Research

Wendy Gabrielle Anderson, M.D., M.S., worked with colleagues in critical care and palliative care at UCSF Medical Center and the Schools of Nursing and Medicine to develop "IMPACT-ICU: Integrating Multidisciplinary Palliative Care into the ICU", a project that integrates palliative care into intensive care units. This is accomplished by training and supporting ICU bedside nurses to identify and address patient and family needs for symptom management, emotional support, and communication. Dr. Anderson currently leads an expansion of the IMPACT-ICU project across the five University of California medical centers, and is developing a program to disseminate the program to other California hospitals. Dr. Anderson also co-leads efforts to engage patients and families into ICU care at UCSF through Project EMERGE. This project is redesigning ICU care to partner with patients and families, reduce preventable harms, and optimize patient and family experience and outcomes.

Rebecca Sudore, M.D. has dedicated her research program to making medical information easier for patients and their families to understand. She published the first prospective study demonstrating the effect of limited literacy on mortality in the elderly, and has shown that elders with limited literacy have greater difficulty making medical decisions for informed consent and advance care planning. She has also designed and tested an informed consent process for patients with limited literacy and an advance directive that is both literacy and culturally appropriate. Both interventions have been shown to benefit patients - particularly those with literacy and/or language barriers. Even though her low-literate advance directive has been translated and widely disseminated, further research with patients and surrogate decision makers helped her realize that advance directives alone are not enough. In 2010, she published a study in the Annals of Internal Medicine calling for a shift in advance care planning from DNR/DNI checklists to preparing patients and their loved ones for medical decision making. Her current research program is focused on designing and testing interactive, web-based interventions to prepare patients and their surrogate decision makers to make difficult medical decisions.

Alexander Smith, M.D., MPH is broadly interested in issues at the intersection of geriatrics and palliative care, his research has largely been organized around three primary areas: end-of-life experiences, patient-doctor communication, and cultural attitudes toward care. In a series of studies examining nationally representative group of older adults who died, Dr. Smith demonstrated that: (1) pain due to arthritis is under-recognized in the last years of life; (2) lengths of stay in nursing homes for patients who die are shorter than generally appreciated (median 5 months, average 14 months); and (3) emergency departments and skilled nursing facilities are common sites of care in the last months of life and should be a focus of efforts to improve the quality of palliative care. Dr. Smith has a strong interest in understanding how cultural factors influence the perspectives and experiences of patients with serious illness or disability and their families. For example, in a recent study, Dr. Smith found that two-thirds of Chinese American, African American, Latino, and white elders with disability would want to be told their prognosis if they had less than 5 years left to live. He therefore argues that clinicians should offer to discuss prognosis with their very elderly patients, because it both allows for more informed medical decision making and because many patients want to know so they can prepare for the future.

• The United States population is rapidly aging
• Older individuals are estimated to account for more than half of the procedures performed in the United States
• Of those aged 70 and older who undergo major surgery, more than half are considered frail
• Frailty puts patients at increased risk for adverse outcomes Multimodal rehabilitation has been shown to mitigate frailty-associated surgical risk
• The Surgery Wellness Program (SWP) at UCSF demonstrated the feasibility and effectiveness of a pre-operative rehabilitation program
• Despite positive patient response, 30% of referred patients were unable to participate due to transportation burdens and conflicting preoperative appointments.
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The research of Ryan Greysen, M.D., is focused on transitions of care for hospitalized older adults and interventions to improve post-discharge continuity of care including novel uses of patient-centered technology such as mobile devices and social media (mHealth). Dr. Greysen, a hospitalist with unique training in social sciences and health outcomes research, is committed to improving the quality of hospital care for vulnerable patients their families, specifically the health, functional status, and independence of elders by improving care transitions between the hospital and home. Through his research, funded by an NIH K-23 award from the National Institute of Aging, Dr. Greysen seeks to accelerate changes in the healthcare system, by developing, testing, and disseminating novel approaches to patient and family focused on the needs of vulnerable, hospitalized elders.