VJ Periyakoil, Professor of Medicine

All Publications

• Loneliness in Seriously Ill Nursing Home Residents During the COVID-19 Pandemic. Journal of palliative medicine Periyakoil, V. S., Bangoy, M., Rodriguez, D., Fuller, J., Neri, E., Kraemer, H. 2024

  Abstract

  Background: Loneliness and social isolation coexist, making it difficult to study each separately. The COVID-19 lockdown provided an unprecedented and ethically viable opportunity to study loneliness in seriously ill nursing home residents under uniformly imposed social isolation conditions. Objective: To understand the phenomenon of loneliness of the seriously ill nursing home patients under a uniform social isolation condition imposed by the COVID-19 pandemic lockdown. Design: Cross-sectional, semi-structured interviews were tape-recorded, transcribed verbatim, and analyzed qualitatively using an inductive thematic analysis. The University of California, Los Angeles (UCLA) Three-Item Loneliness Scale was used to measure loneliness and any relationships between self-reported loneliness and isolation were elucidated. Setting/Participants: Thirty seriously ill nursing home residents living in complete social isolation imposed by the COVID-19 pandemic lockdown. Results: Thematic analysis identified four key themes: (1) Diverse perceptions about the impact of the COVID-19 lockdown, (2) regret over the missed opportunities for spending time with friends and family, (3) using electronic communication to maintain connections with loved ones, and (4) the impact of nursing home staff. In total, 50% of the participants reported feeling socially isolated, 60% patients reported loneliness, and 70% reported being adversely impacted by the lockdown. Patients who felt socially isolated also reported experiencing loneliness (Kendall's Tau = 0.61, 95% confidence interval [CI] = 0.30, 0.89, p < 0.01, large effect size). Persons from communities of color had higher median loneliness scores compared to Non-Hispanic Whites. Participants in the last year of life also reported higher levels of loneliness. Conclusion: A study of loneliness under uniform social isolation conditions in seriously ill nursing home patients showed a high prevalence of loneliness and a strong correlation between self-reported loneliness and social isolation, especially in persons from minority communities and those in the last year of life. In-person support provided by nursing home staff and virtual support from family was helpful to patients.

  View details for DOI 10.1089/jpm.2024.0125

  View details for PubMedID 39162413

• Machine learning prediction of mild cognitive impairment and its progression to Alzheimer's disease. Health science reports Fouladvand, S., Noshad, M., Periyakoil, V. J., Chen, J. H. 2023; 6 (10): e1438

  View details for DOI 10.1002/hsr2.1438

  View details for PubMedID 37867782

  View details for PubMedCentralID PMC10584995

• Childhood Bullying as a Risk Factor for Late-Life Psychological Distress and Cognitive Impairment. medRxiv : the preprint server for health sciences Mejía-Guevara, I., Periyakoil, V. S. 2023

  Abstract

  In the United States, non-Hispanic Black (19%) older adults are more likely to develop dementia than White older adults (10%). As genetics alone cannot account for these differences, the impact of historical social factors is considered. This study examined whether childhood and late-life psychological distress associated with dementia risk could explain part of these disparities. Using longitudinal data from 379 White and 141 Black respondents from the Panel Study of Income Dynamics, we assessed the association between childhood bullying and late-life dementia risk, testing for mediation effects from late-life psychological distress. Mediation analysis was computed via negative binomial regression modeling, stratified by race (White/Black), type of bullying experience (target, bully, and bully-target), and the age range at which the experience occurred (6-12, 13-16). The results indicated that late-life psychological distress fully mediated the association between Black respondents who were bullies and dementia risk. However, no significant association was observed among White respondents. These results suggest that interventions aimed at preventing and treating psychological distress throughout the lifespan could be crucial in mitigating the development and progression of dementia risk.

  View details for DOI 10.1101/2023.09.04.23295046

  View details for PubMedID 37732246

  View details for PubMedCentralID PMC10508796

• Neural responses to gender-based microaggressions in academic medicine. Journal of neuroscience research Balters, S., Foland-Ross, L. C., Bruno, J., Periyakoil, V. S., Valantine, H., Reiss, A. L. 2023

  Abstract

  Gender-based microaggressions have been associated with persistent disparities between women and men in academia. Little is known about the neural mechanisms underlying those often subtle and unintentional yet detrimental behaviors. Here, we assessed the neural responses to gender-based microaggressions in 28 early career faculty in medicine (N = 16 female, N = 12 male sex) using fMRI. Participants watched 33 videos of situations demonstrating gender-based microaggressions and control situations in academic medicine. Video topics had been previously identified through real-life anecdotes about microaggression from women faculty and were scripted and reenacted using professional actors. Primary voxel-wise analyses comparing group differences in activation elucidated a significant group by condition interaction in a right-lateralized cluster across the frontal (inferior and middle frontal gyri, frontal pole, precentral gyrus, postcentral gyrus) and parietal lobes (supramarginal gyrus, angular gyrus). Whereas women faculty exhibited reduced activation in these regions during the microaggression relative to the control condition, the opposite was true for men. Posthoc analyses showed that these patterns were significantly associated with the degree to which participants reported feeling judged for their gender in academic medicine. Lastly, secondary exploratory ROI analyses showed significant between-group differences in the right dorsolateral prefrontal cortex and inferior frontal gyrus. Women activated these two regions less in the microaggression condition compared to the control condition, whereas men did not. These findings indicate that the observation of gender-based microaggressions results in a specific pattern of neural reactivity in women early career faculty.

  View details for DOI 10.1002/jnr.25240

  View details for PubMedID 37654210

• Characterizing subgroup performance of probabilistic phenotype algorithms within older adults: a case study for dementia, mild cognitive impairment, and Alzheimer's and Parkinson's diseases. JAMIA open Banda, J. M., Shah, N. H., Periyakoil, V. S. 2023; 6 (2): ooad043

  Abstract

  Objective: Biases within probabilistic electronic phenotyping algorithms are largely unexplored. In this work, we characterize differences in subgroup performance of phenotyping algorithms for Alzheimer's disease and related dementias (ADRD) in older adults.Materials and methods: We created an experimental framework to characterize the performance of probabilistic phenotyping algorithms under different racial distributions allowing us to identify which algorithms may have differential performance, by how much, and under what conditions. We relied on rule-based phenotype definitions as reference to evaluate probabilistic phenotype algorithms created using the Automated PHenotype Routine for Observational Definition, Identification, Training and Evaluation framework.Results: We demonstrate that some algorithms have performance variations anywhere from 3% to 30% for different populations, even when not using race as an input variable. We show that while performance differences in subgroups are not present for all phenotypes, they do affect some phenotypes and groups more disproportionately than others.Discussion: Our analysis establishes the need for a robust evaluation framework for subgroup differences. The underlying patient populations for the algorithms showing subgroup performance differences have great variance between model features when compared with the phenotypes with little to no differences.Conclusion: We have created a framework to identify systematic differences in the performance of probabilistic phenotyping algorithms specifically in the context of ADRD as a use case. Differences in subgroup performance of probabilistic phenotyping algorithms are not widespread nor do they occur consistently. This highlights the great need for careful ongoing monitoring to evaluate, measure, and try to mitigate such differences.

  View details for DOI 10.1093/jamiaopen/ooad043

  View details for PubMedID 37397506

• Can virtual reality travel help nursing home patients fulfill their bucket list? Journal of the American Geriatrics Society Rodriguez, D. K., Periyakoil, V. S. 2023

  View details for DOI 10.1111/jgs.18392

  View details for PubMedID 37171553

• High-Impact Hospice and Palliative Care Articles of 2022 Casarett, D. J., Liao, S. S., Periyakoil, V. J., Elk, R. ELSEVIER SCIENCE INC. 2023: E535

  View details for Web of Science ID 001006227200042

• Factors affecting the recruitment of Hispanic/Latinx American older adults in clinical trials in the United States: A scoping review. Journal of the American Geriatrics Society Rodriguez, D. K., Hewage, S. A., Periyakoil, V. S. 2023

  Abstract

  OBJECTIVE: Participation of Hispanic/Latinx American older adults (HLAOA) in clinical trials is fundamental to health equity in aging research. However, information on strategies for the successful recruitment of this population in clinical trials is limited.DESIGN: This scoping review aims to identify hindering and facilitating factors that impact the recruitment of HLAOA in clinical trials in the United States.METHODS: Two databases (PubMed, EMBASE) were searched for original research articles from inception until March 2022 reporting on factors that engaged HLAoa (≥65) in clinical trials. One thousand and thirteen studies were scrutinized to identify 31 eligible articles.RESULTS: Most articles were from cancer clinical trials (14 studies). Hindering factors that impacted the recruitment of HLAoa in clinical trials were related to (i) study design and logistics challenges, (ii) challenges imposed by social determinants of health, (iii) communication barriers, and (iv) patients' mistrust, and (v) family issues. Facilitating factors include (i) effective modes of outreach, (ii) strategic clinical trial design, (iii) incorporating culturally-respectful approaches that are tailored to the participants' sociocultural background, and (iv) bridging language barriers.CONCLUSIONS: Successful recruitment of HLAOA into clinical trials requires identifying the study question, co-designing the trial design, implementation, and evaluation in respectful collaboration with the Hispanic/Latinx community with careful attention to their needs and minimizing the study burden on this vulnerable population. Factors identified here may guide researchers to better understand the needs of HLAOA and successfully recruit them into clinical trials, leading to more equitable research that increases their representation in clinical research.

  View details for DOI 10.1111/jgs.18264

  View details for PubMedID 37013348

• Revelations from a Machine Learning Analysis of the Most Downloaded Articles Published in Journal of Palliative Medicine 1999-2018. Journal of palliative medicine Tamang, S., Jin, Z., Periyakoil, V. S. 2023; 26 (1): 13-16

  Abstract

  The Journal of Palliative Medicine (JPM) is globally recognized as a leading interdisciplinary peer-reviewed palliative care journal providing balanced information that informs and improves the practice of palliative care. JPM shapes the values, integrity, and standards of the subspecialty of palliative medicine by what it chooses to publish. The global JPM readership chooses to download the articles that are of most relevance and utility to them. Utilizing machine learning methods, the top 100 most downloaded articles in JPM were analyzed to gain a better understanding of any latent trends and patterns in the topics between 1999 and 2018. The top five topic themes identified in the first decade were different from the ones identified in the second decade of publication. There is evidence of differentiation and maturation of the field in the context of comprehensive health care. Although noncancer serious illnesses have still not risen to the same prominence as cancer palliation, there is a directional quality to the emerging evidence as it pertains to cardiac, respiratory, neurological, renal, and other etiologies. Across both decades under study, there was persistent evidence of the importance of understanding and managing the mental health care needs of seriously ill patients and their families. A cause for concern is that the word "spirituality" was prominent in the first decade and was lacking in the second. Future palliative care clinical and research initiatives should focus on its development as an essential interprofessional and medical subspecialty germane to all types of serious illnesses and across all venues.

  View details for DOI 10.1089/jpm.2022.0574

  View details for PubMedID 36607778

• 25 Years: Looking Back, Looking Forward. Journal of palliative medicine Periyakoil, V. S., von Gunten, C. F., Block, S., Higginson, I., Weissman, D. 2022; 25 (12): 1761-1766

  Abstract

  Palliative medicine and the practice of palliative care has disseminated around the world for the past 25 years. In many countries, palliative medicine is a formally recognized specialty of medicine. Yet, there is a high variability, due in part to the variable resources devoted to its development. New research is needed to improve our ability to control symptoms and to know how best to implement the existing science so that the patients who need palliative care can get it easily and equitably. Achieving this level of access requires expertise in organizational structure and system change strategies. Building the evidence base for best practices requires us to forge research collaborations with collegues from all medical subspecialities, including experts from allied health disciplines, and partner closely with patients and families. It also compels us to look critically at ourselves to overcome the barriers we put in our own way to becoming a routine part of standard health care in all countries.

  View details for DOI 10.1089/jpm.2022.0494

  View details for PubMedID 36472516

• Patient-reported Quality Measures for Palliative Care: The time is now. Journal of pain and symptom management Walling, A. M., Ast, K., Harrison, J., Dy, S., Ersek, M., Hanson, L. C., Kamal, A., Ritchie, C., Teno, J., Rotella, J. D., Periyakoil, V. S., Ahluwalia, S. 2022

  Abstract

  While progress has been made in the ability to measure the quality of hospice and specialty palliative care, there are notable gaps. A recent analysis conducted by Center for Medicare and Medicaid Services (CMS) revealed a paucity of patient-reported measures, particularly in palliative care domains such as symptom management and communication.The research team, consisting of quality measure and survey developers, psychometricians, and palliative care clinicians, used established state-of-the art methods for developing and testing patient-reported measures. We applied a patient-centered, patient-engaged approach throughout the development and testing process. This sequential process included 1) an information gathering phase; 2) a pre-testing phase; 3) a testing phase; and 4) an endorsement phase.To fill quality measure gaps identified during the information gathering phase, we selected two draft measures ("Feeling Heard and Understood" and "Receiving Desired Help for Pain") for testing with patients receiving palliative care in clinic-based settings. In the pre-testing phase, we used an iterative process of cognitive interviews to refine draft items and corresponding response options for the proposed measures. The alpha pilot test supported establishment of protocols for the national beta field test. Measures met conventional criteria for reliability, had strong face and construct validity, and there was diversity in program level scores. The measures received National Quality Forum (NQF) endorsement.These measures highlight the key role of patient voices in palliative care and fill a much-needed gap for patient-reported experience measures in our field.

  View details for DOI 10.1016/j.jpainsymman.2022.11.001

  View details for PubMedID 36395918

• Symptom Control Research. Journal of palliative medicine Periyakoil, V. S., von Gunten, C. F., Bruera, E., Currow, D. C., Roeland, E. J. 2022; 25 (10): 1462-1467

  Abstract

  The need for symptom control research has never been greater. Yet, this is an underdeveloped area in hospice and palliative care. Expert symptom control researchers point out a number of issues that show the way forward over the next 25 years. Chief among them is the need to do the research, rather than being content with the evidence we have. A barrier is to have the self-discipline to honestly evaluate the state of the palliative care science where the gold standard of randomized controlled trials has not been used to establish current practice. Commitment to organized symptom control research groups and clinical trials networks is important. Combining symptom control research with disease-directed research is a promising way forward. Investing in training junior clinicians and researchers is critical. All palliative care fellows and clinicians must receive training in the basics of research methods so that they can effectively support and advance research and evidence-based best practices.

  View details for DOI 10.1089/jpm.2022.0442

  View details for PubMedID 36190485

• Incentives for Palliative Care. Journal of palliative medicine Periyakoil, V. S., von Gunten, C. F., Bowman, B., Emanuel, E., Smith, T. J. 2022; 25 (7): 1024-1030

  Abstract

  The past 25 years have proved that palliative care is effective in improving care of seriously ill patients. Research attention must pivot to focus on policy changes and systems and models of care that ensure easy access to quality palliative care to all patients who need it. Education, alone, has not worked. Leaving it to individual organizations to decide has not worked. The question of whether incentives should be used has arisen. Should we design treatment algorithms, such as for cardiopulmonary resuscitation, where palliative care is part of standard care and requires an "opt out"? Should payers pay more to health care organizations who demonstrate they provide universal access to palliative care and how can we control for unintended consequences? Should provision of specialist palliative care be required for a health care organization to be accredited? How can we advance the state of the science and best support the workforce?

  View details for DOI 10.1089/jpm.2022.0280

  View details for PubMedID 35775898

• Mid-Career Training to Advance Palliative Care. Journal of palliative medicine Periyakoil, V. S., von Gunten, C. F., Bailey, F. A., Dingfield, L. E., Schlögl, M. 2022; 25 (5): 705-711

  Abstract

  The demand for specialist palliative medicine physicians, advanced practice providers, and other team members outstrips supply. Traditional paths to specialty practice will not meet projected need. Therefore, innovation and research are required. One innovation is the training of midcareer professionals; those who have been in practice and want to change to palliative care. Barriers to leaving practice and returning to traditional training are high; not the least of which is the opportunity cost. In this roundtable, experts discuss what they have learned from current research, and point the way to additional needed research.

  View details for DOI 10.1089/jpm.2022.0144

  View details for PubMedID 35499371

  View details for PubMedCentralID PMC9271329

• Building a Culturally Competent Workforce to Care for Diverse Older Adults: Scope of the Problem and Potential Solutions JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Periyakoil, V. S. 2019; 67: S423–S432

  Abstract

  The population of minority older adults is going to explode over the next four decades. Older adults from racial and ethnic minorities face persistent and pervasive health disparities. Health disparities exert a huge fiscal burden on the nation. The national financial cost of health disparities for the years 2002 to 2006 was an estimated 1.23 trillion dollars. As the aging population becomes more diverse, these disparity-related costs are expected to increase. Older adults from racial and ethnic minorities face multiple barriers to accessing health and support services that will help them to age and die in place in the community. Patient-related barriers include limited English proficiency, low health literacy, varying levels of acculturation, biases about Western healthcare and medications, mistrust of clinicians, inability to navigate the complex healthcare system, and cultural beliefs and taboos. Clinician-related barriers include ageism (ie, discrimination against older people due to negative and inaccurate stereotypes), conscious and unconscious bias, being deeply entrenched in the culture of biomedicine, and the lack of training in the principles and practice of providing culturally respectful care. Health system-related barriers include lack of culturally tailored services, including access to medical interpreters. We conclude by identifying three specific strategies to facilitate culturally humble and respectful care for diverse patients. J Am Geriatr Soc 67:S423-S432, 2019.

  View details for DOI 10.1111/jgs.15939

  View details for Web of Science ID 000467584600008

  View details for PubMedID 31074850

• Effect of a Lay Health Worker Intervention on Goals-of-Care Documentation and on Health Care Use, Costs, and Satisfaction Among Patients With Cancer: A Randomized Clinical Trial. JAMA oncology Patel, M. I., Sundaram, V., Desai, M., Periyakoil, V. S., Kahn, J. S., Bhattacharya, J., Asch, S. M., Milstein, A., Bundorf, M. K. 2018

  Abstract

  Importance: Although lay health workers (LHWs) improve cancer screening and treatment adherence, evidence on whether they can enhance other aspects of care is limited.Objective: To determine whether an LHW program can increase documentation of patients' care preferences after cancer diagnosis.Design, Setting, and Participants: Randomized clinical trial conducted from August 13, 2013, through February 2, 2015, among 213 patients with stage 3 or 4 or recurrent cancer at the Veterans Affairs Palo Alto Health Care System. Data analysis was by intention to treat and performed from January 15 to August 18, 2017.Interventions: Six-month program with an LHW trained to assist patients with establishing end-of-life care preferences vs usual care.Main Outcomes and Measures: The primary outcome was documentation of goals of care. Secondary outcomes were patient satisfaction on the Consumer Assessment of Health Care Providers and Systems "satisfaction with provider" item (on a scale of 0 [worst] to 10 [best possible]), health care use, and costs.Results: Among the 213 participants randomized and included in the intention-to-treat analysis, the mean (SD) age was 69.3 (9.1) years, 211 (99.1%) were male, and 165 (77.5%) were of non-Hispanic white race/ethnicity. Within 6 months of enrollment, patients randomized to the intervention had greater documentation of goals of care than the control group (97 [92.4%] vs 19 [17.5%.]; P<.001) and larger increases in satisfaction with care on the Consumer Assessment of Health Care Providers and Systems "satisfaction with provider" item (difference-in-difference, 1.53; 95% CI, 0.67-2.41; P<.001). The number of patients who died within 15 months of enrollment did not differ between groups (intervention, 60 of 105 [57.1%] vs control, 60 of 108 [55.6%]; P=.68). In the 30 days before death, patients in the intervention group had greater hospice use (46 [76.7%] vs 29 [48.3%]; P=.002), fewer emergency department visits (mean [SD], 0.05 [0.22] vs 0.60 [0.76]; P<.001), fewer hospitalizations (mean [SD], 0.05 [0.22] vs 0.50 [0.62]; P<.001), and lower costs (median [interquartile range], $1048 [$331-$8522] vs $23 482 [$9708-$55 648]; P<.001) than patients in the control group.Conclusions and Relevance: Incorporating an LHW into cancer care increases goals-of-care documentation and patient satisfaction and reduces health care use and costs at the end of life.Trial Registration: ClinicalTrials.gov Identifier: NCT02966509.

  View details for PubMedID 30054634

• Common Items on a Bucket List. Journal of palliative medicine Periyakoil, V. S., Neri, E. n., Kraemer, H. n. 2018

  Abstract

  To provide preference-sensitive care, we propose that clinicians might routinely inquire about their patients' bucket-lists and discuss the impact (if any) of their medical treatments on their life goals.This cross-sectional, mixed methods online study explores the concept of the bucket list and seeks to identify common bucket list themes. Data were collected in 2015-2016 through an online survey, which was completed by a total of 3056 participants across the United States. Forty participants who had a bucket list were identified randomly and used as the development cohort: their responses were analyzed qualitatively using grounded theory methods to identify the six key bucket list themes. The responses of the remaining 3016 participants were used for the validation study. The codes identified from the development cohort were validated by analyses of responses from 50 randomly drawn subjects from the validation cohort. All the 3016 validation cohort transcripts were coded for presence or absence of each of the six bucket list themes.Around 91.2% participants had a bucket list. Age and spirituality influence the patient's bucket-list. Participants who reported that faith/religion/spirituality was important to them were most likely (95%) to have a bucket list compared with those who reported it to be unimportant (68.2%), χ2 = 37.67. Six primary themes identified were the desire to travel (78.5%), desire to accomplish a personal goal (78.3%), desire to achieve specific life milestones (51%), desire to spend quality time with friends and family (16.7%), desire to achieve financial stability (24.3%), and desire to do a daring activity (15%).The bucket list is a simple framework that can be used to engage patients about their healthcare decision making. Knowing a patient's bucket list can aid clinicians in relating each treatment option to its potential impact (if any) on the patient's life and life goals to promote informed decision making.

  View details for PubMedID 29415602

• Square Pegs; Round Holes: Our Healthcare System Is Failing Seriously Ill Older Americans in Their Last Years. Journal of the American Geriatrics Society Periyakoil, V. J. 2018; 66 (1): 15–17

  View details for PubMedID 29165786

  View details for PubMedCentralID PMC5777873

• Talk to Your Doctor About Your Bucket List Periyakoil, V. New York Times. 2018 ; Well|Live
• A Randomized Controlled Trial Comparing the Letter Project Advance Directive to Traditional Advance Directive. Journal of palliative medicine Periyakoil, V. S., Neri, E., Kraemer, H. 2017

  Abstract

  Simpler alternatives to traditional advance directives that are easy to understand and available in multiple formats and can be initiated by patients and families will help facilitate advance care planning. The goal of this study was to compare the acceptability of the letter advance directive (LAD) to the traditional advance directive (TAD) of the state of California.A web-based, randomized controlled trial was conducted, in which the participants were randomized to one of two types of advance directives (ADs): the LAD (intervention) or the TAD (control). Primary outcomes were participant ratings of the ease, value, and their level of comfort in the AD document they completed.A total of 400 participants completed the study, with 216 randomized to the LAD and 184 to the TAD by a computerized algorithm. Overall, participants preferred the LAD to the TAD (success rate difference [SRD] = 0.46, 95th percentile confidence interval [CI]: 0.36-0.56, p < 0.001). The participants felt that, compared to the TAD, the LAD was easier to read and understand (SRD = 0.56, CI: 0.47-0.65, p < 0.001); better reflected what matters most to them (SRD = 0.39, CI: 0.29-0.48, p < 0.001); helped stimulate their thinking about the types of treatments they wanted at the end of life (SRD = 0.32, CI: 0.23-0.42, p < 0.001); allowed them to describe how they made medical decisions in their family (SRD = 0.31, CI: 0.21-0.40, p < 0.001); and could help their doctor(s) (SRD = 0.24, CI: 0.13-0.34, p < 0.001) and their families (SRD = 0.19, CI: 0.08-0.28, p < 0.001) understand their end-of-life treatment preferences.Patients reported the letter advance directive to be a better alternative to the traditional advance directive form.

  View details for DOI 10.1089/jpm.2017.0066

  View details for PubMedID 28471713

• Patient-Reported Barriers to High-Quality, End-of-Life Care: A Multiethnic, Multilingual, Mixed-Methods Study. Journal of palliative medicine Periyakoil, V. S., Neri, E., Kraemer, H. 2016; 19 (4): 373-379

  Abstract

  The study objective was to empirically identify barriers reported by multiethnic patients and families in receiving high-quality end-of-life care (EOLC).This cross-sectional, mixed-methods study in Burmese, English, Hindi, Mandarin, Tagalog, Spanish, and Vietnamese was held in multiethnic community centers in five California cities. Data were collected in 2013-2014. A snowball sampling technique was used to accrue 387 participants-261 women, 126 men, 133 Caucasian, 204 Asian Americans, 44 African Americans, and 6 Hispanic Americans. Measured were multiethnic patient-reported barriers to high-quality EOLC. A development cohort (72 participants) of responses was analyzed qualitatively using grounded theory to identify the six key barriers to high-quality EOLC. A new validation cohort (315 participants) of responses was transcribed, translated, and back-translated for verification. The codes were validated by analyses of responses from 50 randomly drawn subjects from the validation cohort. All the 315 validation cohort transcripts were coded for presence or absence of the six barriers.In the validation cohort, 60.6% reported barriers to receiving high-quality EOLC for persons in their culture/ethnicity. Primary patient-reported barriers were (1) finance/health insurance barriers, (2) doctor behaviors, (3) communication chasm between doctors and patients, (4) family beliefs/behaviors, (5) health system barriers, and (6) cultural/religious barriers. Age (χ(2) = 9.15, DF = 1, p = 0.003); gender (χ(2) = 6.605, DF = 1, p = 0.01); and marital status (χ(2) = 16.11 DF = 3, p = 0.001) were associated with reporting barriers; and women <80 years were most likely to report barriers to receiving high-quality EOLC. Individual responses of reported barriers were analyzed and only the participant's level of education (Friedman statistic = 2.16, DF = 10, p = 0.02) significantly influenced choices.Multiethnic patients report that high-quality EOLC is important to them; but unfortunately, a majority state that they have encountered barriers to receiving such care. Efforts must be made to rapidly improve access to culturally competent EOLC for diverse populations.

  View details for DOI 10.1089/jpm.2015.0403

  View details for PubMedID 26575114

• Achieving High-Quality Multicultural Geriatric Care. Journal of the American Geriatrics Society 2016

  Abstract

  As the ethnic diversity of the U.S. population increases, there is a growing awareness of healthcare disparities and the need to address them. This position statement that the American Geriatrics Society (AGS) Ethnogeriatrics Committee developed outlines healthcare disparities in the United States and the minimum quality indicators that healthcare organizations and healthcare providers should adopt to ensure that all older adults receive care that is culturally appropriate and takes into account level of health literacy.

  View details for DOI 10.1111/jgs.13924

  View details for PubMedID 26804356

• INviting Veterans InTo Enrollment in Alzheimer's Disease Research Centers (INVITE-ADRC): An NIA and VA-sponsored initiative to increase veteran participation in aging and dementia research. Alzheimer's & dementia : the journal of the Alzheimer's Association Padula, C. B., Ball, S., Wyman, M. F., Evans, K., Grant, H., Periyakoil, V. S., Zhu, C. W., Yaffe, K., Huang, G. D. 2024

  Abstract

  Older military veterans often present with unique and complex risk factors for Alzheimer's disease (AD) and related dementias. Increasing veteran participation in research studies offers one avenue to advance the field and improve health outcomes.To this end, the National Institute on Aging (NIA) and Department of Veterans Affairs (VA) partnered to build infrastructure, improve collaboration, and intensify targeted recruitment of veterans. This initiative, INviting Veterans InTo Enrollment in Alzheimer's Disease Research Centers (INVITE-ADRC), provided funding for five sites and cross-site organizing structure. Diverse and innovative recruitment strategies were used.Across five sites, 172 veterans entered registries, and 99 were enrolled into ADRC studies. Of the enrolled, 39 were veterans from historically underrepresented racial and ethnic groups.This initiative laid the groundwork to establish sustainable relationships between the VA and ADRCs. The partnership between both federal agencies demonstrates how mutual interests can accelerate progress. In turn, efforts can help our aging veterans.

  View details for DOI 10.1002/alz.13725

  View details for PubMedID 38348782

• Disabilities Reporting in Cardiac Clinical Trials: How Are We Doing? Journal of the American Heart Association Lan, R. H., Rice, E. N., Nunes, J. C., Shah, R., Igwe, J. K., Clark, K., Periyakoil, V. S., Chen, J. H., Lin, B., Awad, C., Idris, M., Cruz, E. R., Lewis, E. F., Johnson, C. B., Wang, P. J. 2023: e029726

  View details for DOI 10.1161/JAHA.123.029726

  View details for PubMedID 37949834

• Evaluating equity in the Journal of Pain & Symptom Management's editorial processes. Journal of pain and symptom management Casarett, D. J., Periyakoil, V. J., Hui, D., Liao, S. 2023

  View details for DOI 10.1016/j.jpainsymman.2023.10.020

  View details for PubMedID 37924995

• Bystander Empowerment Workshop: How to Respond to Microaggressions in Clinical Environments O'Neill, L., Fisher, H., Bernacki, R., Carey, E., Thomas, J., Kapo, J., Morrison, L. J., Periyakoil, V. J. ELSEVIER SCIENCE INC. 2023: E533-E534

  View details for Web of Science ID 001006227200038

• WHO ARE WE MISSING? REPORTING OF TRANSGENDER AND GENDER EXPANSIVE POPULATIONS IN CLINICAL TRIALS Rice, E., Lan, R., Nunes, J., Shah, R., Echols, M. R., Lunn, M., Bryant, L., Lewis, E. F., Awad, C., Idris, M. Y., Clark, K., Periyakoil, V., Cruz, E., Chen, J., Brown-Johnson, C., Palaniappan, L. P., Wang, P. J. ELSEVIER SCIENCE INC. 2023: 119

  View details for Web of Science ID 000990866100120

• DISABILITIES REPORTING IN CLINICAL TRIALS. HOW ARE WE DOING? Lan, R., Rice, E., Nunes, J., Shah, R., Joseph, I. E., Echols, M. R., Echols, M. R., Lunn, M., Bryant, L., Lewis, E. F., Awad, C., Idris, M. Y., Clark, K., Periyakoil, V., Cruz, E., Chen, J., Brown-Johnson, C., Palaniappan, L. P., Wang, P. J. ELSEVIER SCIENCE INC. 2023: 172

  View details for Web of Science ID 000990866100173

• Become an Accomplished JEDI: Secrets of Getting Your Justice, Equity, Diversity, and Inclusion (JEDI) Journal Article Published Periyakoil, V., Casarett, D. J. ELSEVIER SCIENCE INC. 2023: E298

  View details for Web of Science ID 001038555400105

• Mild Cognitive Impairment: Data-Driven Prediction, Risk Factors, and Workup. AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science Fouladvand, S., Noshad, M., Goldstein, M. K., Periyakoil, V. J., Chen, J. H. 2023; 2023: 167-175

  Abstract

  Over 78 million people will suffer from dementia by 2030, emphasizing the need for early identification of patients with mild cognitive impairment (MCI) at risk, and personalized clinical evaluation steps to diagnose potentially reversible causes. Here, we leverage real-world electronic health records in the observational medical outcomes partnership (OMOP) data model to develop machine learning models to predict MCI up to a year in advance of recorded diagnosis. Our experimental results with logistic regression, random forest, and xgboost models trained and evaluated on more than 531K patient visits show random forest model can predict MCI onset with ROC-AUC of 68.2±0.7. We identify the clinical factors mentioned in clinician notes that are most predictive of MCI. Using similar association mining techniques, we develop a data-driven list of clinical procedures commonly ordered in the workup of MCI cases, that could be used as a basis for guidelines and clinical order set templates.

  View details for PubMedID 37350911

• Palliative Care Is Proven JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., von Gunten, C. F. 2023; 26 (1): 2-4

  Abstract

  Palliative care was officially recognized by the World Health Organization in 1990 as a distinct specialty dedicated to relieving suffering and improving quality of life for patients with serious illnesses. Journal of Palliative Medicine (JPM) was founded in 1997 in response to the need for a scientifically rigorous peer-reviewed journal to advance the field. In our first quarter of the century, JPM has become a leading global peer-reviewed scientific journal. What is the way forward? We engaged with this question in two ways. First, we utilized artificial intelligence techniques to analyze the trends of the articles published in JPM for the past two decades to discern key topic themes. Second, we applied human intelligence by convening seven panels of experts to discuss current topics of interest to the field as a separate strategy for discerning the future. Taken together, the way forward is clear. The field of palliative care has become broader and more subspecialized than anyone ever imagined at the beginning. The expansion of new knowledge has accelerated in all directions from its origins in the end-of-life care of patients with cancer. Although implementation science is of paramount importance, the barriers to implementation of this growing body of specialized knowledge lie not just with the need for more science. Some of the barriers lie within our field. The way forward requires confidence in what we know and the establishment of new collaborations outside of our field, including with people outside of traditional health care.

  View details for DOI 10.1089/jpm.2022.0568

  View details for Web of Science ID 000911679500001

  View details for PubMedID 36607788

• Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults Augmenting group hoarding disorder treatment with virtual reality discarding: A pilot study in older adults Raila, H. 2023

  View details for DOI 10.1016/j.jpsychires.2023.08.002

• Geriatrics assessment in older adults referred for hematopoietic cell transplantation. Journal of the American Geriatrics Society Sossenheimer, P. H., Bharadwaj, S., Johnston, L., Periyakoil, V. S. 2022

  View details for DOI 10.1111/jgs.17929

  View details for PubMedID 35708096

• Bystander Empowerment Workshop: How to Respond to Microaggressions in Clinical Environments O'Neill, L., Thomas, J., Bernacki, R., Kapo, J., Morrison, L., Carey, E., Sanchez-Reilly, S., Periyakoil, V., Fisher, H., Kozelka, K., Natarajan, S., Mbewe, A. ELSEVIER SCIENCE INC. 2022: 796-797

  View details for Web of Science ID 000812783700043

• Standardized outcome measures of mental health in research with older adults who are incarcerated INTERNATIONAL JOURNAL OF PRISONER HEALTH Prost, S., Golembeski, C., Periyakoil, V. S., Arias, J., Knittel, A. K., Ballin, J., Oliver, H. D., Tran, N. 2022; 18 (2): 200-212

  Abstract

  The targeted use of standardized outcome measures (SOMs) of mental health in research with older adults who are incarcerated promotes a common language that enables interdisciplinary dialogue, contributes to the identification of disparities and supports data harmonization and subsequent synthesis. This paper aims to provide researchers with rationale for using "gold-standard" measures used in research with community-dwelling older adults, reporting associated study sample psychometric indexes, and detailing alterations in the approach or measure.The authors highlight the mental health of older adults who are incarcerated. They also discuss the benefits of SOMs in practice and research and then identify gold-standard measures of mental health used in research with community-dwelling older adults and measures used in research with older adults who are incarcerated. Finally, the authors provide several recommendations related to the use of SOMs of mental health in research with this population.Depression, anxiety and post-traumatic stress disorder are common among older adults who are incarcerated. Researchers have used a variety of measures to capture these mental health problems, some parallel to those used with community-dwelling samples. However, a more targeted use of SOMs of mental health in research with this population will contribute to important strides in this burgeoning field.This review offers several practical recommendations related to SOMs of mental health in research with older adults who are incarcerated to contribute to a rigorous evidence base and thus inform practice and potentially improve the health and well-being of this population.

  View details for DOI 10.1108/IJPH-08-2021-0085

  View details for Web of Science ID 000776612100001

  View details for PubMedID 35362688

  View details for PubMedCentralID PMC9328480

• Accountable and Transparent Palliative Quality Measures Will Improve Care. Journal of palliative medicine Periyakoil, V. S., Gunten, C. F., Check, D., Kaufman, B., Maxwell, T. L., Teno, J. M. 2022; 25 (4): 542-548

  Abstract

  How do we build on the proven successes of hospice and palliative care and build clinical programs to serve those who need it in the context of real-world health care? Experiences with glide pathways have clearly shown that changes in financial incentives must always be implemented with counterbalancing measures that ensure that seriously ill patients are getting high-quality care consistent with their goals and values. There are quality measures for quality improvement and there are quality measures for accountability or transparency. We must balance any financial incentives with concrete quality measures that act as a check and balance to the care that is being provided. This area of investigation is rich in opportunity. Much research is needed to advance the craft of hospice and palliative care if the field is to move forward at scale in a timely manner. We need to democratize research and engage both "small r" and a "big R" researchers in the manner of other subspecialties such as oncology and cardiology. Future research should focus on building innovative systems and models of care to uncover needs of seriously ill patients and their caregivers and effectively cater to those needs.

  View details for DOI 10.1089/jpm.2022.0063

  View details for PubMedID 35363070

  View details for PubMedCentralID PMC9206470

• Evaluating implementation strategies to support documentation of veterans' care preferences. Health services research Carpenter, J. G., Scott, W. J., Kononowech, J., Foglia, M. B., Haverhals, L. M., Hogikyan, R., Kolanowski, A., Landis-Lewis, Z., Levy, C., Miller, S. C., Periyakoil, V. J., Phibbs, C. S., Potter, L., Sales, A., Ersek, M. 2022

  Abstract

  OBJECTIVE: To evaluate the effectiveness of feedback reports and feedback reports + external facilitation on completion of life-sustaining treatment (LST) note the template and durable medical orders. This quality improvement program supported the national roll-out of the Veterans Health Administration (VA) LST Decisions Initiative (LSTDI), which aims to ensure that seriously-ill veterans have care goals and LST decisions elicited and documented.DATA SOURCES: Primary data from national databases for VA nursing homes (called Community Living Centers [CLCs]) from 2018 to 2020.STUDY DESIGN: In one project, we distributed monthly feedback reports summarizing LST template completion rates to 12 sites as the sole implementation strategy. In the second involving five sites, we distributed similar feedback reports and provided robust external facilitation, which included coaching, education, and learning collaboratives. For each project, principal component analyses matched intervention to comparison sites, and interrupted time series/segmented regression analyses evaluated the differences in LSTDI template completion rates between intervention and comparison sites.DATA COLLECTION METHODS: Data were extracted from national databases in addition to interviews and surveys in a mixed-methods process evaluation.PRINCIPAL FINDINGS: LSTDI template completion rose from 0% to about 80% throughout the study period in both projects' intervention and comparison CLCs. There were small but statistically significant differences for feedback reports alone (comparison sites performed better, coefficient estimate 3.48, standard error 0.99 for the difference between groups in change in trend) and feedback reports + external facilitation (intervention sites performed better, coefficient estimate -2.38, standard error 0.72).CONCLUSIONS: Feedback reports + external facilitation was associated with a small but statistically significant improvement in outcomes compared with comparison sites. The large increases in completion rates are likely due to the well-planned national roll-out of the LSTDI. This finding suggests that when dissemination and support for widespread implementation are present and system-mandated, significant enhancements in the adoption of evidence-based practices may require more intensive support.

  View details for DOI 10.1111/1475-6773.13958

  View details for PubMedID 35261022

• Caught in a Loop with Advance Care Planning and Advance Directives: How to Move Forward? Journal of palliative medicine Periyakoil, V. S., Gunten, C. F., Arnold, R., Hickman, S., Morrison, S., Sudore, R. 2022; 25 (3): 355-360

  Abstract

  Completion of an advance care planning (ACP) process and/or an advance directive should result in patients receiving the care they desire at the end of life. However, three decades of research have shown that is just not the case. ACP has been a front runner in developing the science within palliative care. Some positive outcomes such as lowering levels of surrogate grief may be associated with ACP. Yet, it does not appear that further ACP research will ensure that seriously ill patients will get goal-concordant care. An unfortunate consequence of palliative care research and advocacy so far is the misguided notion of many hospital systems trying to solve their palliative care problems by only implementing an ACP initiative. At best, ACP is but one tool in the collective palliative care toolbox. New tools are needed. Given that we have finite resources, future research should focus more on tools to improve symptom management, better models of care, and systems that will ensure goal-concordant care that meet the needs of the population that the health care system is designed to meet.

  View details for DOI 10.1089/jpm.2022.0016

  View details for PubMedID 35230896

  View details for PubMedCentralID PMC9022450

• Generalist versus Specialist Palliative Medicine. Journal of palliative medicine Periyakoil, V. S., Gunten, C. F., Fischer, S., Pantilat, S., Quill, T. 2022; 25 (2): 193-199

  Abstract

  The issue of generalist versus specialist palliative care is on the minds of healthcare leaders everywhere. We are amid changing demographics of physicians. The industrialization of medicine is well underway in the US and around the developing world. Is it important to identify patients who benefit the most from specialist palliative care, given that it is currently a limited resource? Should we step out of standard practice and redesign palliative care using principles of population management? The COVID pandemic rapidly introduced virtual palliative care consults. Is it a better way to promote wide access to specialty palliative care? Looking forward, should we promote ways to advance primary palliative care and reserve specialty palliative care to patients who will benefit most from this level of care? These questions, and others, are considered in this transcribed discussion between leading physicians in the field.

  View details for DOI 10.1089/jpm.2021.0644

  View details for PubMedID 35103529

  View details for PubMedCentralID PMC9022124

• 25 Year Anniversary: Looking Back, Looking Forward. Journal of palliative medicine von Gunten, C. F., Periyakoil, V. S. 1800; 25 (1): 2

  View details for DOI 10.1089/jpm.2021.0543

  View details for PubMedID 34978904

• Factors associated with smoking in low-income persons with and without chronic illness TOBACCO INDUCED DISEASES Cano, M. T., Pennington, D. L., Reyes, S., Pineda, B. S., Llamas, J. A., Periyakoil, V. S., Munoz, R. F. 2021; 19: 59

  Abstract

  Tobacco disparities persist among low-income smokers who seek care from safety-net clinics. Many of these patients suffer from chronic illnesses (CILs) that are associated with and exacerbated by smoking. The objective of the current study was to examine the differences between safety-net patients with and without CILs in terms of nicotine dependence and related factors (such as depression, anxiety) and self-efficacy regarding ability to abstain from smoking.Sixty-four low-income smokers who thought about or intended to quit smoking were recruited from the San Francisco Health Network (SFHN) and assessed for CILs, nicotine dependence, depression, anxiety, and smoking abstinence self-efficacy. Four one-way analyses of variance were used to examine the difference between those with and without CIL on the latter four variables.The CIL group had significantly higher anxiety (CIL: 8.0 ± 5.35; non-CIL: 4.44 ± 3.48; p=0.02) and tended to have higher nicotine dependence (CIL: 5.40 ± 2.58; non-CIL: 3.88 ± 2.28; p=0.04). In the CIL group, nicotine dependence was positively correlated with anxiety [r(62)=0.39; p<0.01] and negatively correlated with smoking abstinence self-efficacy [r(62)= -0.38; p<0.01]. Both depression (Spearman's rho=0.39; p<0.01) and anxiety (Spearman's rho=0.29; p<0.05) were associated with total number of CIL categories.Safety-net patients who smoke and suffer from CILs may be suffering from higher levels of anxiety and have less confidence in their ability to quit smoking. Incorporating mood management and developing interventions that increase a sense of self-efficacy for refraining from smoking may be necessary to help low-income smokers quit smoking.

  View details for DOI 10.18332/tid/138241

  View details for Web of Science ID 000681689200002

  View details for PubMedID 34305505

  View details for PubMedCentralID PMC8280622

• Virtual Interinstitutional Palliative Care Consultation during the COVID-19 Pandemic in New York City JOURNAL OF PALLIATIVE MEDICINE Asprec, L., Blinderman, C. D., Berlin, A., Callahan, M. E., Widera, E., Periyakoil, V. S., Smith, A. K., Nakagawa, S. 2021; 24 (9): 1387-1390

  Abstract

  Context: Amid the COVID-19 surge in New York City, the need for palliative care was highlighted. Virtual consultation was introduced to expand specialist-level care to meet demand. Objectives: To examine the outcomes of COVID-19 patients who received virtual palliative care consultation from outside institutions. Design: This is a retrospective case series. Setting/Subjects: Subjects were 34 patients who received virtual palliative care consultation between April 13, 2020, and June 14, 2020. Measurements: Follow-up frequency and duration, code status change, withdrawal of life-sustaining treatment (LST), and multidisciplinary involvement. Results: Twenty-eight patients (82.3%) were in the intensive care unit and 29 patients (85.3%) were on at least two LSTs. Fifteen patients (44.1%) died in the hospital, 9 patients (26.4%) were discharged alive, and 10 patients (29.4%) were signed off. The median frequency of visits was 4.5 (IQR 6) over 11 days follow-up (IQR 17). Code status change was more frequent in deceased patients. LSTs were withdrawn in eight patients (23.5%). Conclusions: Virtual palliative care consultation was feasible during the height of the COVID-19 pandemic.

  View details for DOI 10.1089/jpm.2021.0208

  View details for Web of Science ID 000668303400001

  View details for PubMedID 34191591

• Improving Medical and Nurse Practitioner Student Confidence and Clinical Skill in Advance Care Plan Development: A Multidisciplinary Mentorship Model. The American journal of hospice & palliative care Coogan, A. C., Shifrin, M. M., Williams, M. T., Alverio, J., Periyakoil, V. J., Karlekar, M. B. 2021: 10499091211017871

  Abstract

  BACKGROUND: Advance care planning (ACP) is an integral aspect of patient-centered care, however medical (MD) and Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) students receive minimal education on how to facilitate ACP discussions and ultimately feel uncomfortable having these discussions with patients.1-4 The aim of this project was to increase MD and AGACNP students' perceived ability and confidence in leading ACP conversations through an ACP educational program called the Letter Project Pilot (LPP).METHODS: The LPP consisted of faculty-supervised interactions in the inpatient setting during which students were able to lead ACP discussions with patients by guiding them through an advance directive worksheet that was structured in the format of a letter. Student participants were recruited from the MD and AGACNP programs associated with the academic medical center. Patients were recruited from inpatient medicine and geriatrics units at the academic medical center. At the end of the 3-month pilot, a voluntary, anonymous REDCap survey was used to evaluate 2 primary outcomes of interest:1) the association of the LPP pilot on perceived ACP skills, and 2) the perceived impact of the LPP pilot on ACP in future practice.RESULTS: Students perceived that their experiences positively enhanced their current ACP skills and their ability to have ACP conversations in their future practice.CONCLUSION: The results support that the LPP is a scalable, cost-effective project that increases students' perceived ability and confidence in leading ACP conversations.

  View details for DOI 10.1177/10499091211017871

  View details for PubMedID 33982604

• Motivation to Participate in Precision Health Research and Acceptability of Texting as a Recruitment and Intervention Strategy Among Vietnamese Americans: Qualitative Study. JMIR mHealth and uHealth Ta Park, V., Kim, A., Cho, I. H., Nam, B., Nguyen, K., Vuong, Q., Periyakoil, V. S., Hong, Y. A. 2021; 9 (3): e23058

  Abstract

  BACKGROUND: The largest effort undertaken in precision health research is the Precision Medicine Initiative (PMI), also known as the All of Us Research Program, which aims to include 1 million or more participants to be a part of a diverse database that can help revolutionize precision health research studies. Research participation from Asian Americans and Pacific Islanders in precision health research is, however, limited; this includes Vietnamese Americans, especially those with limited English proficiency. PMI engagement efforts with underserved communities, including members of minority populations or individuals who have experienced health disparities such as Vietnamese Americans with limited English proficiency, may help to enrich the diversity of the PMI.OBJECTIVE: The aim of this study is to examine the attitudes towards and perceptions of precision health, motivations and barriers to participation in precision health research, and acceptability of SMS text messaging as a recruitment and intervention strategy among underserved Vietnamese Americans.METHODS: A community sample of 37 Vietnamese Americans completed a survey and participated in one of 3 focus groups classified by age (18-30, 31-59, and ≥60 years) on topics related to precision health, participation in precision health research, texting or social media use experience, and insights on how to use text messages for recruitment and intervention. Participants were recruited via community organizations that serve Vietnamese Americans, flyers, word of mouth, and Vietnamese language radio announcements.RESULTS: Most participants had little knowledge of precision health initially. After brief education, they had positive attitudes toward precision health, although the motivation to participate in precision health research varied by age and prior experience of research participation. The main motivators to participate included the desire for more knowledge and more representation of Vietnamese Americans in research. Participants were open to receiving text messages as part of their research participation and provided specific suggestions on the design and delivery of such messages (eg, simple, in both English and Vietnamese). Examples of barriers included misinterpretation of messages, cost (to send text messages), and preferences for different texting platforms across age groups.CONCLUSIONS: This study represents one of the first formative research studies to recruit underserved Vietnamese Americans to precision health research. It is critical to understand target communities' motivations and barriers to participation in research. Delivering culturally appropriate text messages via age-appropriate texting and social media platforms may be an effective recruitment and intervention strategy. The next step is to develop and examine the feasibility of a culturally tailored precision health texting strategy for Vietnamese Americans.

  View details for DOI 10.2196/23058

  View details for PubMedID 33704080

• Effect of electronic clinical decision support on inappropriate prescriptions in older adults. Journal of the American Geriatrics Society Singhal, S., Krishnamurthy, A., Wang, B., Weng, Y., Sharp, C., Shah, N., Ahuja, N., Hosamani, P., Periyakoil, V. S., Hom, J. 2021

  View details for DOI 10.1111/jgs.17608

  View details for PubMedID 34877652

• Racial Equity in Palliative Care. Journal of pain and symptom management Quest, T. E., Periyakoil, V. S., Quill, T. E., Casarett, D. 2020

  View details for DOI 10.1016/j.jpainsymman.2020.12.005

  View details for PubMedID 33346065

• Launching the Next Steps to Improve Hospice and Palliative Medicine Fellow Performance Assessment: A Look Back to the Initial Toolkit of Assessment Methods. Journal of pain and symptom management Morrison, L. J., Periyakoil, V. S., Arnold, R. M., Tucker, R., Chittenden, E., Sanchez-Reilly, S., Carey, E. C. 2020

  Abstract

  Education leaders in hospice and palliative medicine (HPM) have long acknowledged the challenge of fellow performance assessment and the need for HPM-specific fellow assessment tools. In 2010, and in alignment with the Accreditation Council for Graduate Medical Education's (ACGME's) directive toward competency-based medical education, the national HPM Competencies Workgroup curated a set of assessment tools, the HPM Toolkit of Assessment Methods. The Toolkit has been a resource for HPM fellowship directors in evolving practical, multifaceted fellow assessment strategies. Now, as American Academy of Hospice and Palliative Medicine plans for a national workgroup in 2020 to define current HPM fellow assessment methods and to propose strategies to strengthen and standardize future assessment, the Toolkit provides a strong base from which to launch. However, the field learned important lessons from the 2010 Workgroup about the consensus process, gaps in areas of assessment, opportunities to address gaps with new or adapted tools, and limitations in implementing the Toolkit over time in terms of tracking, accessibility, and dissemination. This article describes the development of the Toolkit, including recommended tools and methods for assessment within each ACGME competency domain, and links the lessons learned to recommendations for the 2020 workgroup to consider in creating the next HPM assessment strategy and toolkit. Effective implementation will be crucial in supporting fellows to reach independent practice, which will further strengthen the field and workforce to provide the highest quality patient and family-centered care in serious illness. This will require an inspired, committed effort from the HPM community, which we enthusiastically anticipate.

  View details for DOI 10.1016/j.jpainsymman.2020.10.014

  View details for PubMedID 33091584

• Longitudinal Coaching and Decision Support Provided by a Patient-Family Liaison Promotes Goal-Concordant Care JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Periyakoil, V. S., Blinderman, C. D., Schechter, W. S. 2020; 68 (9): 1933–35

  View details for DOI 10.1111/jgs.16684

  View details for Web of Science ID 000562914400001

  View details for PubMedID 32853396

• Case Report of the Importance of 'Body Integrity' to a Vietnamese-Chinese American Patient for End of Life Care and Terminal Extubation Zeng, H., Periyakoil, V. J. ELSEVIER SCIENCE INC. 2020: 306–7

  View details for Web of Science ID 000542565600235

• Pandemic Palliative Care Consultations Spanning State and Institutional Borders JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Nakagawa, S., Berlin, A., Widera, E., Periyakoil, V. S., Smith, A. K., Blinderman, C. D. 2020; 68 (8): 1683–85

  View details for DOI 10.1111/jgs.16643

  View details for Web of Science ID 000541171900001

  View details for PubMedID 32441788

  View details for PubMedCentralID PMC7280694

• The Need of the Hour: Culturally Competent Care for Seriously Ill Patients JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. J. 2020; 23 (4): 440–41

  View details for DOI 10.1089/jpm.2020.0087

  View details for Web of Science ID 000521747200002

  View details for PubMedID 32216689

• Culture Eats Strategy for Breakfast: Reflections on Wang (DOI: 10.1089/jpm.2019.0251) Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients in the Emergency Department. Journal of palliative medicine Zeng, H., Sekhon, S., Periyakoil, V. S. 2020; 23 (1): 12

  View details for DOI 10.1089/jpm.2019.0472

  View details for PubMedID 31905087

• A randomized trial of a specialist palliative care intervention for patients undergoing surgery for cancer: rationale and design of the Surgery for Cancer with Option of Palliative Care Expert (SCOPE) Trial TRIALS Shinall, M. C., Hoskins, A., Hawkins, A. T., Bailey, C., Brown, A., Agarwal, R., Duggan, M. C., Beskow, L. M., Periyakoil, V. S., Penson, D. F., Jarrett, R. T., Chandrasekhar, R., Ely, E. 2019; 20 (1): 713

  Abstract

  In medical oncology settings, early specialist palliative care interventions have demonstrated improvements in patient quality of life and survival compared with usual oncologic care. However, the effect of early specialist palliative care interventions in surgical oncology settings is not well studied.The Surgery for Cancer with Option for Palliative Care Expert (SCOPE) Trial is a single-center, prospective, single-blind, randomized controlled trial of a specialist palliative care intervention for cancer patients undergoing non-palliative surgery. It will enroll 236 patients scheduled for major abdominal operations for malignancy, who will be randomized 1:1 at enrollment to receive usual care (control arm) or specialist palliative care consultation (intervention arm). Intervention arm patients will receive consultations from a palliative care specialist (physician or nurse practitioner) preoperatively and postoperatively. The primary outcome is physical and functional wellbeing at 90 days postoperatively. Secondary outcomes are quality of life at 90 days postoperatively, posttraumatic stress disorder symptoms at 180 days postoperatively, days alive at home without an emergency room visit in the first 90 postoperative days, and overall survival at 1 year postoperatively. Participants will be followed for 3 years after surgery for exploratory analyses of their ongoing quality of life, healthcare utilization, and mortality.SCOPE is an ongoing randomized controlled trial evaluating specialist palliative care interventions for cancer patients undergoing non-palliative oncologic surgery. Findings from the study will inform ways to identify and improve care of surgical patients who will likely benefit from specialist palliative care services.ClinicalTrials.gov Identifier: NCT03436290 First Registered: 16 February 2018 Enrollment Began: 1 March 2018 Last Update: 20 December 2018.

  View details for DOI 10.1186/s13063-019-3754-0

  View details for Web of Science ID 000506885800008

  View details for PubMedID 31829237

  View details for PubMedCentralID PMC6907134

• Results From a Survey of American Geriatrics Society Members' Views on Physician-Assisted Suicide JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Rosenberg, L. J., Butler, J. M., Caprio, A. J., Rhodes, R. L., Braun, U. K., Vitale, C. A., Telonidis, J., Periyakoil, V. S., Farrell, T. W. 2020; 68 (1): 23–30

  Abstract

  Physician-assisted suicide (PAS) is a controversial practice, currently legal in nine states and the District of Columbia. No prior study explores the views of the American Geriatrics Society (AGS) membership on PAS.We surveyed 1488 randomly selected AGS members via email.A total of 369 AGS members completed the survey (24.8% response rate).We conducted bivariate correlation analyses of beliefs related to support for PAS. We also conducted qualitative analysis of open-ended responses.There was no consensus regarding the acceptability of PAS, with 47% supporting and 52% opposing this practice. PAS being legal in the respondent's state, belief that respect for autonomy alone is sufficient to justify PAS, and intent to prescribe or support requests for PAS if legal in state of practice all correlated with support for PAS. There was no consensus on whether the AGS should oppose, support, or adopt a neutral stance on PAS. Most respondents believed that PAS is more complex among patients with low health literacy, low English proficiency, disability, dependency, or frailty. Most respondents supported mandatory palliative care consultation and independent assessments from two physicians. Themes identified from qualitative analysis include role of the medical profession, uncertainty of the role of professional organizations, potential unintended consequences, autonomy, and ethical and moral considerations.There was no consensus among respondents regarding the acceptability of PAS. Respondents expressed concern about vulnerable older populations and the need for safeguards when responding to requests for PAS. Ethical, legal, and policy discussions regarding PAS should consider vulnerable populations. J Am Geriatr Soc 68:23-30, 2019.

  View details for DOI 10.1111/jgs.16245

  View details for Web of Science ID 000499782200001

  View details for PubMedID 31791113

• Common Types of Gender-Based Microaggressions in Medicine. Academic medicine : journal of the Association of American Medical Colleges Periyakoil, V. S., Chaudron, L., Hill, E. V., Pellegrini, V., Neri, E., Kraemer, H. C. 2019

  Abstract

  PURPOSE: Microaggressions are subtle verbal or nonverbal everyday behaviors that arise from unconscious bias, covert prejudice, or hostility. They may contribute to the persistent disparities faced by women in medicine. In this study, the authors sought to identify common microaggressions experienced by women faculty in medicine and to determine if specific demographic characteristics affect the reported frequencies of these microaggressions.METHOD: The authors used chain referral sampling to collect real-life anecdotes about microaggressions from women faculty across the nation. Thirty-four unique experiences from those reported were identified and scripted then reenacted using professional actors to create 34 videos of the real-life microaggressions and 34 corresponding fictional "control" versions of the same situations. The videos, presented in a random order, were evaluated by faculty from 4 academic medical centers from 2016-2018.RESULTS: A total of 124 faculty (79 women, 45 men) participated. Women reported higher frequencies of microaggressions than men in 33 of the 34 videos depicting microaggressions (P value range: < .001 to .042, area under the curve [AUC] range: 0.60 to 0.69). No such differences were seen with the control videos. Women identified 21 microaggressions as occurring frequently. No significant differences were found with respect to participants' age, race/ethnicity, academic rank, or years in medicine. Post hoc analyses showed that the microaggressions fell into 6 themes: encountering sexism, encountering pregnancy and child care related bias, having abilities underestimated, encountering sexually inappropriate comments, being relegated to mundane tasks, and feeling excluded/marginalized.CONCLUSIONS: Privilege is often invisible to those who have it, whereas bias and discrimination are readily apparent to those who experience it. Knowledge of common microaggressions will allow for targeted individual, interpersonal, and institutional solutions to mitigate disparities in medicine.

  View details for DOI 10.1097/ACM.0000000000003057

  View details for PubMedID 31688038

• Reply to: Older People's Loneliness in Clinical Work JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Perissinotto, C., Holt-Lunstad, J., Periyakoil, V. S., Covinsky, K. 2019; 67 (10): 2212–13

  View details for DOI 10.1111/jgs.16115

  View details for Web of Science ID 000479915900001

  View details for PubMedID 31381836

• Healthcare Utilization is High in Adult Patients Relapsing after Allogeneic Hematopoietic Cell Transplantation BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Langston, J. A., Sundaram, V., Periyakoil, V. S., Muffly, L. 2019; 25 (8): 1659–65

  View details for DOI 10.1016/j.bbmt.2019.04.001

  View details for Web of Science ID 000483008500026

• Providing Culturally Respectful Care for Seriously Ill Vietnamese Americans JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Tran, Q. H., Dieu-Hien, H. T., King, I. N., Sheehan, K., Iglowitz, M., Periyakoil, V. S. 2019; 58 (2): 344–54

  Abstract

  Vietnamese Americans are a heterogeneous population with a rich, shared experience and historical and cultural influences from Asia and Europe. Societal upheaval resulting from the Vietnam War and varied immigration patterns to the U.S. and levels of acculturation layer complexity to this resilient population. These experiences influence how the communities as a whole and how the family as a unit approach health care issues, their attitudes toward serious illness and care at the end of life. Challenges with caring for this population include lack of resources and training to provide culturally sensitive care, lack of appropriate advance care planning, and lack of interpreters or culture-specific care programs. All contribute to poor end-of-life care. An understanding of how these complexities interplay may help clinicians provide compassionate and patient-centric care to these patients, their families, and their supporting communities. This article provides an overview of culturally effective care for seriously ill Vietnamese American patients and makes recommendations for potential strategies for providing respectful end-of-life care.

  View details for DOI 10.1016/j.jpainsymman.2019.03.012

  View details for Web of Science ID 000477705700022

  View details for PubMedID 30922704

• VA Interprofessional Fellowship in Palliative Care: 15 Years of Training Excellence JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE Weller, R., Healy, J., Hettler, D. L., Howe, J. L., Smith, H. M., Steckart, M., Periyakoil, V. S. 2019; 15 (2-3): 85–98

  Abstract

  Since 2002, the Department of Veterans Affairs (VA) has provided a unique training opportunity in palliative care at six VA medical centers. The VA Interprofessional Fellowship in Palliative Care has trained chaplains, nurses, pharmacists, physicians, psychologists, and social workers to provide clinical palliative care and to develop as leaders in the profession. This article describes the program's origin, mission, outcomes, and lessons learned.

  View details for DOI 10.1080/15524256.2019.1645797

  View details for Web of Science ID 000486759900005

  View details for PubMedID 31385743

• Introduction to the Special Issue on the Workforce for Seriously Ill Older Adults in the Community JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Spetz, J., Periyakoil, V. S. 2019; 67: S390

  View details for DOI 10.1111/jgs.15942

  View details for Web of Science ID 000467584600001

  View details for PubMedID 31074848

• Health Care Utilization is High in Adult Patients Relapsing After Allogeneic Hematopoietic Cell Transplantation. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation Langston, J. A., Sundaram, V., Periyakoil, V. S., Muffly, L. 2019

  Abstract

  Disease relapse is the leading cause of death for patients with acute leukemia (AL) and myelodyspastic syndrome (MDS) who undergo allogeneic hematopoietic cell transplantation (HCT). Relapse post-HCT is associated with poor prognosis; however, the inpatient health care utilization of this population is unknown. Here we describe survival, intensity of health care utilization, and characteristics associated with high resource utilization at the end-of-life (EOL). Adult patients with AL/MDS who underwent HCT at a large regional referral center with subsequent relapse between 2005 and 2015 were included in this retrospective study. We compared the distribution of demographic and clinical characteristics of patients as well as health care utilization over two years post-relapse and at EOL by post-relapse disease-directed therapeutic interventions. We created a composite score for EOL healthcare utilization intensity summing the presence of any of the following criteria: death in the hospital, the use of chemotherapy, emergency department, hospitalization, intensive care unit, intubation, cardiopulmonary resuscitation, or hemodialysis in the last month of life. Higher scores indicate more intense health care use at EOL. Multivariable linear regression analysis was used to determine variables (demographic characteristics, post-relapse treatment group, advance directives documentation, palliative care referral, time to relapse) associated with EOL healthcare utilization intensity. 154 patients were included; median age at relapse was 56 years (IQR 39-63), 55% were male, 79% had AL, median time from HCT to relapse was 6 months (IQR 3-10 months). Following relapse, 28% received supportive care only, 50% received chemotherapy only, and 22% received chemotherapy plus cell therapy (either donor lymphocyte infusion (DLI), second HCT, or DLI plus second HCT). With the exception of time until relapse, baseline characteristics (gender, age, race, graft versus host disease, year of treatment) did not significantly differ by post-relapse treatment group. One hundred and thirty-six patients (88%) died within two years of relapse; survival differed significantly by post-relapse treatment group, with those receiving disease directed treatment showing lower risk of death. Health care utilization in AL/MDS patients following post-HCT relapse was high overall with 44% visiting the ED at least once (22% >= 2 times), 93% hospitalized (55% >= 2 times; 16% >= 5 times), and 38% using the ICU (median length of stay 5 days; IQR 3-10 days). Utilization was high even among those receiving only supportive care. For those patients who died, the mean (SD) intensity score for EOL healthcare use was 1.8 (1.8). Most (70%) had a marker of high-intensity healthcare utilization at the EOL or died in hospital. In multivariable analysis, post-relapse chemotherapy plus cell therapy (estimate (95% CI): 1.30 (0.35-2.26) compared to no treatment was associated with more intense EOL health care use; no other variables were associated with intensity of EOL health care use. Health care utilization following post-HCT relapse is associated with receipt of disease-directed therapy, but remains high across all groups despite known poor prognosis. Interventions are needed to minimize nonbeneficial treatments and promote goal-concordant EOL care in this seriously ill patient population.

  View details for PubMedID 30959162

• Beyond the Horizon: Providing Palliative and End-of-Life Care for Undocumented Immigrants in the United States Lal, A., O'Mahony, S., Periyakoil, V., Quinlan, N., Metchnikoff, C., Kinderman, A., Patel, M., Stroe, S. ELSEVIER SCIENCE INC. 2019: 393

  View details for DOI 10.1016/j.jpainsymman.2018.12.089

  View details for Web of Science ID 000456406900101

• Health Care Utilization and Intensity at End of Life is High Amongst Adults Who Relapse Following Allogeneic Hematopoietic Cell Transplantation Langston, J., Sundaram, V., Periyakoil, V., Muffly, L. ELSEVIER SCIENCE INC. 2019: 506

  View details for DOI 10.1016/j.jpainsymman.2018.12.297

  View details for Web of Science ID 000456406900300

• Partnership to Enhance Resident Outcomes for Community Living Center Residents With Dementia: Description of the Protocol and Preliminary Findings. Journal of gerontological nursing Carpenter, J. n., Miller, S. C., Kolanowski, A. M., Karel, M. J., Periyakoil, V. S., Lowery, J. n., Levy, C. n., Sales, A. E., Ersek, M. n. 2019; 45 (3): 21–30

  Abstract

  The goal of this quality improvement project is to improve care planning around preferences for life-sustaining treatments (LST) and daily care to promote quality of life, autonomy, and safety for U.S. Department of Veterans Affairs (VA) Community Living Center (CLC) (i.e., nursing home) residents with dementia. The care planning process occurs through partnerships between staff and family surrogate decision makers. This process is separate from but supports implementation of the LST Decision Initiative-developed by the VA National Center for Ethics in Health Care-which seeks to increase the number, quality, and documentation of goals of care conversations (GOCC) with Veterans who have life-limiting illnesses. The current authors will engage four to six VA CLCs in the Mid-Atlantic states, provide teams with audit and feedback reports, and establish learning collaboratives to address implementation concerns and support action planning. The expected outcomes are an increase in CLC residents with dementia who have documented GOCC and LST plans. [Journal of Gerontological Nursing, 45(3), 21-30.].

  View details for DOI 10.3928/00989134-20190211-03

  View details for PubMedID 30789986

• A Practical Approach to Assessing and Mitigating Loneliness and Isolation in Older Adults. Journal of the American Geriatrics Society Perissinotto, C. n., Holt-Lunstad, J. n., Periyakoil, V. S., Covinsky, K. n. 2019

  Abstract

  Loneliness and social isolation are strongly associated with several adverse health outcomes in older persons including death and functional impairments. The strength of these associations has been compared with smoking. Accordingly, loneliness and isolation have significant public health implications. Despite the adverse impacts of loneliness and social isolation on quality of life, and their strong association with health outcomes, the evaluation of loneliness and isolation have not been integrated into medical care. The risks for loneliness may be of particular concern to persons with serious illness as patients and caregivers cope with the experience of loss, loss of independence, and increasing care needs. To date, there has been no uniform way of evaluating and documenting loneliness and social isolation as a part of a review of a patient's social determinants of health. This article provides a framework for healthcare systems, providers, and community members working with older adults to (1) understand loneliness, isolation, and its counterpart social connection; (2) describe the different ways loneliness affects health; and (3) create a framework for asking about and documenting these experiences. Finally, because the lack of studies assessing whether targeting loneliness can improve health outcomes is a major gap, we provide guidance on the future of interventions.

  View details for DOI 10.1111/jgs.15746

  View details for PubMedID 30762228

• Health Care Utilization Is High Amongst Adults Who Relapse Following Allogeneic Hematopoietic Cell Transplantation Langston, J., Sundaram, V., Periyakoil, V., Muffly, L. S. AMER SOC HEMATOLOGY. 2018

  View details for DOI 10.1182/blood-2018-99-113633

  View details for Web of Science ID 000454842805058

• Effect of a Lay HealthWorker Intervention on Goals-of-Care Documentation and on Health Care Use, Costs, and Satisfaction Among Patients With Cancer A Randomized Clinical Trial JAMA ONCOLOGY Patel, M. I., Sundaram, V., Desai, M., Periyakoil, V. S., Kahn, J. S., Bhattacharya, J., Asch, S. M., Milstein, A., Bundorf, M. 2018; 4 (10): 1359–66

  View details for DOI 10.1001/jamaoncol.2018.2446

  View details for Web of Science ID 000447066300012

• A Three-Step Letter Advance Directive Procedure to Facilitate Patient-Proxy Alignment in Advance Care Planning JOURNAL OF PALLIATIVE MEDICINE Alagappan, M., Richardson, M. T., Schoen, M. K., Muffly, L., Tierney, K., Jenkins, P., Neri, E., Kraemer, H. C., Periyakoil, V. S. 2018

  Abstract

  Little is known about the extent of alignment between hematopoietic stem cell transplant (HSCT) patients and their healthcare proxies with respect to advance care planning (ACP).To determine if a structured three-step process using the letter advance directive (LAD) could (1) allow for the differences in opinion between patient-proxy dyads to surface and (2) help bridge preexisting discordance about specific treatment choices.Blinded to each other, the HSCT patient (LAD-1) and proxy (LAD-2) each completed the LAD (step 1). They unmasked, compared LAD-1 and LAD-2, and discussed their choices (step 2). They completed a final letter directive (LAD-3) by consensus (step 3). Settings/Participants: Convenience sample of eighty dyads (patient and proxy) at a regional HSCT referral center.The mean patient-proxy concordance was 72.9% for the 12 questions in the LAD. Wanting to be pain free at the end of life was the statement with the most amount of agreement (88.75% in LAD-1, 91.25% in LAD-2, and 90% in LAD-3). Patient-proxy dyads had notable discordance related to specific treatments. The highest discordance was related to ventilator support (46.3% of patients refused it, while 58.8% of proxies refused on behalf of the patient). Overall, proxies were more likely than patients to opt in for dialyses and hospice care but more likely to opt out for cardiac resuscitation and sedation to palliate refractory symptoms. On open discussion, patient-proxy discordance mostly resolved in favor of the patient.The ACP process should allow for patient-proxy differences to surface, facilitate a discussion about the granular details with the goal of reaching consensus. Our three-step approach using the LAD is an effective way to identify areas of patient-proxy concordance and discordance about specific treatment preferences. A structured patient-proxy discussion using the LAD helped reconcile discordance and most often in favor of a patient's original wishes.

  View details for PubMedID 30247088

• Advance Care Planning in Cognitively Impaired Older Adults. Journal of the American Geriatrics Society deLima Thomas, J., Sanchez-Reilly, S., Bernacki, R., O'Neill, L., Morrison, L. J., Kapo, J., Periyakoil, V. S., Carey, E. C. 2018; 66 (8): 1469-1474

  Abstract

  Older adults with cognitive impairment face many healthcare challenges, chief among them participating in medical decision-making about their own health care. Advance care planning (ACP) is the process whereby individuals communicate their wishes for future care with their clinicians and surrogate decision-makers while they are still able to do so. ACP has been shown to improve important outcomes for individuals with cognitive impairment, but rates of ACP for these individuals are low because of individual-, clinician-, and system-related factors. Addressing ACP early in the illness trajectory can maximize the chances that people can participate meaningfully. This article recommends best practices for approaching ACP for older adults with cognitive impairment. The importance of providing anticipatory guidance and eliciting values to guide future care to create a shared framework between clinicians, individuals, and surrogate decision-makers is emphasized. It is recommended that ACP be approached as an iterative process to continue to honor and support people's wishes as cognitive impairment progresses and increasingly threatens independence and function. The article describes effective strategies for assessing decision-making capacity, identifying surrogate decision-makers, and using structured communication tools for ACP. It also provides guidelines for documentation and billing. Finally, special considerations for individuals with advanced dementia are described, including the use of artificial hydration and nutrition, decisions about site of care, and the role of hospice care.

  View details for DOI 10.1111/jgs.15471

  View details for PubMedID 30277566

• Advance Care Planning in Cognitively Impaired Older Adults JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Thomas, J., Sanchez-Reilly, S., Bernacki, R., O'Neill, L., Morrison, L. J., Kapo, J., Periyakoil, V. S., Carey, E. C. 2018; 66 (8): 1469–74

  View details for DOI 10.1111/jgs.15471

  View details for Web of Science ID 000444228500005

• End-of-Life Care for Unauthorized Immigrants in the U.S. Journal of pain and symptom management Metchnikoff, C., Naughton, G., Periyakoil, V. S. 2018; 55 (5): 1400–1407

  Abstract

  The Universal Declaration of Human Rights recognizes the inherent dignity, the equal and unalienable rights to be universally protected for all humans irrespective of race, color, gender, language, religion, political or other opinion, national or social origin, property, birth or other status. Though this includes the right to dignity-conserving care for terminally ill unauthorized immigrants, access to quality end-of-life care eludes them. Most of the estimated 11.3 million unauthorized immigrants either entered the country without the knowledge of the U.S. Immigration and Customs Enforcement, or were admitted on a temporary visa and stayed past its expiration date. Unsafe living conditions, occupational hazards, lack of access to routine healthcare, scarceness of a social and financial support system, fear of deportation, discrimination and incarceration limit healthcare access of unauthorized immigrants. Lack of access to preventative primary care encounters often results in this population's dependence on acute emergency services for treatment. Lack of opportunity for advance care planning discussions and lack of eligibility to hospice services commonly contributes to poor end of life care. As unauthorized immigrants approach the last days of life, they may often die alone, away from their loved ones, with little-to-no psychosocial support in their final moments. This article provides an overview on end-of-life care for unauthorized immigrants and makes recommendations for potential strategies to providing humane care and support to this vulnerable population.

  View details for PubMedID 29496325

• Common Items on a Bucket List JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., Neri, E., Kraemer, H. 2018; 21 (5): 652–58

  View details for DOI 10.1089/jpm.2017.0512

  View details for Web of Science ID 000432202700016

• End-of-Life Care for Unauthorized Immigrants in the US JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Metchnikoff, C., Naughton, G., Periyakoil, V. S. 2018; 55 (5): 1400–1407

  View details for DOI 10.1016/j.jpainsymman.2018.01.012

  View details for Web of Science ID 000430180700023

• Advance Directive Utilization Is Associated with Less Aggressive End-of-Life Care in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Cappell, K., Sundaram, V., Park, A., Shiraz, P., Gupta, R., Jenkins, P., Periyakoil, V. J., Muffly, L. 2018; 24 (5): 1035–40

  View details for DOI 10.1016/j.bbmt.2018.01.014

  View details for Web of Science ID 000433400000021

• Should We Bury "The Good Death"? JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Smith, A. K., Periyakoil, V. S. 2018; 66 (5): 856–58

  View details for DOI 10.1111/jgs.15321

  View details for Web of Science ID 000433585500004

  View details for PubMedID 29508391

  View details for PubMedCentralID PMC5992042

• Our Differences Make Us Stronger. Journal of pain and symptom management Periyakoil, V. S., O'Mahony, S., Elk, R., Quill, T. 2018; 55 (5): 1398–99

  View details for DOI 10.1016/j.jpainsymman.2018.02.008

  View details for PubMedID 29481962

• Reversals and limitations on high-intensity, life-sustaining treatments PLOS ONE Chavez, G., Richman, I. B., Kaimal, R., Bentley, J., Yasukawa, L., Altman, R. B., Periyakoil, V. S., Chen, J. H. 2018; 13 (2): e0190569

  Abstract

  Critically ill patients often receive high-intensity life sustaining treatments (LST) in the intensive care unit (ICU), although they can be ineffective and eventually undesired. Determining the risk factors associated with reversals in LST goals can improve patient and provider appreciation for the natural history and epidemiology of critical care and inform decision making around the (continued) use of LSTs.This is a single institution retrospective cohort study of patients receiving life sustaining treatment in an academic tertiary hospital from 2009 to 2013. Deidentified patient electronic medical record data was collected via the clinical data warehouse to study the outcomes of treatment limiting Comfort Care and do-not-resuscitate (DNR) orders. Extended multivariable Cox regression models were used to estimate the association of patient and clinical factors with subsequent treatment limiting orders.10,157 patients received life-sustaining treatment while initially Full Code (allowing all resuscitative measures). Of these, 770 (8.0%) transitioned to Comfort Care (with discontinuation of any life-sustaining treatments) while 1,669 (16%) patients received new DNR orders that reflect preferences to limit further life-sustaining treatment options. Patients who were older (Hazard Ratio(HR) 1.37 [95% CI 1.28-1.47] per decade), with cerebrovascular disease (HR 2.18 [95% CI 1.69-2.81]), treated by the Medical ICU (HR 1.92 [95% CI 1.49-2.49]) and Hematology-Oncology (HR 1.87 [95% CI 1.27-2.74]) services, receiving vasoactive infusions (HR 1.76 [95% CI 1.28, 2.43]) or continuous renal replacement (HR 1.83 [95% CI 1.34, 2.48]) were more likely to transition to Comfort Care. Any new DNR orders were more likely for patients who were older (HR 1.43 [95% CI 1.38-1.48] per decade), female (HR 1.30 [95% CI 1.17-1.44]), with cerebrovascular disease (HR 1.45 [95% CI 1.25-1.67]) or metastatic solid cancers (HR 1.92 [95% CI 1.48-2.49]), or treated by Medical ICU (HR 1.63 [95% CI 1.42-1.86]), Hematology-Oncology (HR 1.63 [95% CI 1.33-1.98]) and Cardiac Care Unit-Heart Failure (HR 1.41 [95% CI 1.15-1.72]).Decisions to reverse or limit treatment goals occurs after more than 1 in 13 trials of LST, and is associated with older female patients, receiving non-ventilator forms of LST, cerebrovascular disease, and treatment by certain medical specialty services.

  View details for PubMedID 29489814

• Implementing goals of care conversations with veterans in VA long-term care setting: a mixed methods protocol (vol 11, 132, 2016) IMPLEMENTATION SCIENCE Sales, A. E., Ersek, M., Intrator, O. K., Levy, C., Carpenter, J. G., Hogikyan, R., Kales, H. C., Landis-Lewis, Z., Olsan, T., Miller, S. C., Montagnini, M., Periyakoil, V. S., Reder, S. 2018; 13: 29

  Abstract

  The authors would like to correct errors in the original article [1] that may have lead readers to misinterpret the scope, evidence base and target population of VHA Handbook 1004.03 "Life-Sustaining Treatment (LST) Decisions: Eliciting, Documenting, and Honoring Patients' Values, Goals, and Preferences".

  View details for DOI 10.1186/s13012-018-0724-y

  View details for Web of Science ID 000425143900003

  View details for PubMedID 29426346

  View details for PubMedCentralID PMC5809112

• Why Do You Want to Know and Why Should I Trust You? Implicit Messaging in Cross-Cultural (Mis)Understandings Singer, M., Periyakoil, V., Elk, R. ELSEVIER SCIENCE INC. 2018: 583

  View details for Web of Science ID 000425399300117

• Advance Directive Utilization is Associated with Less Aggressive End-of-Life Care in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation Cappell, K. n., Sundaram, V. n., Park, A. n., Shiraz, P. n., Gupta, R. n., Jenkins, P. n., Periyakoil, V. S., Muffly, L. n. 2018

  Abstract

  Background Allogeneic hematopoietic cell transplantation (HCT) is associated with significant morbidity and mortality, making advance care planning (ACP) and management especially important in this patient population. A paucity of data exists on the utilization of ACP amongst allogeneic HCT recipients, and the relationship between ACP and intensity of health care utilization in these patients. Methods We performed a retrospective review of patients receiving allogeneic HCT at our institution from 2008 to 2015 who had subsequently died following HCT. Documentation and timing of advance directive (AD) completion were abstracted from the electronic medical record. Outcomes of interest included (a) utilization of intensive care unit level of care (ICU) at (i) any time point following HCT, (ii) within 30 days of death, (iii) within 14 days of death, (b) use of mechanical ventilation at any time point following HCT, and (c) location of death. Univariate logistic regression was performed to explore associations between AD completion and each outcome. Results Of the 1031 patients who received allogeneic HCT during the study period, there were 422 (41%) decedents who are included in the analysis. Forty-four percent had AD documentation prior to death. A majority of patients (69%) indicated that if terminally ill, they did not wish to be subjected to life-prolonging treatment attempts. Race/ethnicity was significantly associated with AD documentation, with Non-Hispanic White patients documenting ADs more frequently (51%) compared to Hispanic (22%) or Asian patients (35%); p= 0.0007. Patients with AD were less likely to utilize the ICU during the transplant course (41% for patients with AD versus 52% of patients without AD; p= 0.03) and also were less likely to receive mechanical ventilation at any point following transplantation (21% versus 37%; p<0.001). AD documentation was also associated with decreased ICU utilization at the end-of-life; relative to patients without AD, patients with AD were more likely to die at home or in hospital as opposed to in the ICU (OR 0.44, 95% CI 0.27-0.72).ACP remains underutilized in allogeneic HCT. Adoption of a systematic practice to standardize AD documentation as part of allogeneic HCT planning has the potential to significantly reduce ICU utilization and mechanical ventilation while improving quality of care at end-of-life in HCT recipients.

  View details for PubMedID 29371107

• Integration of palliative care into oncology: A curriculum development project. Von Gunten, C. F., Periyakoil, V. J., Brown, A., Yzaguirre, B., Spiegel, S., Paris, A., Bender, S., Von Roenn, J. H. AMER SOC CLINICAL ONCOLOGY. 2017

  View details for DOI 10.1200/JCO.2017.35.31_suppl.202

  View details for Web of Science ID 000443263300195

• Disrupting end-of-life cancer care delivery: Results from the engagment of patients with advanced cancer trial. Patel, M. I., Sundaram, V., Desai, M., Periyakoil, V. J., Kahn, J., Asch, S. M., Milstein, A., Bundorf, K. AMER SOC CLINICAL ONCOLOGY. 2017

  View details for DOI 10.1200/JCO.2017.35.15_suppl.6525

  View details for Web of Science ID 000411931706021

• A Randomized Clinical Trial Comparing the Letter Advance Directive to Traditional Advance Directives Periyakoil, V. WILEY. 2017: S113

  View details for Web of Science ID 000402876300322

• Redesigning Cancer Care Delivery: Views From Patients and Caregivers. Journal of oncology practice Patel, M. I., Periyakoil, V. S., Blayney, D. W., Moore, D., Nevedal, A., Asch, S., Milstein, A., Coker, T. R. 2017; 13 (4): e291-e302

  Abstract

  Cancer is a leading cause of death in the United States. Although treatments have improved, patients and caregivers continue to report significant gaps in their care. The objective of this study was to examine the views of patients and caregivers on their experiences with current cancer care delivery and identify key strategies to improve the delivery of care.Semistructured interviews were conducted with 75 patients and 45 caregivers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis.Participants reported multiple gaps in care delivery, including barriers in health communication with health care providers, lack of elucidation of care goals, lack of care coordination, and challenges in accessing care. Participants identified that greater use of nonphysician providers and alternative formats, such as telephone-based care and home and community-based care, would narrow these gaps.Understanding patients' and caregivers' experiences with gaps in cancer care delivery can inform cancer care delivery redesign efforts and lead to targeted interventions that result in patient-centered and family-oriented care.

  View details for DOI 10.1200/JOP.2016.017327

  View details for PubMedID 28399387

• "I Understand There's A New Law ...": Responding to Patient Inquiries About Physician-Assisted Dying VandeKieft, G., Widera, E., Periyakoil, V., Hess, D. ELSEVIER SCIENCE INC. 2017: 332

  View details for DOI 10.1016/j.jpainsymman.2016.12.060

  View details for Web of Science ID 000397118300089

• A Randomized Clinical Feasibility Trial Comparing the Letter Project Advance Directive to Traditional Advance Directive Periyakoil, V. J. ELSEVIER SCIENCE INC. 2017: 419

  View details for DOI 10.1016/j.jpainsymman.2016.12.228

  View details for Web of Science ID 000397118300250

• 2017 AAHPM Fellowship Directors Program: Building a Community of Educators Thomas, J., Back, A. L., Gustin, J., Jackson, V. A., Jacobsen, J., Landzaat, L. H., Levine, S. K., Neri, V., Periyakoil, V., Smith, C. ELSEVIER SCIENCE INC. 2017: 305–6

  View details for Web of Science ID 000397118300035

• Delivering End-of-Life Cancer Care: Perspectives of Providers. The American journal of hospice & palliative care Patel, M. I., Periyakoil, V. S., Moore, D. n., Nevedal, A. n., Coker, T. R. 2017: 1049909117719879

  Abstract

  Persistent gaps in end-of-life cancer care delivery and growing associated expenditures remain imminent US public health issues. The objective of this study was to understand clinical providers' experiences delivering cancer care for patients at the end of life and their perspectives on potential solutions to improve quality of care.Semistructured interviews were conducted with 75 cancer care providers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis.Providers identified 3 major cancer care delivery challenges including lack of time to educate patients and caregivers due to clinical volume and administrative burdens, ambiguity in determining both prognosis and timing of palliative care at the end-of-life, and lack of adequate systems to support non-face-to-face communication with patients. To address these challenges, providers endorsed several options for clinical practice redesign in their settings. These include use of a lay health worker to assist in addressing early advance care planning, proactive non-face-to-face communication with patients specifically regarding symptom management, and community and in-home delivery of cancer care services.Specific strategies for cancer care redesign endorsed by health-care providers may be used to create interventions that can more efficiently and effectively address gaps in end-of-life cancer care.

  View details for PubMedID 28691498

• Supporting patients who are bereaved. BMJ (Clinical research ed.) Shear, M. K., Muldberg, S. n., Periyakoil, V. n. 2017; 358: j2854

  View details for DOI 10.1136/bmj.j2854

  View details for PubMedID 28684392

• Multi-Ethnic Attitudes Toward Physician-Assisted Death in California and Hawaii JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., Kraemer, H., Neri, E. 2016; 19 (10): 1060-1065

  Abstract

  As aid-in-dying laws are gaining more public acceptance and support, it is important to understand diverse perceptions toward physician-assisted death (PAD). We compare attitudes of residents from California and Hawaii to identify variables that may predict attitudes toward PAD.A cross-sectional online survey of 1095 participants (a 75.8% survey completion rate) from California and 819 from Hawaii (a 78.4% survey completion rate). Data were collected between July through October 2015.Majority of study participants in California (72.5%) and Hawaii (76.5%) were supportive of PAD. Only 36.8% of participants in Hawaii and 34.8% of participants in California reported completing advance directives. To better understand which subgroups were most in favor of PAD, data were analyzed using both recursive partitioning and stepwise logistic regression. Older participants were more supportive of PAD in both states. Also, all ethnic groups were equally supportive of PAD. Completion of advance directives was not a significant predictor of attitudes toward PAD. Persons who reported that faith/religion/spirituality was less important to them were more likely to support PAD in both states. Thus, the major influences on the attitudes to PAD were religious/spiritual views and age, not ethnicity and gender. Even in the subgroups least supportive of PAD, the majority supported PAD.This study shows that in the ethnically diverse states of California and Hawaii, faith/religion/spirituality and age are major influencers of attitudes toward PAD and not ethnicity and gender. Even in the subgroups least supportive of PAD, the majority supports PAD.

  View details for DOI 10.1089/jpm.2016.0160

  View details for PubMedID 27276445

• Implementing goals of care conversations with veterans in VA long-term care setting: a mixed methods protocol IMPLEMENTATION SCIENCE Sales, A. E., Ersek, M., Intrator, O. K., Levy, C., Carpenter, J. G., Hogikyan, R., Kales, H. C., Landis-Lewis, Z., Olsan, T., Miller, S. C., Montagnini, M., Periyakoil, V. S., Reder, S. 2016; 11

  Abstract

  The program "Implementing Goals of Care Conversations with Veterans in VA LTC Settings" is proposed in partnership with the US Veterans Health Administration (VA) National Center for Ethics in Health Care and the Geriatrics and Extended Care Program Offices, together with the VA Office of Nursing Services. The three projects in this program are designed to support a new system-wide mandate requiring providers to conduct and systematically record conversations with veterans about their preferences for care, particularly life-sustaining treatments. These treatments include cardiac resuscitation, mechanical ventilation, and other forms of life support. However, veteran preferences for care go beyond whether or not they receive life-sustaining treatments to include issues such as whether or not they want to be hospitalized if they are acutely ill, and what kinds of comfort care they would like to receive.Three projects, all focused on improving the provision of veteran-centered care, are proposed. The projects will be conducted in Community Living Centers (VA-owned nursing homes) and VA Home-Based Primary Care programs in five regional networks in the Veterans Health Administration. In all the projects, we will use data from context and barrier and facilitator assessments to design feedback reports for staff to help them understand how well they are meeting the requirement to have conversations with veterans about their preferences and to document them appropriately. We will also use learning collaboratives-meetings in which staff teams come together and problem-solve issues they encounter in how to get veterans' preferences expressed and documented, and acted on-to support action planning to improve performance.We will use data over time to track implementation success, measured as the proportions of veterans in Community Living Centers (CLCs) and Home-Based Primary Care (HBPC) who have a documented goals of care conversation soon after admission. We will work with our operational partners to spread approaches that work throughout the Veterans Health Administration.

  View details for DOI 10.1186/s13012-016-0497-0

  View details for Web of Science ID 000384773200001

  View details for PubMedID 27682236

  View details for PubMedCentralID PMC5041212

• Renal Palliative Care Studies: Coming of Age JOURNAL OF PALLIATIVE MEDICINE Cheung, K. L., Periyakoil, V. S. 2016; 19 (6): 582–83

  View details for DOI 10.1089/jpm.2016.0175

  View details for Web of Science ID 000378044100001

• Physician Assisted Death in California and Hawaii: Multi-ethnic Perspectives Periyakoil, V., Kraemer, H., Neri, E. WILEY-BLACKWELL. 2016: S99

  View details for Web of Science ID 000374763800275

• Patient-Reported Barriers to High-Quality, End-of-Life Care: A Multiethnic, Multilingual, Mixed-Methods Study JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., Neri, E., Kraemer, H. 2016; 19 (4): 373-379

  Abstract

  The study objective was to empirically identify barriers reported by multiethnic patients and families in receiving high-quality end-of-life care (EOLC).This cross-sectional, mixed-methods study in Burmese, English, Hindi, Mandarin, Tagalog, Spanish, and Vietnamese was held in multiethnic community centers in five California cities. Data were collected in 2013-2014. A snowball sampling technique was used to accrue 387 participants-261 women, 126 men, 133 Caucasian, 204 Asian Americans, 44 African Americans, and 6 Hispanic Americans. Measured were multiethnic patient-reported barriers to high-quality EOLC. A development cohort (72 participants) of responses was analyzed qualitatively using grounded theory to identify the six key barriers to high-quality EOLC. A new validation cohort (315 participants) of responses was transcribed, translated, and back-translated for verification. The codes were validated by analyses of responses from 50 randomly drawn subjects from the validation cohort. All the 315 validation cohort transcripts were coded for presence or absence of the six barriers.In the validation cohort, 60.6% reported barriers to receiving high-quality EOLC for persons in their culture/ethnicity. Primary patient-reported barriers were (1) finance/health insurance barriers, (2) doctor behaviors, (3) communication chasm between doctors and patients, (4) family beliefs/behaviors, (5) health system barriers, and (6) cultural/religious barriers. Age (χ(2) = 9.15, DF = 1, p = 0.003); gender (χ(2) = 6.605, DF = 1, p = 0.01); and marital status (χ(2) = 16.11 DF = 3, p = 0.001) were associated with reporting barriers; and women <80 years were most likely to report barriers to receiving high-quality EOLC. Individual responses of reported barriers were analyzed and only the participant's level of education (Friedman statistic = 2.16, DF = 10, p = 0.02) significantly influenced choices.Multiethnic patients report that high-quality EOLC is important to them; but unfortunately, a majority state that they have encountered barriers to receiving such care. Efforts must be made to rapidly improve access to culturally competent EOLC for diverse populations.

  View details for DOI 10.1089/jpm.2015.0403

  View details for Web of Science ID 000373237500009

• Women in Academic Medicine: Measuring Stereotype Threat Among Junior Faculty JOURNAL OF WOMENS HEALTH Fassiotto, M., Hamel, E. O., Ku, M., Correll, S., Grewal, D., Lavori, P., Periyakoil, V. J., Reiss, A., Sandborg, C., Walton, G., Winkleby, M., Valantine, H. 2016; 25 (3): 292-298

  Abstract

  Gender stereotypes in science impede supportive environments for women. Research suggests that women's perceptions of these environments are influenced by stereotype threat (ST): anxiety faced in situations where one may be evaluated using negative stereotypes. This study developed and tested ST metrics for first time use with junior faculty in academic medicine.Under a 2012 National Institutes of Health Pathfinder Award, Stanford School of Medicine's Office of Diversity and Leadership, working with experienced clinicians, social scientists, and epidemiologists, developed and administered ST measures to a representative group of junior faculty.174 School of Medicine junior faculty were recruited (62% women, 38% men; 75% assistant professors, 25% instructors; 50% white, 40% Asian, 10% underrepresented minority). Women reported greater susceptibility to ST than did men across all items including ST vulnerability (p < 0.001); rejection sensitivity (p = 0.001); gender identification (p < 0.001); perceptions of relative potential (p = 0.048); and, sense of belonging (p = 0.049). Results of career-related consequences of ST were more nuanced. Compared with men, women reported lower beliefs in advancement (p = 0.021); however, they had similar career interest and identification, felt just as connected to colleagues, and were equally likely to pursue careers outside academia (all p > 0.42).Innovative ST metrics can provide a more complete picture of academic medical center environments. While junior women faculty are susceptible to ST, they may not yet experience all of its consequences in their early careers. As such, ST metrics offer a tool for evaluating institutional initiatives to increase supportive environments for women in academic medicine.

  View details for DOI 10.1089/jwh.2015.5380

  View details for Web of Science ID 000372173200014

• When Faith Hurts: Redemptive Suffering and Refusal of Symptomatic Treatment Macauley, R., Periyakoil, V. ELSEVIER SCIENCE INC. 2016: 315–16

  View details for DOI 10.1016/j.jpainsymman.2015.12.127

  View details for Web of Science ID 000373472900053

• A Mixed-Methods Study of Multi-Ethnic, Multi-Lingual Patient-Reported Barriers to Receiving Quality Care at the End of Life Periyakoil, V. ELSEVIER SCIENCE INC. 2016: 371–72

  View details for DOI 10.1016/j.jpainsymman.2015.12.236

  View details for Web of Science ID 000373472900159

• From Surviving to Thriving: A Self-Care Path to Resilience Sanchez-Reilly, S., Periyakoil, V., Kapo, J., Thomas, J., O'Neill, L. ELSEVIER SCIENCE INC. 2016: 312

  View details for DOI 10.1016/j.jpainsymman.2015.12.118

  View details for Web of Science ID 000373472900045

• A Never-Ending Battle. New England journal of medicine Periyakoil, V. S. 2015; 373 (25): 2399-2401

  Abstract

  "Were you in the Army, Navy, Air Force, Marine Corps, or the `Guard'?" I asked as I admitted my patient, a 78-year-old veteran. Mr. M. had florid heart failure, the result of multiple myocardial infarctions over years, each one taking a big bite out of his heart's pumping abilities and leaving his lungs and body waterlogged. His aging kidneys had slacked off, too, and despite maximal medical therapy he was now looking at a remaining lifespan of weeks. He was wheelchair-bound and tethered to his oxygen cylinder owing to profound air hunger. He sketched me a mocking salute. "U.S. Army . . .

  View details for DOI 10.1056/NEJMp1505976

  View details for PubMedID 26536398

• Women in Academic Medicine: Measuring Stereotype Threat Among Junior Faculty. Journal of women's health (2002) Fassiotto, M., Hamel, E. O., Ku, M., Correll, S., Grewal, D., Lavori, P., Periyakoil, V. J., Reiss, A., Sandborg, C., Walton, G., Winkleby, M., Valantine, H. 2015

  Abstract

  Gender stereotypes in science impede supportive environments for women. Research suggests that women's perceptions of these environments are influenced by stereotype threat (ST): anxiety faced in situations where one may be evaluated using negative stereotypes. This study developed and tested ST metrics for first time use with junior faculty in academic medicine.Under a 2012 National Institutes of Health Pathfinder Award, Stanford School of Medicine's Office of Diversity and Leadership, working with experienced clinicians, social scientists, and epidemiologists, developed and administered ST measures to a representative group of junior faculty.174 School of Medicine junior faculty were recruited (62% women, 38% men; 75% assistant professors, 25% instructors; 50% white, 40% Asian, 10% underrepresented minority). Women reported greater susceptibility to ST than did men across all items including ST vulnerability (p < 0.001); rejection sensitivity (p = 0.001); gender identification (p < 0.001); perceptions of relative potential (p = 0.048); and, sense of belonging (p = 0.049). Results of career-related consequences of ST were more nuanced. Compared with men, women reported lower beliefs in advancement (p = 0.021); however, they had similar career interest and identification, felt just as connected to colleagues, and were equally likely to pursue careers outside academia (all p > 0.42).Innovative ST metrics can provide a more complete picture of academic medical center environments. While junior women faculty are susceptible to ST, they may not yet experience all of its consequences in their early careers. As such, ST metrics offer a tool for evaluating institutional initiatives to increase supportive environments for women in academic medicine.

  View details for DOI 10.1089/jwh.2015.5380

  View details for PubMedID 26555562

• No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End-of-Life Conversations with Diverse Patients PLOS ONE Periyakoil, V. S., Neri, E., Kraemer, H. 2015; 10 (4)

  Abstract

  Though most patients wish to discuss end-of-life (EOL) issues, doctors are reluctant to conduct end-of-life conversations. Little is known about the barriers doctors face in conducting effective EOL conversations with diverse patients. This mixed methods study was undertaken to empirically identify barriers faced by doctors (if any) in conducting effective EOL conversations with diverse patients and to determine if the doctors' age, gender, ethnicity and medical sub-specialty influenced the barriers reported.Mixed-methods study of multi-specialty doctors caring for diverse, seriously ill patients in two large academic medical centers at the end of the training; data were collected from 2010 to 2012.Doctor-reported barriers to EOL conversations with diverse patients.1040 of 1234 potential subjects (84.3%) participated. 29 participants were designated as the development cohort for coding and grounded theory analyses to identify primary barriers. The codes were validated by analyses of responses from 50 randomly drawn subjects from the validation cohort (n= 996 doctors). Qualitative responses from the validation cohort were coded and analyzed using quantitative methods. Only 0.01 % doctors reported no barriers to conducting EOL conversations with patients. 99.99% doctors reported barriers with 85.7% finding it very challenging to conduct EOL conversations with all patients and especially so with patients whose ethnicity was different than their own. Asian-American doctors reported the most struggles (91.3%), followed by African Americans (85.3%), Caucasians (83.5%) and Hispanic Americans (79.3%) in conducting EOL conversations with their patients. The biggest doctor-reported barriers to effective EOL conversations are (i) language and medical interpretation issues, (ii) patient/family religio-spiritual beliefs about death and dying, (iii) doctors' ignorance of patients' cultural beliefs, values and practices, (iv) patient/family's cultural differences in truth handling and decision making, (v) patients' limited health literacy and (vi) patients' mistrust of doctors and the health care system. The doctors' ethnicity (Chi-Square = 12.77, DF = 4, p = 0.0125) and medical subspecialty (Chi-Square = 19.33, DF = 10, p =0.036) influenced their reported barriers. Friedman's test used to examine participants relative ranking of the barriers across sub-groups identified significant differences by age group (F statistic = 303.5, DF = 5, p < 0.0001) and medical sub-specialty (F statistic =163.7, DF = 5, p < 0.0001).Doctors report struggles with conducting effective EOL conversations with all patients and especially with those whose ethnicity is different from their own. It is vital to identify strategies to mitigate barriers doctors encounter in conducting effective EOL conversations with seriously ill patients and their families.

  View details for DOI 10.1371/journal.pone.0122321

  View details for Web of Science ID 000353331500019

  View details for PubMedID 25902309

  View details for PubMedCentralID PMC4406531

• No Easy Task: A Mixed Methods Study of Barriers to Conducting Effective End-Of-Life Conversations Reported by Multi-Specialty Doctors Periyakoil, V., Neri, E., Kraemer, H. ELSEVIER SCIENCE INC. 2015: 446–47

  View details for DOI 10.1016/j.jpainsymman.2014.11.255

  View details for Web of Science ID 000348478200234

• Training Fellows to Be Leaders: Ensuring the Future of Palliative Care Kapo, J., Carey, E., Periyakoil, V., Thomas, J., Morrison, L. ELSEVIER SCIENCE INC. 2015: 354

  View details for DOI 10.1016/j.jpainsymman.2014.11.078

  View details for Web of Science ID 000348478200057

• Understanding frailty in cancer patients. Cancer journal Baijal, P., Periyakoil, V. 2014; 20 (5): 358-366

  Abstract

  As population ages, the number of older adults with cancer is increasing rapidly. Chronological age per se is a poor guide for an oncologist to determine tolerance to cancer treatment. Older adults have been underrepresented in cancer clinical trials, leading to paucity of guidelines to meet the treatment challenges in this population. To evaluate an older adult with cancer, oncologists must understand age-related changes and identify the subset of population who is vulnerable and at risk of cancer treatment toxicity. Comprehensive geriatric assessments focusing on functional status, multimorbidity, nutritional status, cognitive impairment, and psychosocial support help recognize heterogeneity among older adults, leading to individualized approaches toward cancer treatment. The treatment decisions need to be made in collaboration with the patient's values and preferences.

  View details for DOI 10.1097/PPO.0000000000000068

  View details for PubMedID 25299146

• Prognostic stratification in older adults commencing dialysis. journals of gerontology. Series A, Biological sciences and medical sciences Cheung, K. L., Montez-Rath, M. E., Chertow, G. M., Winkelmayer, W. C., Periyakoil, V. S., Kurella Tamura, M. 2014; 69 (8): 1033-1039

  Abstract

  Accurate prognostic models could inform treatment decisions for older adults with end-stage renal disease who are considering dialysis and might identify patients more appropriate for conservative care or hospice.In a cohort of patients aged ≥67 years commencing dialysis in the United States between January 1, 2008 and June 30, 2009, we compared the discrimination of three existing instruments (the Liu index; the French Renal Epidemiology and Information Network score; and hospice eligibility criteria) for the prediction of 6-month mortality. We estimated the odds of death associated with each prognostic index using logistic regression with and without adjustment for age. Predictive indices were compared using the concordance ("c")-statistic.Of 44,109 eligible patients, 10,289 (23.3%) died within 6 months of dialysis initiation. The c-statistic for the Liu, Renal Epidemiology and Information Network, hospice eligibility criteria, and combined Liu/hospice eligibility criteria scores without and with age were 0.62/0.65, 0.63/0.66, 0.65/0.68, and 0.68/0.70, respectively. Discrimination was poorer at older ages, especially for the Liu and Renal Epidemiology and Information Network scores. Although sensitivity was poor, a Renal Epidemiology and Information Network score ≥9 or an hospice eligibility criteria ≥3 had relatively high specificity.Existing prognostic indices based on administrative data perform poorly with respect to prediction of 6-month mortality in older patients with end-stage renal disease commencing dialysis.

  View details for DOI 10.1093/gerona/glt289

  View details for PubMedID 24482541

• Raising the Bar for the Care of Seriously Ill Patients: Results of a National Survey to Define Essential Palliative Care Competencies for Medical Students and Residents ACADEMIC MEDICINE Schaefer, K. G., Chittenden, E. H., Sullivan, A. M., Periyakoil, V. S., Morrison, L. J., Carey, E. C., Sanchez-Reilly, S., Block, S. D. 2014; 89 (7): 1024-1031

  Abstract

  Given the shortage of palliative care specialists in the United States, to ensure quality of care for patients with serious, life-threatening illness, generalist-level palliative care competencies need to be defined and taught. The purpose of this study was to define essential competencies for medical students and internal medicine and family medicine (IM/FM) residents through a national survey of palliative care experts.Proposed competencies were derived from existing hospice and palliative medicine fellowship competencies and revised to be developmentally appropriate for students and residents. In spring 2012, the authors administered a Web-based, national cross-sectional survey of palliative care educational experts to assess ratings and rankings of proposed competencies and competency domains.The authors identified 18 comprehensive palliative care competencies for medical students and IM/FM residents, respectively. Over 95% of survey respondents judged the competencies as comprehensive and developmentally appropriate (survey response rate = 72%, 71/98). Using predefined cutoff criteria, experts identified 7 medical student and 13 IM/FM resident competencies as essential. Communication and pain/symptom management were rated as the most critical domains.This national survey of palliative care experts defines comprehensive and essential palliative care competencies for medical students and IM/FM residents that are specific, measurable, and can be used to report educational outcomes; provide a sequence for palliative care curricula in undergraduate and graduate medical education; and highlight the importance of educating medical trainees in communication and pain management. Next steps include seeking input and endorsement from stakeholders in the broader medical education community.

  View details for DOI 10.1097/ACM.0000000000000271

  View details for Web of Science ID 000338210000023

  View details for PubMedCentralID PMC4077186

• Position statement on interdisciplinary team training in geriatrics: an essential component of quality health care for older adults. Journal of the American Geriatrics Society 2014; 62 (5): 961-965

  Abstract

  Interdisciplinary team training (IDT) is an important component of ensuring quality geriatric care delivery, which can be complex and time intensive, requiring coordination of many medical, psychosocial, and therapeutic interventions and professionals. The Partnership for Health in Aging (PHA), a loose coalition of more than 30 organizations representing healthcare professionals who care for older adults supported by the American Geriatrics Society, identified IDT training in geriatrics as a priority area in addressing the geriatrics workforce shortage described in the 2008 Institute of Medicine report, Retooling for An Aging America: Building the Health Care Workforce. A PHA Workgroup on Interdisciplinary Team Training in Geriatrics was convened to review the literature focused on geriatrics IDT training and to develop a position statement that would inform and influence groups involved in the development and expansion of academic and continuing education programs in IDT training, including professional associations, credentialing and licensing bodies, accreditation organizations, and university administrators. There are significant challenges to expanding the development and implementation of geriatrics IDT training for health professionals, and such training will be successful only with substantial and sustained advocacy from the above professional groups.

  View details for DOI 10.1111/jgs.12822

  View details for PubMedID 24738753

• Do Unto Others: Doctors' Personal End-of-life Resuscitation Preferences and Their Attitudes Towards Advance Directives Periyakoil, V., Kraemer, H. C., Neri, E. WILEY-BLACKWELL. 2014: S1–S2

  View details for Web of Science ID 000333405500004

• Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA-the journal of the American Medical Association Porsteinsson, A. P., Drye, L. T., Pollock, B. G., Devanand, D. P., Frangakis, C., Ismail, Z., Marano, C., Meinert, C. L., Mintzer, J. E., Munro, C. A., Pelton, G., Rabins, P. V., Rosenberg, P. B., Schneider, L. S., Shade, D. M., Weintraub, D., Yesavage, J., Lyketsos, C. G. 2014; 311 (7): 682-691

  Abstract

  Agitation is common, persistent, and associated with adverse consequences for patients with Alzheimer disease. Pharmacological treatment options, including antipsychotics are not satisfactory.The primary objective was to evaluate the efficacy of citalopram for agitation in patients with Alzheimer disease. Key secondary objectives examined effects of citalopram on function, caregiver distress, safety, cognitive safety, and tolerability.The Citalopram for Agitation in Alzheimer Disease Study (CitAD) was a randomized, placebo-controlled, double-blind, parallel group trial that enrolled 186 patients with probable Alzheimer disease and clinically significant agitation from 8 academic centers in the United States and Canada from August 2009 to January 2013.Participants (n = 186) were randomized to receive a psychosocial intervention plus either citalopram (n = 94) or placebo (n = 92) for 9 weeks. Dosage began at 10 mg per day with planned titration to 30 mg per day over 3 weeks based on response and tolerability.Primary outcome measures were based on scores from the 18-point Neurobehavioral Rating Scale agitation subscale (NBRS-A) and the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change (mADCS-CGIC). Other outcomes were based on scores from the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory (NPI), ability to complete activities of daily living (ADLs), caregiver distress, cognitive safety (based on scores from the 30-point Mini Mental State Examination [MMSE]), and adverse events.Participants who received citalopram showed significant improvement compared with those who received placebo on both primary outcome measures. The NBRS-A estimated treatment difference at week 9 (citalopram minus placebo) was -0.93 (95% CI, -1.80 to -0.06), P = .04. Results from the mADCS-CGIC showed 40% of citalopram participants having moderate or marked improvement from baseline compared with 26% of placebo recipients, with estimated treatment effect (odds ratio [OR] of being at or better than a given CGIC category) of 2.13 (95% CI, 1.23-3.69), P = .01. Participants who received citalopram showed significant improvement on the CMAI, total NPI, and caregiver distress scores but not on the NPI agitation subscale, ADLs, or in less use of rescue lorazepam. Worsening of cognition (-1.05 points; 95% CI, -1.97 to -0.13; P = .03) and QT interval prolongation (18.1 ms; 95% CI, 6.1-30.1; P = .01) were seen in the citalopram group.Among patients with probable Alzheimer disease and agitation who were receiving psychosocial intervention, the addition of citalopram compared with placebo significantly reduced agitation and caregiver distress; however, cognitive and cardiac adverse effects of citalopram may limit its practical application at the dosage of 30 mg per day.clinicaltrials.gov Identifier: NCT00898807.

  View details for DOI 10.1001/jama.2014.93

  View details for PubMedID 24549548

• Hear Today, Gone Tomorrow: Working Effectively With Seriously Ill Patients with Limited Health Literacy and Numeracy Periyakoil, V. ELSEVIER SCIENCE INC. 2014: 388–89

  View details for DOI 10.1016/j.jpainsymman.2013.12.031

  View details for Web of Science ID 000331150000050

• Special Issues in Effectively Palliating Head and Neck Cancer Periyakoil, V., Sirjani, D. ELSEVIER SCIENCE INC. 2014: 435

  View details for DOI 10.1016/j.jpainsymman.2013.12.103

  View details for Web of Science ID 000331150000121

• Do unto others: doctors' personal end-of-life resuscitation preferences and their attitudes toward advance directives. PloS one Periyakoil, V. S., Neri, E., Fong, A., Kraemer, H. 2014; 9 (5)

  Abstract

  High-intensity interventions are provided to seriously-ill patients in the last months of life by medical sub-specialists. This study was undertaken to determine if doctors' age, ethnicity, medical sub-specialty and personal resuscitation and organ donation preferences influenced their attitudes toward Advance Directives (AD) and to compare a cohort of 2013 doctors to a 1989 (one year before the Patient Self Determination Act in 1990) cohort to determine any changes in attitudes towards AD in the past 23 years.Doctors in two academic medical centers participated in an AD simulation and attitudes survey in 2013 and their responses were compared to a cohort of doctors in 1989.Resuscitation and organ donation preferences (2013 cohort) and attitudes toward AD (1989 and 2013 cohorts).In 2013, 1081 (94.2%) doctors of the 1147 approached participated. Compared to 1989, 2013 cohort did not feel that widespread acceptance of AD would result in less aggressive treatment even of patients who do not have an AD (p<0.001, AUC = 0.77); had greater confidence in their treatment decisions if guided by an AD (p<.001, AUC = 0.58) and were less worried about legal consequences of limiting treatment when following an AD (p<.001, AUC  = 0.57). The gender (p = 0.00172), ethnicity (χ2 14.68, DF = 3,p = .0021) and sub-specialty (χ2 28.92, p = .004, DF = 12) influenced their attitudes towards AD. 88.3% doctors chose do-not-resuscitate status and wanted to become organ donors. Those less supportive of AD were more likely to opt for "full code" even if terminally ill and were less supportive of organ donation.Doctors' attitudes towards AD has not changed significantly in the past 23 years. Doctors' gender, ethnicity and sub-specialty influence their attitudes towards AD. Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.

  View details for DOI 10.1371/journal.pone.0098246

  View details for PubMedID 24869673

  View details for PubMedCentralID PMC4037207

• Asian Indian American Older Adults Doorway Thoughts: Cross-Cultural Health Care for Older Adults Periyakoil, V. S. American Geriatrics Society. 2014
• Hinduism Doorway Thoughts: Cross-Cultural Health Care for Older Adults Periyakoil, V. S., Rao, A., Sharma, P. American Geriatrics Society. 2014; 2
• Pakistani American Older Adults Doorway Thoughts: Cross-Cultural Health Care for Older Adults Buttar, A., Periyakoil, V. S. American Geriatrics Society. 2014; 2
• Filipino American Older Adults Doorway Thoughts: Cross-Cultural Health Care for Older Adults McBride, M., Nora, R., Periyakoil, V. American Geriatrics Society. 2014; 2

  View details for DOI 1-886775-33-8

• Successful Aging of Multi-cultural American Older Adults edited by Periyakoil, V. S. Stanford University. 2014
• Doorway Thoughts: Cross-Cultural Health Care for Older Adults edited by Brangman, S., Periyakoil, V. S. American Geriatrics Society. 2014
• Do Unto Others: Doctors' Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives. PloS one Periyakoil, V. S., Neri, E., Fong, A., Kraemer, H. 2014; 9 (5): e98246

  Abstract

  High-intensity interventions are provided to seriously-ill patients in the last months of life by medical sub-specialists. This study was undertaken to determine if doctors' age, ethnicity, medical sub-specialty and personal resuscitation and organ donation preferences influenced their attitudes toward Advance Directives (AD) and to compare a cohort of 2013 doctors to a 1989 (one year before the Patient Self Determination Act in 1990) cohort to determine any changes in attitudes towards AD in the past 23 years.Doctors in two academic medical centers participated in an AD simulation and attitudes survey in 2013 and their responses were compared to a cohort of doctors in 1989.Resuscitation and organ donation preferences (2013 cohort) and attitudes toward AD (1989 and 2013 cohorts).In 2013, 1081 (94.2%) doctors of the 1147 approached participated. Compared to 1989, 2013 cohort did not feel that widespread acceptance of AD would result in less aggressive treatment even of patients who do not have an AD (p<0.001, AUC = 0.77); had greater confidence in their treatment decisions if guided by an AD (p<.001, AUC = 0.58) and were less worried about legal consequences of limiting treatment when following an AD (p<.001, AUC  = 0.57). The gender (p = 0.00172), ethnicity (χ2 14.68, DF = 3,p = .0021) and sub-specialty (χ2 28.92, p = .004, DF = 12) influenced their attitudes towards AD. 88.3% doctors chose do-not-resuscitate status and wanted to become organ donors. Those less supportive of AD were more likely to opt for "full code" even if terminally ill and were less supportive of organ donation.Doctors' attitudes towards AD has not changed significantly in the past 23 years. Doctors' gender, ethnicity and sub-specialty influence their attitudes towards AD. Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.

  View details for DOI 10.1371/journal.pone.0098246

  View details for PubMedID 24869673

  View details for PubMedCentralID PMC4037207

• Changes in QTc Interval in the Citalopram for Agitation in Alzheimer's Disease (CitAD) Randomized Trial. PloS one Drye, L. T., Spragg, D., Devanand, D. P., Frangakis, C., Marano, C., Meinert, C. L., Mintzer, J. E., Munro, C. A., Pelton, G., Pollock, B. G., Porsteinsson, A. P., Rabins, P. V., Rosenberg, P. B., Schneider, L. S., Shade, D. M., Weintraub, D., Yesavage, J., Lyketsos, C. G. 2014; 9 (6)

  Abstract

  A Food and Drug Administration (FDA) safety communication in August 2011 warned that citalopram was associated with a dose dependent risk of QT prolongation and recommended dose restriction in patients over the age of 60 but did not provide data for this age group.CitAD was a randomized, double-masked, placebo-controlled, multicenter clinical trial for agitation in Alzheimer's disease (AD). Participants were assigned to citalopram (target dose of 30 mg/day) or placebo in a 1∶1 ratio. 186 people, 181 of whom were over the age of 60, having probable AD with clinically significant agitation were recruited from September 2009 to January 2013. After the FDA safety communication about citalopram, ECG was added to the required study procedures before enrollment and repeated at week 3 to monitor change in QTc interval. Forty-eight participants were enrolled after enhanced monitoring began.Citalopram treatment was associated with a larger increase in QTc interval than placebo (difference in week 3 QTc adjusting for baseline QTc: 18.1 ms [95% CI: 6.1, 30.1]; p = 0.004). More participants in the citalopram group had an increase ≥30 ms from baseline to week 3 (7 in citalopram versus 1 in placebo; Fisher's exact p = 0.046), but only slightly more in the citalopram group met a gender-specific threshold for prolonged QTc (450 ms for males; 470 ms for females) at any point during follow-up (3 in citalopram versus 1 in placebo, Fisher's exact p = 0.611). One of the citalopram participants who developed prolonged QTc also displayed ventricular bigeminy. No participants in either group had a cardiovascular-related death.Citalopram at 30 mg/day was associated with improvement in agitation in patients with AD but was also associated with QT prolongation.ClinicalTrials.gov NCT00898807.

  View details for DOI 10.1371/journal.pone.0098426

  View details for PubMedID 24914549

  View details for PubMedCentralID PMC4051660

• The flipped classroom paradigm for teaching palliative care skills. The virtual mentor : VM Periyakoil, V. S., Basaviah, P. 2013; 15 (12): 1034-1037

  View details for DOI 10.1001/virtualmentor.2013.15.12.medu1-1312

  View details for PubMedID 24331444

• The patient perspective and physician's role in making decisions on instituting dialysis. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Kurella Tamura, M., Periyakoil, V. S. 2013; 28 (11): 2663-2666

  View details for DOI 10.1093/ndt/gft379

  View details for PubMedID 24009286

  View details for PubMedCentralID PMC3811061

• Unmet quality indicators for metastatic cancer patients admitted to intensive care unit in the last two weeks of life. Journal of palliative medicine Blechman, J. A., Rizk, N., Stevens, M. M., Periyakoil, V. S. 2013; 16 (10): 1285-1289

  Abstract

  The majority of U.S. cancer patients express the desire to die at home, though most do not, and are often subjected to ineffective therapies near the end of life (EOL). In 2008 the U.K. Department of Health and National Health Care Service implemented a set of 10 quality markers to improve EOL care (EOLC) for seriously ill persons. Data show that this intervention has had a positive impact on patients' EOLC.The study assessed the quality of EOLC received by terminally ill cancer patients admitted to the intensive care unit (ICU) in the last two weeks of life.A retrospective chart review was done of the electronic medical record (EMR) of 2498 patients admitted to the ICU from January to August 2011. The six U.K. quality indicators pertaining to patients were used to assess quality of EOLC.The setting was a tertiary academic medical center with 663 beds and 66 adult ICU beds in northern California.EMR analysis identified 2498 patients admitted to the ICU during the study period--232 died within two weeks of admission. Sixty-nine decedents had metastatic cancer. Of the patients, 58% were male, average age 59.8 years (range 25-91).Quality indicators were met in a relatively small percentage of patients admitted to the ICU in the last two weeks of life: prognostication 67%, advance care planning 32%, goals of care 42%, caregiver needs 0%, coordination of care across organizational boundaries 7%, and standardized care pathway implementation 58%. Palliative care consultations occurred in 28 patients.Quality indicators for EOLC were unmet in cancer patients admitted to the ICU in the last two weeks of life. Hospital-wide provider education about the need for early advance care planning with all seriously ill patients has been implemented in an effort to improve quality of care at EOL.

  View details for DOI 10.1089/jpm.2013.0257

  View details for PubMedID 24020919

• Unmet quality indicators for metastatic cancer patients admitted to intensive care unit in the last two weeks of life. Journal of palliative medicine Blechman, J. A., Rizk, N., Stevens, M. M., Periyakoil, V. S. 2013; 16 (10): 1285-1289

  View details for DOI 10.1089/jpm.2013.0257

  View details for PubMedID 24020919

• Frailty as a terminal illness. American family physician Periyakoil, V. S. 2013; 88 (6): 363-368

  View details for PubMedID 24134043

• Caring for oneself to care for others: physicians and their self-care. The journal of supportive oncology Sanchez-Reilly, S., Morrison, L. J., Carey, E., Bernacki, R., O'Neill, L., Kapo, J., Periyakoil, V. S., Thomas, J. d. 2013; 11 (2): 75-81

  Abstract

  It is well known that clinicians experience distress and grief in response to their patients' suffering. Oncologists and palliative care specialists are no exception since they commonly experience patient loss and are often affected by unprocessed grief. These emotions can compromise clinicians' personal well-being, since unexamined emotions may lead to burnout, moral distress, compassion fatigue, and poor clinical decisions which adversely affect patient care. One approach to mitigate this harm is self-care, defined as a cadre of activities performed independently by an individual to promote and maintain personal well-being throughout life. This article emphasizes the importance of having a self-care and self-awareness plan when caring for patients with life-limiting cancer and discusses validated methods to increase self-care, enhance self-awareness and improve patient care.

  View details for PubMedID 23967495

• Multicultural Long-Term Care Nurses' Perceptions of Factors Influencing Patient Dignity at the End of Life JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Periyakoil, V. S., Stevens, M., Kraemer, H. 2013; 61 (3): 440-446

  Abstract

  The goal of this mixed-methods study was to characterize the perceptions of multicultural long-term care nurses about patient dignity at the end-of-life (EOL). The study was conducted in a large, urban, long-term care (LTC) facility. Participants were 45 long-term care nurses and 26 terminally ill nursing home residents. Nurses completed an openended interview about their perceptions of the concept of dying with dignity, and the data were analyzed using grounded theory methods. Main themes identified as promoting resident dignity at the EOL included treating them with respect, helping them prepare for the EOL, promoting shared decision-making, and providing high-quality care. The nurses’ cultural and religious backgrounds influenced their perceptions of what constitutes dignity-conserving care. Foreign-born nurses stressed the need for EOL rituals, but this was strikingly absent in the statements of U.S.-born nurses. Foreign-born Catholic nurses stated that the dying experience should not be altered using analgesics to relieve suffering or by attempts to hasten death by forgoing curative therapy or by other means. Nurses and terminally ill individuals completed the Dignity Card-sort Tool (DCT). A comparison of the DCT responses of the LTC nurses cohort with those of the terminally ill participants revealed that the nurses felt patient dignity was eroded when patient wishes were not followed and when they were treated without respect. In contrast, dying LTC residents felt that poor medical care and loss of ability to choose care options were the most important factors leading to erosion of dignity.

  View details for DOI 10.1111/jgs.12145

  View details for Web of Science ID 000316334900019

  View details for PubMedID 23496266

  View details for PubMedCentralID PMC3636182

• Doctoring in the 21st Century: Improve Patient Safety and Enhance Quality of Patient Care Using the ACGME's Competency-Based Training Model Periyakoil, V., Dohn, A. ELSEVIER SCIENCE INC. 2013: 347–48

  View details for DOI 10.1016/j.jpainsymman.2012.10.056

  View details for Web of Science ID 000315684600066

• Fellowship Directors-Looking 10 Years into the Future Levine, S., Reilly, S., Periyakoil, V., Ross, J., Rosielle, D., Gustin, J. ELSEVIER SCIENCE INC. 2013: 319–20

  View details for DOI 10.1016/j.jpainsymman.2012.10.010

  View details for Web of Science ID 000315684600020

• Last Among Equals? Identifying and Managing Pain Disparities in Multicultural Populations Periyakoil, V. ELSEVIER SCIENCE INC. 2013: 335

  View details for DOI 10.1016/j.jpainsymman.2012.10.037

  View details for Web of Science ID 000315684600047

• Dying After Discontinuing Dialysis: Two Patients' Stories and Lessons Learned Periyakoil, V., Cheung, K. ELSEVIER SCIENCE INC. 2013: 409

  View details for DOI 10.1016/j.jpainsymman.2012.10.269

  View details for Web of Science ID 000315684600160

• Unmet Quality Indicators of Care for Metastatic Cancer Patients Admitted to ICU in Last 2 Weeks of Life Blechman, J., Periyakoil, V. J. ELSEVIER SCIENCE INC. 2013: 422

  View details for DOI 10.1016/j.jpainsymman.2012.10.127

  View details for Web of Science ID 000315684600180

• Mentoring Academy: An Immersive Learning Workshop for Interdisciplinary Professionals Periyakoil, V., O'Neill, L., Bernacki, R., Reilly, S., Thomas, J., Kapo, J., Block, S., Ferrell, B., Weissman, D., von Gunten, C. ELSEVIER SCIENCE INC. 2013: 324–25

  View details for DOI 10.1016/j.jpainsymman.2012.10.019

  View details for Web of Science ID 000315684600029

• What Would Osler Do? : Editorial Journal of Palliative Medicine Periyakoil, V. 2013; 16 (2): 118-119
• Measuring Grief and Depression in Seriously III Outpatients Using the Palliative Grief Depression Scale JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., Kraemer, H. C., Noda, A. 2012; 15 (12): 1350-1355

  View details for DOI 10.1089/jpm.2012.0280

  View details for Web of Science ID 000311937500011

  View details for PubMedID 23066859

  View details for PubMedCentralID PMC3509503

• Differentiating Grief and Depression in Patients Who Are Seriously Ill AMERICAN FAMILY PHYSICIAN Periyakoil, V. S. 2012; 86 (3): 232-?

  View details for Web of Science ID 000307152500004

  View details for PubMedID 22962985

• "SERIOUSLY ILL OCTOGENARIANS & NONAGENARIANS"-ROLE OF PALLIATIVE CARE CONSULTS IN INITIATING "DO NOT ESCALATE CARE" PATHWAY AND DISCHARGE TO HOSPICE IN SERIOUSLY ILL OLDEST OLD PATIENTS ADMITTED TO A TERTIARY ACADEMIC MEDICAL CENTER. Kawai, F., Periyakoil, V. WILEY-BLACKWELL. 2012: S123–S124

  View details for Web of Science ID 000302464800358

• Citalopram for agitation in Alzheimer's disease: Design and methods ALZHEIMERS & DEMENTIA Drye, L. T., Ismail, Z., Porsteinsson, A. P., Rosenberg, P. B., Weintraub, D., Marano, C., Pelton, G., Frangakis, C., Rabins, P. V., Munro, C. A., Meinert, C. L., Devanand, D. P., Yesavage, J., Mintzer, J. E., Schneider, L. S., Pollock, B. G., Lyketsos, C. G. 2012; 8 (2): 121-130

  Abstract

  Agitation is one of the most common neuropsychiatric symptoms of Alzheimer's disease (AD), and is associated with serious adverse consequences for patients and caregivers. Evidence-supported treatment options for agitation are limited. The citalopram for agitation in Alzheimer's disease (CitAD) study was designed to evaluate the potential of citalopram to ameliorate these symptoms.CitAD is a randomized, double-masked, placebo-controlled multicenter clinical trial, with two parallel treatment groups assigned in a 1:1 ratio and randomization stratified by clinical center. The study included eight recruiting clinical centers, a chair's office, and a coordinating center located in university settings in the United States and Canada. A total of 200 individuals having probable AD with clinically significant agitation and without major depression were recruited for this study. Patients were randomized to receive citalopram (target dose of 30 mg/d) or matching placebo. Caregivers of patients in both treatment groups received a structured psychosocial therapy. Agitation was compared between treatment groups using the NeuroBehavioral Rating Scale and the AD Cooperative Study- Clinical Global Impression of Change, which are the primary outcomes. Functional performance, cognition, caregiver distress, and rates of adverse and serious adverse events were also measured.The authors believe the design elements in CitAD are important features to be included in trials assessing the safety and efficacy of psychotropic medications for clinically significant agitation in AD.

  View details for DOI 10.1016/j.jalz.2011.01.007

  View details for Web of Science ID 000301991600005

  View details for PubMedID 22301195

  View details for PubMedCentralID PMC3333484

• Defining and Validating Palliative Care Competencies for Medical Students and Residents: A National Consensus Project Schaefer, K., Chittenden, E., Periyakoil, V., Carey, E., Morrison, L., Reilly, S., Block, S. ELSEVIER SCIENCE INC. 2012: 363

  View details for DOI 10.1016/j.jpainsymman.2011.12.083

  View details for Web of Science ID 000300054900067

• Giving Feedback to Palliative Care Learners Morrison, L., Thomas, J., O'Neill, L., Carey, E., Jacobsen, J., Reilly, S., Kapo, J., Bernacki, R., Periyakoil, V. ELSEVIER SCIENCE INC. 2012: 414

  View details for DOI 10.1016/j.jpainsymman.2011.12.166

  View details for Web of Science ID 000300054900150

• Latest Updates in Geriatrics and Palliative Medicine: A Skill-Based Immersive Learning Workshop Periyakoil, V. S. ELSEVIER SCIENCE INC. 2011: 167

  View details for DOI 10.1016/j.jpainsymman.2010.10.007

  View details for Web of Science ID 000286053400020

• Assessment of Factors Influencing Preservation of Dignity at Life's End: Creation and the Cross-Cultural Validation of the Preservation of Dignity Card-Sort Tool JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., Noda, A. M., Kraemer, H. C. 2010; 13 (5): 495-500

  Abstract

  Preserving patient dignity is a sentinel premise of palliative care. This study was conducted to gain a better understanding of factors influencing preservation of dignity in the last chapter of life.We conducted an open-ended written survey of 100 multidisciplinary providers (69% response rate) and responses were categorized to identify 2 main themes, 5 subthemes, and 10 individual factors that were used to create the preservation of dignity card-sort tool (p-DCT). The 10-item rank order tool was administered to a cohort of community dwelling Filipino Americans (n = 140, age mean = 61.3, 45% male and 55% female). A Spearman correlation matrix was constructed for all the 10 individual factors as well as the themes and subthemes based on the data generated by the subjects.The individual factors were minimally correlated with each other indicating that each factor was an independent stand-alone factor. The median, 25th and 75th percentile ranks were calculated and "s/he has self-respect" (intrinsic theme, self-esteem subtheme) emerged as the most important factor (mean rank 3.0 and median rank 2.0) followed by "others treat her/him with respect" (extrinsic theme, respect subtheme) with a mean rank = 3.6 and median = 3.0.The p-DCT is a simple, rank order card-sort tool that may help clinicians identify patients' perceptions of key factors influencing the preservation of their dignity in the last chapter of life.

  View details for DOI 10.1089/jpm.2009.0279

  View details for Web of Science ID 000277973800004

  View details for PubMedID 20420549

  View details for PubMedCentralID PMC2938912

• Blue's Clues: Differentiating between Grief and Depression in Patients with Serious Life Limiting Illnesses (422) Periyakoil, V. J. ELSEVIER SCIENCE INC. 2010: 399

  View details for DOI 10.1016/j.jpainsymman.2009.11.299

  View details for Web of Science ID 000279280400148

• Hidden in Plain Sight: Master the Secrets of Non-Verbal Communication (400) Periyakoil, V. J. ELSEVIER SCIENCE INC. 2010: 370–71

  View details for DOI 10.1016/j.jpainsymman.2009.11.285

  View details for Web of Science ID 000279280400104

• Peer Mentoring: An Innovative Model for Professional Advancement in Hospice and Palliative Medicine (320) Bernacki, R., Sanchez-Reilly, S., Carey, E., Thomas, J., Kapo, J., Morrison, L., Periyakoil, V. J., O'Neill, L. ELSEVIER SCIENCE INC. 2010: 357

  View details for DOI 10.1016/j.jpainsymman.2009.11.068

  View details for Web of Science ID 000279280400080

• Creation and the Empirical Validation of the Dignity Card-Sort Tool To Assess Factors Influencing Erosion of Dignity at Life's End JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., Kraemer, H. C., Noda, A. 2009; 12 (12): 1125-1130

  Abstract

  Patients often experience erosion of dignity as they cope with the dying process. Preserving patient dignity is a sentinel premise of palliative care. This study was conducted to gain a better understanding of factors influencing erosion of dignity at the end of life. We conducted an open-ended written survey of 100 multidisciplinary providers (69% response rate) and responses were categorized to identify 18 themes that were used to create a card-sort tool. The initial 18-item tool was administered to nurses (n = 83), nonhospice community-dwelling subjects (n = 190) and hospice patients (n = 26) and a principal component analysis (PCA) was used to identify the 6 primary factors. The key item in each factor as identified by the PCA was used to create the final 6-item dignity card-sort tool (DCT). The DCT was also administered to physicians caring for palliative care patients (n = 21). For each of the final 6 items, the correlation between the respondents (nurses, physicians, nonterminally ill subjects, and subjects receiving hospice care) was calculated using the Spearman's correlation coefficient. The nurses were very highly positively correlated with the physicians (correlation coefficient = 0.94) and the community-dwelling nonterminally ill subjects were highly positively correlated with the subjects receiving hospice care (correlation coefficient = 0.67). More importantly, both the nurses and physicians were negatively correlated with both community dwelling nonterminally ill subjects and the subjects receiving hospice care. The health professionals in the study felt that treating a patient with disrespect and not carrying out their wishes resulted in erosion of dignity. In contrast patients thought that poor medical care and untreated pain were the most important factors leading to erosion of dignity at life's end. The DCT is a promising tool that may help clinicians identify key factors resulting in perceptions of erosion of dignity in adult palliative care patients.

  View details for DOI 10.1089/jpm.2009.0123

  View details for Web of Science ID 000272525200017

  View details for PubMedID 19708793

  View details for PubMedCentralID PMC2939852

• Change Management: The Secret Sauce of Successful Program Building JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2009; 12 (4): 329-330

  View details for DOI 10.1089/jpm.2009.9645

  View details for Web of Science ID 000264626700015

  View details for PubMedID 19327068

• Education techniques in palliative care Center for advancement of palliative care: http://campus.capc.org/PalliativeCareCourses/EducationTechniquesinPalliativeCare V.S. Periyakoil, MD, Weissman.D 2009
• Consultation etiquette: Marketing and patient referrals Center for Advancement of Palliative Care Campus Online: http://campus.capc.org/PalliativeCareCourses/ConsultationEtiquette Periyakoil VS, Weissman D 2009
• Marketing for palliative care programs Center for advancement of palliative care: http://campus.capc.org/PalliativeCareCourses/MarketingforPalliativeCarePrograms Periyakoil V.S., Weissman D 2009
• Organizational change Center for advancement of palliative care: http://campus.capc.org/PalliativeCareCourses/OrganizationalChange Periyakoil V.S., Weissman D 2009
• Using metaphors in medicine JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (6): 842-844

  View details for DOI 10.1089/jpm.2008.9885

  View details for Web of Science ID 000258896100011

  View details for PubMedID 18715175

• Geography decides destiny JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (5): 694-695

  View details for DOI 10.1089/jpm.2008.9905

  View details for Web of Science ID 000257535100009

  View details for PubMedID 18588399

• The role of international medical graduates in the future of palliative care JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (4): 563-564

  View details for DOI 10.1089/jpm.2008.9925

  View details for Web of Science ID 000256241300007

  View details for PubMedID 18454607

• On the endangered species list: Palliative care junior faculty JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (3): 431-433

  View details for DOI 10.1089/jpm.2008.9955

  View details for Web of Science ID 000254651800009

  View details for PubMedID 18363484

• Growing pains: Health care enters "team"-age JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (2): 171-175

  View details for DOI 10.1089/jpm.2008.9975

  View details for Web of Science ID 000254651600011

  View details for PubMedID 18333730

• Borders without doctors JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2008; 11 (1): 31-32

  View details for DOI 10.1089/jpm.2008.9995

  View details for Web of Science ID 000252559900008

  View details for PubMedID 18370889

• Wrap your worthy cause in a corporate image JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2007; 10 (6): 1256-1257

  View details for DOI 10.1089/jpm.2007.9845

  View details for Web of Science ID 000252157200011

  View details for PubMedID 18095802

• Declaration of interdependence: The need for mosaic mentoring in palliative care JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2007; 10 (5): 1048-1049

  View details for DOI 10.1089/jpm.2006.9911

  View details for Web of Science ID 000251086100012

  View details for PubMedID 17985959

• First, do not abandon JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2007; 10 (4): 865-866

  View details for DOI 10.1089/jpm.2007.9932

  View details for Web of Science ID 000249251700014

  View details for PubMedID 17803405

• Taming wicked problems in modern health care systems JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2007; 10 (3): 658-659

  View details for DOI 10.1089/jpm.2007.9955

  View details for Web of Science ID 000247498900013

  View details for PubMedID 17592976

• "Be nice-until it is time not to be nice". Journal of palliative medicine Periyakoil, V. S. 2007; 10 (2): 308-?

  View details for PubMedID 17472500

• Panic disorder at the end of life # 145 JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S. 2007; 10 (2): 483-484

  View details for DOI 10.1089/jpm.2006.9977

  View details for Web of Science ID 000246275900032

  View details for PubMedID 17472520

• Quality of care in a veterans affairs' nursing home-based hospice unit JOURNAL OF PALLIATIVE MEDICINE Hallenbeck, J., Hickey, E., Czarnowski, E., Lehner, L., Periyakoil, V. S. 2007; 10 (1): 127-135

  Abstract

  To report on quality of care in a Veterans Affairs (VA) dedicated hospice unit.Mortality follow-back survey of bereaved family members, using a quality of care instrument.A VA inpatient hospice unit.Bereaved family members.Satisfaction with care as perceived by family members using a telephone survey.159 family members were contacted with 102 completing full and 37 completing abbreviated surveys. (Overall response rate: 87.4%, complete responses: 64.2%) 98% of all respondents reported overall quality of care as Excellent or Very Good.High levels of satisfaction were reported by family members. Implications of this initiative for the provision of hospice care in nursing homes are discussed, including replication of the model in both VA and non-VA nursing home settings.

  View details for DOI 10.1089/jpm.2006.0141

  View details for Web of Science ID 000244135100021

  View details for PubMedID 17298261

• Mainstreaming palliative care JOURNAL OF PALLIATIVE MEDICINE Periyakoil, V. S., von Gunten, C. F. 2007; 10 (1): 40-42

  View details for DOI 10.1089/jpm.2006.9993

  View details for Web of Science ID 000244135100011

  View details for PubMedID 17298251

• Prazosin helpful in pacing for patients with dementia. Kim, S. J., Fayad, W., Wexler, B., Periyakoil BLACKWELL PUBLISHING. 2006: S161

  View details for Web of Science ID 000237069300472

• Perceptions of loss of dignity at the end-of-life: Providers are from abstractville; Patients are from concretecity Periyakoil, V. S., Kraemer, H., Noda, A. BLACKWELL PUBLISHING. 2006: S78

  View details for Web of Science ID 000237069300227

• Posttraumatic stress disorder at the end of life JOURNAL OF PALLIATIVE MEDICINE Feldman, D. B., Periyakoil, V. S. 2006; 9 (1): 213–18

  View details for DOI 10.1089/jpm.2006.9.213

  View details for Web of Science ID 000237674300036

• Differentiating grief from depression in patients at the end-of-life Periyakoil GERONTOLOGICAL SOCIETY AMER. 2005: 527–28

  View details for Web of Science ID 000233615001511

• Patient and provider perspectives on factors influencing loss of dignity at the end of life Periyakoil GERONTOLOGICAL SOCIETY AMER. 2005: 226–27

  View details for Web of Science ID 000233615000588

• The development and initial validation of the Terminally Ill Grief or Depression Scale (TIGDS) INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH Periyakoil, V. S., Kraemer, H. C., Noda, A., Moos, R., Hallenbeck, J., Webster, M., Yesavage, J. A. 2005; 14 (4): 202-212

  Abstract

  Patients often experience 'preparatory-grief' as they cope with the dying process. Some may be depressed. The Terminally Ill Grief or Depression Scale (TIGDS), comprising grief and depression sub-scales, is a new self-report measure designed to differentiate between preparatory-grief and depression in adult inpatients. The initial 100-item inventory was assembled based on literature review, interviews with clinicians and dying patients and then shortened to 42 items based on consensus expert opinion. Validity and reliability were tested in a sample of 55 terminally ill adults. The consensus clinical opinion was used as the gold standard to differentiate between preparatory grief and depression. The intra-class correlation coefficient was high (it was calculated to estimate the test-retest reliability for the 47 patients who had completed the TIGDS twice--retest was administered 2 to 7 days after the initial test), ranging from 0.86 (grief) to 0.97 (depression). The validity of TIGDS was assessed using a receiver operating characteristic curve analysis, comparing the first test with the clinical criterion. The first and only variable and cut-point was the depression score (chi-square = 18.4, p < 0.001, cut point = 3). The sensitivity of the TIGDS was 0.727 and specificity was 0.886 for the depression = 3 cutoff score. The construct validity of the TIGDS was tested by comparing with the Hospital Anxiety and Depression Scale (HADS). The TIGDS depression subscale showed strong convergent validity and the TIGDS grief subscale showed strong discriminant validity with the HADS total score.

  View details for DOI 10.1002/mpr.8

  View details for Web of Science ID 000234094000003

  View details for PubMedID 16395873

• Kappa coefficients in medical research STATISTICS IN MEDICINE Kraemer, H. C., Periyakoil, V. S., Noda, A. 2002; 21 (14): 2109-2129

  Abstract

  Kappa coefficients are measures of correlation between categorical variables often used as reliability or validity coefficients. We recapitulate development and definitions of the K (categories) by M (ratings) kappas (K x M), discuss what they are well- or ill-designed to do, and summarize where kappas now stand with regard to their application in medical research. The 2 x M(M>/=2) intraclass kappa seems the ideal measure of binary reliability; a 2 x 2 weighted kappa is an excellent choice, though not a unique one, as a validity measure. For both the intraclass and weighted kappas, we address continuing problems with kappas. There are serious problems with using the K x M intraclass (K>2) or the various K x M weighted kappas for K>2 or M>2 in any context, either because they convey incomplete and possibly misleading information, or because other approaches are preferable to their use. We illustrate the use of the recommended kappas with applications in medical research.

  View details for DOI 10.1002/sim.1180

  View details for Web of Science ID 000176726900009

  View details for PubMedID 12111890

• Identifying and managing preparatory grief and depression at the end of life AMERICAN FAMILY PHYSICIAN Periyakoil, V. S., Hallenbeck, J. 2002; 65 (5): 883-890

  Abstract

  Grief and depression present similarly in patients who are dying. Conventional symptoms (e.g., frequent crying, weight loss, thoughts of death) used to assess for depression in these patients may be imprecise because these symptoms are also present in preparatory grief and as a part of the normal dying process. Preparatory grief is experienced by virtually all patients who are dying and can be facilitated with psychosocial support and counseling. Ongoing pharmacotherapy is generally not beneficial and may even be harmful to patients who are grieving. Evidence of disturbed self-esteem, hopelessness, an active desire to die and ruminative thoughts about death and suicide are indicative of depression in patients who are dying. Physicians should have a low threshold for treating depression in patients nearing the end of life because depression is associated with tremendous suffering and poor quality of life.

  View details for Web of Science ID 000174255800009

  View details for PubMedID 11898960

• Differentiating between preparatory-grief and depression at the end of life Periyakoil, V. S., Kraemer, H., Hallenbeck, J. LIPPINCOTT WILLIAMS & WILKINS. 2000: S13

  View details for Web of Science ID 000088887000076