Arif Kamal

Overview:

health services and outcomes research, information-technology enabled registries, supportive oncology and palliative care, quality assessment and improvement

Positions:

Associate Professor of Medicine

Medicine, Medical Oncology
School of Medicine

Associate Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Core Faculty in Innovation & Entrepreneurship

Duke Innovation & Entrepreneurship
Institutes and Provost's Academic Units

Member in the Duke Clinical Research Institute

Duke Clinical Research Institute
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2005

University of Missouri Kansas City, School of Medicine

M.H.S. 2015

Duke University

M.B.A. 2016

University of Massachusetts - Amherst

Resident, Internal Medicine

Mayo Clinic, Alix School of Medicine

Fellowship, Hematology/ Oncology

Mayo Clinic, Alix School of Medicine

Grants:

Validating TOGETHER CARE, a mobile application ("app") for caregivers to implement home-based follow-up care for cancer survivors

Administered By
Duke Cancer Institute
Awarded By
Medable Inc.
Role
Principal Investigator
Start Date
End Date

Randomized Trial of Stepped Palliative Care versus Early Integrated Palliative Care in Patients with Advanced Lung Cancer

Administered By
Duke Cancer Institute
Awarded By
Massachusetts General Hospital
Role
Principal Investigator
Start Date
End Date

Developing and testing a web-based tool to engage advanced cancer patients in palliative care (PCforMe-Upstream)

Administered By
Duke Cancer Institute
Awarded By
Mayo Clinic
Role
Principal Investigator
Start Date
End Date

Which palliative care quality measures improve patient-centered outcome?

Administered By
Duke Cancer Institute
Awarded By
Cambia Health Foundation
Role
Principal Investigator
Start Date
End Date

Development of national registry for patients receiving primary care in the home

Administered By
Duke Clinical Research Institute
Awarded By
University of California - San Francisco
Role
Principal Investigator
Start Date
End Date

Publications:

Importance of quality-of-life priorities and preferences surrounding treatment decision making in patients with cancer and oncology clinicians.

BACKGROUND: Shared decision-making (SDM) occurs when a patient partners with their oncologist to integrate personal preferences and values into treatment decisions. A key component of SDM is the elicitation of patient preferences and values, yet little is known about how and when these are elicited, communicated, prioritized, and documented within clinical encounters. METHODS: This cross-sectional study evaluated nationwide data collected by CancerCare to better understand current patterns of SDM between patients and their oncology clinicians. Patient surveys included questions about the importance of quality-of-life preferences and discussions regarding quality-of-life priorities with their clinicians. Clinician surveys included questions about the discussion of quality-of-life priorities and preferences with patients, the effect of quality-of-life priorities on treatment recommendations, and quality-of-life priority documentation in practice. RESULTS: Patient survey completers (n = 320; 33% response rate) were predominantly women (95%), had a diagnosis of breast cancer (59%), or were receiving active cancer treatment (59%). Clinician survey completers (n = 112; 5% response rate) predominately identified as hematologists or oncologists (66%). Although 67% of clinicians reported knowing their patients' personal quality-of-life priorities and preferences before finalizing treatment plans, only 37% of patients reported that these discussions occurred before treatment initiation. Most patients (95%) considered out-of-pocket expenses important during treatment planning, yet only 59% reported discussing out-of-pocket expenses with their clinician before finalizing treatment plans. A majority of clinicians (52%) considered clinic questionnaires as feasible to document quality-of-life priorities and preferences. CONCLUSIONS: Patients and clinicians reported that preferences related to quality-of-life should be considered in treatment decision making, yet barriers to SDM, preference elicitation, and documentation remain.
Authors
Williams, CP; Miller-Sonet, E; Nipp, RD; Kamal, AH; Love, S; Rocque, GB
MLA Citation
Williams, Courtney P., et al. “Importance of quality-of-life priorities and preferences surrounding treatment decision making in patients with cancer and oncology clinicians.Cancer, vol. 126, no. 15, Aug. 2020, pp. 3534–41. Pubmed, doi:10.1002/cncr.32961.
URI
https://scholars.duke.edu/individual/pub1441162
PMID
32426870
Source
pubmed
Published In
Cancer
Volume
126
Published Date
Start Page
3534
End Page
3541
DOI
10.1002/cncr.32961

Occupational and Personal Consequences of the COVID-19 Pandemic on US Oncologist Burnout and Well-Being: A Study From the ASCO Clinician Well-Being Task Force.

INTRODUCTION: The COVID-19 pandemic is an unprecedented global crisis profoundly affecting oncology care delivery. PURPOSE: This study will describe the occupational and personal consequences of the COVID-19 pandemic on oncologist well-being and patient care. MATERIALS AND METHODS: Four virtual focus groups were conducted with US ASCO member oncologists (September-November 2020). Inquiry and subsequent discussions centered on self-reported accounts of professional and personal COVID-19 experiences affecting well-being, and oncologist recommendations for well-being interventions that the cancer organization and professional societies (ASCO) might implement were explored. Qualitative interviews were analyzed using Framework Analysis. RESULTS: Twenty-five oncologists were interviewed: median age 44 years (range: 35-69 years), 52% female, 52% racial or ethnic minority, 76% medical oncologists, 64% married, and an average of 51.5 patients seen per week (range: 20-120). Five thematic consequences emerged: (1) impact of pre-COVID-19 burnout, (2) occupational or professional limitations and adaptations, (3) personal implications, (4) concern for the future of cancer care and the workforce, and (5) recommendations for physician well-being interventions. Underlying oncologist burnout exacerbated stressors associated with disruptions in care, education, research, financial practice health, and telemedicine. Many feared delays in cancer screening, diagnosis, and treatment. Oncologists noted personal and familial stressors related to COVID-19 exposure fears and loss of social support. Many participants strongly considered working part-time or taking early retirement. Yet, opportunities arose to facilitate personal growth and rise above pandemic adversity, fostering greater resilience. Recommendations for organizational well-being interventions included psychologic or peer support resources, flexible time-off, and ASCO and state oncology societies involvement to develop care guidelines, well-being resources, and mental health advocacy. CONCLUSION: Our study suggests that the COVID-19 pandemic has adversely affected oncologist burnout, fulfillment, practice health, cancer care, and workforce. It illuminates where professional organizations could play a significant role in oncologist well-being.
Authors
Hlubocky, FJ; Back, AL; Shanafelt, TD; Gallagher, CM; Burke, JM; Kamal, AH; Paice, JA; Page, RD; Spence, R; McGinnis, M; McFarland, DC; Srivastava, P
MLA Citation
Hlubocky, Fay J., et al. “Occupational and Personal Consequences of the COVID-19 Pandemic on US Oncologist Burnout and Well-Being: A Study From the ASCO Clinician Well-Being Task Force.Jco Oncol Pract, vol. 17, no. 7, July 2021, pp. e427–38. Pubmed, doi:10.1200/OP.21.00147.
URI
https://scholars.duke.edu/individual/pub1486192
PMID
34152789
Source
pubmed
Published In
Jco Oncol Pract
Volume
17
Published Date
Start Page
e427
End Page
e438
DOI
10.1200/OP.21.00147

Palliative Care Use for Critically Ill Patients With Brain Metastases.

CONTEXT: Critically ill patients with brain metastases (BM) face significant uncertainty regarding prognosis and survival and can benefit from Palliative care (PC). However, research regarding the role of PC in this population is lacking. OBJECTIVES: We sought to compare BM patients admitted to an intensive care unit who received an inpatient PC consult (PC cohort) to those who did not (Usual Care, UC cohort). METHODS: We performed a single-institution retrospective cohort analysis. Our outcome variables were mortality, time from intensive care unit admission to death, disposition, and change in code status. We also evaluated PC's role in complex medical decision making, symptom management and hospice education. RESULTS: PC consult was placed in 31 of 118 (28%) of patients. The overall mortality rates were not statistically different (78.8% vs. 90.3%, P= 0.15, UC vs. PC cohort). Patients in the PC cohort had a shorter time to death, higher rate of death within 30 days of admission, increased rate of discharge to hospice, and increase percentage of code status change to "do not attempt resuscitation" during the admission. The primary services provided by PC were symptom management (n = 21, 67.7%) and assistance in complex medical decision making (n = 20, 64.5%). CONCLUSION: In our patient cohort, PC is an underutilized service that can assist in complex medical decision making and symptom management of critically ill BM patients. Further prospective studies surveying patient, family and provider experiences could better inform the qualitative impact of PC in this unique patient population.
Authors
Kang, JH; Price, M; Dalton, T; Ramirez, L; Fecci, PE; Kamal, AH; Johnson, MO; Peters, KB; Goodwin, CR
MLA Citation
Kang, Jennifer H., et al. “Palliative Care Use for Critically Ill Patients With Brain Metastases.J Pain Symptom Manage, vol. 62, no. 5, Nov. 2021, pp. 927–35. Pubmed, doi:10.1016/j.jpainsymman.2021.05.003.
URI
https://scholars.duke.edu/individual/pub1483303
PMID
33992757
Source
pubmed
Published In
J Pain Symptom Manage
Volume
62
Published Date
Start Page
927
End Page
935
DOI
10.1016/j.jpainsymman.2021.05.003

Identification of Patient-Reported Outcome Phenotypes Among Oncology Patients With Palliative Care Needs.

<h4>Purpose</h4>Despite evidence-based guidelines recommending early palliative care, it remains unclear how to identify and refer oncology patients, particularly in settings with constrained access to palliative care. We hypothesize that patient-reported outcome (PRO) data can be used to characterize patients with palliative care needs. To determine if PRO data can identify latent phenotypes that characterize indications for specialty palliative care referral.<h4>Methods</h4>We conducted a retrospective study of self-reported symptoms on the Edmonton Symptom Assessment System collected from solid tumor oncology patients (n = 745) referred to outpatient palliative care. Data were collected as part of routine clinical care from October 2012 to March 2018 at eight community and academic sites. We applied latent profile analysis to identify PRO phenotypes and examined the association of phenotypes with clinical and demographic characteristics using multinomial logistic regression.<h4>Results</h4>We identified four PRO phenotypes: (1) Low Symptoms (n = 295, 39.6%), (2) Moderate Pain/Fatigue + Mood (n = 180, 24.2%), (3) Moderate Pain/Fatigue + Appetite + Dyspnea (n = 201, 27.0%), and (4) High Symptoms (n = 69, 9.3%). In a secondary analysis of 421 patients, we found that two brief items assessing social and existential needs aligned with higher severity symptom and psychological distress phenotypes.<h4>Conclusion</h4>Oncology patients referred to outpatient palliative care in a real-world setting can be differentiated into clinically meaningful phenotypes using brief, routinely collected PRO measures. Latent modeling provides a mechanism to use patient-reported data on a population level to identify distinct subgroups of patients with unmet palliative needs.
Authors
Kaufmann, TL; Getz, KD; Hsu, JY; Bennett, AV; Takvorian, SU; Kamal, AH; DeMichele, A
MLA Citation
Kaufmann, Tara L., et al. “Identification of Patient-Reported Outcome Phenotypes Among Oncology Patients With Palliative Care Needs.Jco Oncology Practice, vol. 17, no. 10, Oct. 2021, pp. e1473–88. Epmc, doi:10.1200/op.20.00849.
URI
https://scholars.duke.edu/individual/pub1477101
PMID
33760637
Source
epmc
Published In
Jco Oncology Practice
Volume
17
Published Date
Start Page
e1473
End Page
e1488
DOI
10.1200/op.20.00849

Top Ten Tips Palliative Care Clinicians Should Know About Prognostication in Critical Illness and Heart, Kidney, and Liver Diseases.

Specialty palliative care (PC) clinicians are frequently asked to discuss prognosis with patients and their families. When conveying information about prognosis, PC clinicians need also to discuss the likelihood of prolonged hospitalization, cognitive and functional disabilities, and death. As PC moves further and further upstream, it is crucial that PC providers have a broad understanding of curative and palliative treatments for serious diseases and can collaborate in prognostication with specialists. In this article, we present 10 tips for PC clinicians to consider when caring and discussing prognosis for the seriously ill patients along with their caregivers and care teams. This is the second in a three-part series around prognostication in adult and pediatric PC.
Authors
Schlögl, M; Pak, ES; Bansal, AD; Schell, JO; Ganai, S; Kamal, AH; Swetz, KM; Maguire, JM; Perrakis, A; Warraich, HJ; Jones, CA
MLA Citation
Schlögl, Mathias, et al. “Top Ten Tips Palliative Care Clinicians Should Know About Prognostication in Critical Illness and Heart, Kidney, and Liver Diseases.J Palliat Med, vol. 24, no. 10, Sept. 2021, pp. 1561–67. Pubmed, doi:10.1089/jpm.2021.0330.
URI
https://scholars.duke.edu/individual/pub1489369
PMID
34283924
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
24
Published Date
Start Page
1561
End Page
1567
DOI
10.1089/jpm.2021.0330