs 2.5%; P< .001). In multivariate analysis, African American patients had a 70% higher odds of leaving hospice to pursue life-prolonging therapies (odds ratio, 1.70; 95% confidence interval, 1.57-1.84). In the subgroup analysis, 48.4% of the enrollees who revoked hospice to pursue life-prolonging therapies were still alive at 1 year. CONCLUSIONS: African American patients were more likely than white patients to revoke hospice to pursue life-prolonging therapies. Models of health care that couple curative and palliative therapies may be more attractive to African American patients and more effective at maximizing continuity throughout life-limiting illness.

Authors
Johnson, KS; Kuchibhatla, M; Tanis, D; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, Tanis, D, and Tulsky, JA. "Racial differences in hospice revocation to pursue aggressive care." Arch Intern Med 168.2 (January 28, 2008): 218-224.
PMID
18227371
Source
pubmed
Published In
Archives of internal medicine
Volume
168
Issue
2
Publish Date
2008
Start Page
218
End Page
224
DOI
10.1001/archinternmed.2007.36

Racial differences in the growth of noncancer diagnoses among hospice enrollees.

Patients with noncancer life-limiting illnesses now represent over half of all hospice enrollees, compared to only one-quarter of enrollees in 1992. Whether this growth in enrollees with noncancer diagnoses has been similar for Caucasians and African Americans, a group historically underrepresented in hospice, has not been described. The purpose of this study was to compare rates of noncancer diagnoses among African American and Caucasian hospice enrollees. We analyzed data from the administrative database of VITAS Healthcare Corporation, including all African Americans and Caucasians discharged from hospice between January 1, 1999 and December 31, 2003. Of the 166,390 eligible discharges, 14.6% were African American, and 85.4% were Caucasian. Over the five-year study period, there was a similar increase in the crude proportion of enrollees with noncancer diagnoses in both groups, from 42% to 49.7% among African Americans and 57.9% to 64.3% among Caucasians. However, in multivariate analysis (adjusted for age, gender, admission level of care, payment source, Health Maintenance Organization (HMO) use, discharge year, and hospice program characteristics-size, location, presence of an inpatient unit), African Americans had 32% lower odds of having a noncancer (vs. cancer) diagnosis than Caucasians (odds ratio [OR] 0.68 [0.66, 0.77]). While numerous studies document lower rates of hospice use among African Americans than Caucasians, these findings suggest disease-specific differences in patterns of hospice use, with greater disparities in hospice use among African Americans with noncancer diagnoses than those with cancer diagnoses. Targeted efforts to increase hospice use among African Americans with noncancer diagnoses may be important in reducing racial disparities in overall hospice use and improving the quality of care for dying African Americans.

Authors
Johnson, KS; Kuchibhatla, M; Tanis, D; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, Tanis, D, and Tulsky, JA. "Racial differences in the growth of noncancer diagnoses among hospice enrollees." J Pain Symptom Manage 34.3 (September 2007): 286-293.
PMID
17555922
Source
pubmed
Published In
Journal of Pain and Symptom Management
Volume
34
Issue
3
Publish Date
2007
Start Page
286
End Page
293
DOI
10.1016/j.jpainsymman.2006.11.010

Cause of death certification: Do physicians at an academic medical center meet guidelines for death certificate completion?

Authors
Elbert-Avila, K; Johnson, KS
MLA Citation
Elbert-Avila, K, and Johnson, KS. "Cause of death certification: Do physicians at an academic medical center meet guidelines for death certificate completion?." April 2007.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
55
Issue
4
Publish Date
2007
Start Page
S39
End Page
S39

Racial differences in next-of-kin participation in an ongoing survey of satisfaction with end-of-life care: a study of a study.

Despite disparities in health care access and quality, African Americans are underrepresented in many areas of clinical investigation, including research in end-of-life care. Because of the importance of surrogate reports in assessing the quality of end-of-life care, this study examined racial differences in next-of-kin participation in an ongoing study of satisfaction with end-of-life care. The parent study includes after-death interviews with next-of-kin of elderly African Americans and Caucasians who died at Duke Hospital. This analysis included next-of-kin of elders who died at Duke Hospital from December 1, 2003 to December 31, 2004. During this period, there were 471 decedents whose next-of-kin were eligible for participation. Of these, 133 (28%) were African American and 338 (72%) were Caucasian. There were no racial differences in completion, contact, or overall response rates. Of those contacted, 39.8% of African Americans and 37.8% of Caucasians completed the study. In multivariate analysis, only the relationship of the next-of-kin to the decedent was an independent predictor of study completion. Children of decedents were significantly more likely to participate than spouses (odds ratio [OR] 2.1 [1.14, 3.86]). In this analysis, next-of-kin of African American and Caucasian decedents were equally likely to participate in an after-death interview assessing satisfaction with end-of-life care. The use of racially concordant interviewers, subject identification with the institution, and the absence of socioeconomic constraints may partly explain these findings. Given the growing diversity of the U.S. population, researchers in end-of-life care must use strategies aimed at recruiting racially and ethnically diverse samples.

Authors
Johnson, KS; Elbert-Avila, K; Kuchibhatla, M; Tulsky, JA
MLA Citation
Johnson, KS, Elbert-Avila, K, Kuchibhatla, M, and Tulsky, JA. "Racial differences in next-of-kin participation in an ongoing survey of satisfaction with end-of-life care: a study of a study." J Palliat Med 9.5 (October 2006): 1076-1085.
PMID
17040145
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
9
Issue
5
Publish Date
2006
Start Page
1076
End Page
1085
DOI
10.1089/jpm.2006.9.1076

"You just do your part. God will do the rest.": spirituality and culture in the medical encounter.

Authors
Johnson, KS
MLA Citation
Johnson, KS. ""You just do your part. God will do the rest.": spirituality and culture in the medical encounter." South Med J 99.10 (October 2006): 1163-.
PMID
17100055
Source
pubmed
Published In
Southern Medical Journal
Volume
99
Issue
10
Publish Date
2006
Start Page
1163

Racial differences in survival after hospice revocation to pursue aggressive care.

Authors
Johnson, KS; Kuchibhatla, M; Tanis, D; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatla, M, Tanis, D, and Tulsky, JA. "Racial differences in survival after hospice revocation to pursue aggressive care." April 2006.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
54
Issue
4
Publish Date
2006
Start Page
S142
End Page
S142

Ethnic differences in the place of death of elderly hospice enrollees.

Elderly minorities are more likely to die in inpatient settings than their Caucasian counterparts. It is not known whether this difference is due to cultural preferences for place of death or decreased access to hospice. This analysis examines ethnic differences in the place of death of elderly hospice patients. Using data from a large, national hospice provider, elderly (> or = 65) African-American, Hispanic, and Caucasian decedents admitted to hospice between January 1, 2000, and December 31, 2003, were identified. Of the 115,854 eligible decedents, 78.3% were Caucasian, 10.7% African American, and 11% Hispanic. Hispanics and African Americans were more likely to die in inpatient hospice settings than Caucasians (38.5%, 38.5%, and 32%, respectively). After adjustment for demographic and hospice use variables, older African Americans had higher odds than older Caucasians of dying in an inpatient hospice setting than a nursing home (odds ratio (OR)=1.12, 95% confidence interval (CI)=1.07-1.19). However, African-American ethnicity was not a significant predictor of death in an inpatient setting versus home (OR=1.03, 95% CI=0.97-1.08)). Hispanics had lower odds than Caucasians of death in an inpatient hospice setting than at home (OR=0.88, 95% CI=0.84, 0.93) and higher odds of death in an inpatient setting than a nursing home (OR=1.45, 95% CI=1.37-1.53). Admission to hospice reduces but does not eliminate ethnic differences in place of death. Further research should examine the effect of individual and cultural preferences for place of death on decisions to enroll in hospice.

Authors
Johnson, KS; Kuchibhatala, M; Sloane, RJ; Tanis, D; Galanos, AN; Tulsky, JA
MLA Citation
Johnson, KS, Kuchibhatala, M, Sloane, RJ, Tanis, D, Galanos, AN, and Tulsky, JA. "Ethnic differences in the place of death of elderly hospice enrollees." J Am Geriatr Soc 53.12 (December 2005): 2209-2215.
PMID
16398911
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
53
Issue
12
Publish Date
2005
Start Page
2209
End Page
2215
DOI
10.1111/j.1532-5415.2005.00502.x

The influence of spiritual beliefs and practices on the treatment preferences of African Americans: a review of the literature.

Spirituality is an important part of African-American culture and is often cited as an explanation for the more-aggressive treatment preferences of some African Americans at the end of life. This paper reviews the literature on spiritual beliefs that may influence the treatment decisions of African Americans. Medline 1966 to February 2003, Psych Info 1872 to February 2003, and CINAHL 1982 to February 2003 were searched for studies exploring spiritual beliefs that may influence the treatment preferences of African Americans. All candidate papers were examined for quality, and data were extracted on study population, design, analysis, and results to identify recurrent themes. Forty studies met inclusion criteria. Recurrent themes describing spiritual beliefs that may influence the treatment preferences of African Americans throughout the course of illness include the following: spiritual beliefs and practices are a source of comfort, coping, and support and are the most effective way to influence healing; God is responsible for physical and spiritual health; and the doctor is God's instrument. Spiritual beliefs specifically addressing treatment preferences at the end of life include: only God has power to decide life and death, there are religious prohibitions against physician-assisted death or advance directives limiting life-sustaining treatments, and divine intervention and miracles occur. For some African Americans, spiritual beliefs are important in understanding and coping with illness and may provide a framework within which treatment decisions are made. Given the growing ethnic diversity of the United States, some understanding of the complexities of culture and spirituality is essential for healthcare providers.

Authors
Johnson, KS; Elbert-Avila, KI; Tulsky, JA
MLA Citation
Johnson, KS, Elbert-Avila, KI, and Tulsky, JA. "The influence of spiritual beliefs and practices on the treatment preferences of African Americans: a review of the literature." J Am Geriatr Soc 53.4 (April 2005): 711-719. (Review)
PMID
15817022
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
53
Issue
4
Publish Date
2005
Start Page
711
End Page
719
DOI
10.1111/j.1532-5415.2005.53224.x

How do dementia and cancer patients enrolled in hospice differ?

Authors
Elbert-Avila, KI; Johnson, KS; Pieper, C; Tanis, D; Tulsky, JA
MLA Citation
Elbert-Avila, KI, Johnson, KS, Pieper, C, Tanis, D, and Tulsky, JA. "How do dementia and cancer patients enrolled in hospice differ?." April 2005.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
53
Issue
4
Publish Date
2005
Start Page
S201
End Page
S201

Predictors of extended prognosis in hospice patients with dementia.

Authors
Elbert-Avila, KI; Johnson, KS; Kuchibhatla, M; Tanis, D; Tulsky, JA
MLA Citation
Elbert-Avila, KI, Johnson, KS, Kuchibhatla, M, Tanis, D, and Tulsky, JA. "Predictors of extended prognosis in hospice patients with dementia." April 2005.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
53
Issue
4
Publish Date
2005
Start Page
S9
End Page
S9

Who revokes hospice? Differences by race.

Authors
Johnson, KS; Pieper, CF; Elbert-Avila, K; Tanis, D; Tulsky, JA
MLA Citation
Johnson, KS, Pieper, CF, Elbert-Avila, K, Tanis, D, and Tulsky, JA. "Who revokes hospice? Differences by race." April 2005.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
53
Issue
4
Publish Date
2005
Start Page
S10
End Page
S10

Place of death among elderly hospice users: Differences by race.

Authors
Johnson, KS; Sloane, R; Galanos, AN; Tulsky, JA
MLA Citation
Johnson, KS, Sloane, R, Galanos, AN, and Tulsky, JA. "Place of death among elderly hospice users: Differences by race." April 2004.
Source
wos-lite
Published In
Journal of American Geriatrics Society
Volume
52
Issue
4
Publish Date
2004
Start Page
S190
End Page
S190
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