Exploration through enhanced research

Members of the Center for Palliative Care began our research program in 2010. Our research aligns with our mission to relieve the suffering and to improve the quality of life for patients with advanced disease, as well as their families. We hope to accomplish this through compassionate and high quality care while advancing the field of palliative care through innovation, education and research.

Research objectives

Research objectives

Improve the Quality of Life for Patients Living with Advanced Cancer and Other Serious Illnesses

Patients with advanced cancer experience a myriad of symptoms such as pain, depression and insomnia. Research indicates that many of these symptoms tend to co-occur, forming symptom clusters. However, research and treatment continues to focus on individual symptoms with limited attention to the interrelationship of these symptoms. The most distressing symptom cluster reported by our patients is anxiety-insomnia-depression-pain-fatigue. Evidence suggests that this symptom cluster may be tied to a series of bio-behavioral mechanisms that develop over time including anxiety-induced elevations in cortisol and pro-inflammatory cytokines and insomnia-related changes in diurnal cortisol rhythms and consequent inflammatory dysregulation. These processes result in a symptom cascade that is not well-controlled by innate endocrine and immune mechanisms.

Few studies have systematically evaluated interventions for symptom clusters for this population of patients, particularly patients with more advanced disease. Although many proposed symptom cluster interventions are pharmacologic, cognitive behavioral therapy (CBT) is a well-established treatment for generalized anxiety, insomnia, depression, fatigue and pain. Randomized trials of CBT for these symptoms report moderate to large effect sizes and many report longterm maintenance of treatment effects. Dr. Wells-Di Gregorio has developed a clinical trial utilizing cognitive-behavioral strategies for treating anxiety and insomnia. We anticipate that by treating anxiety and insomnia with CBT, the other symptoms in this cluster will also be reduced. We currently have a randomized trial underway to evaluate this CBT iIntervention and characterize the biobehavioral mechanisms underlying this symptom cluster. If the intervention demonstrates positive effects, we plan to expand this intervention to other populations of seriously ill patients (e.g. congestive heart failure, COPD, HIV).

Enhance Communication and Shared Decision Making, Especially During Critical Transitions

Patients and families faced with the need for intensive care experience significant distress. A growing body of literature supports the importance of good communication in the intensive care unit (ICU) and a need for improved communication training. Pulmonary and critical care fellows are required to show competency in communication skills. Unfortunately, there are few published materials on fellowship curricula or methods of assessment to address communication as a core skill of critical care education.

Dr. Jillian Gustin focuses on operationalizing the components of shared decision-making in the ICU as well as methods for teaching and assessing these important communication skills. We have examined the literature on communication in ICU settings and written manuscripts that broadly discuss the components of effective patient/family-centered communication. We have used our knowledge of the literature as well as educational theory to develop and implement a communication curriculum for our pulmonary and critical care fellows. As part of the curriculum, we have created and are validating an assessment tool that can be used for both formative and summative feedback. Our next step is to use this instrument with families as educational feedback for fellows and as a means to assess the communication strategies that are most helpful to family members with a loved one in the ICU.

Develop Innovative and Effective Educational Programs to Enhance Pain and Symptom Management

Many medical, nursing, pharmacy and psychological programs are now beginning to provide more comprehensive pain management education to their students. This is a significant advance given that, historically, educational programs across all healthcare disciplines have included limited pain management training. Although this effort is encouraging, pain management is unlikely to improve in most institutions until key instructors such as attendings, preceptors and supervisors are themselves equipped with adequate pain education. Ultimately, the preceptors’ decisions, uncertainty and attitudinal barriers will determine whether students are able to learn about and implement effective pain management plans. The goal of this project is to improve pain management by supporting preceptors through the creation and dissemination of a pain management development program for preceptors and equipping preceptors to integrate standardized pain management teaching into clinical rotations.

Dr. Amber Hartman has led an interdisciplinary team of pain management experts from The Ohio State University Wexner Medical Center in developing a didactic program designed to improve the fundamental pain management knowledge of preceptors. Our proposed project, Equipping Preceptors: A Practical Approach to Improving Pain Education, will transition this didactic program to an interdisciplinary, interactive, e-learning environment with enhanced content. We have coordinated with The Ohio State University College of Medicine, the College of Nursing and the College of Pharmacy to study the impact of this teaching resource with an interdisciplinary group of preceptors including physicians, nurses, psychologists and pharmacists. The primary outcomes will be change in preceptor and student pain management knowledge, skills, self-efficacy and attitudes.

Improve Care Provided to Families During Serious or Terminal Illness

Individuals living with cancer experience many psychological, physical, social and spiritual challenges throughout their disease journey. Unaddressed, these challenges can disrupt cancer treatment and negatively impact survival. In order to promote screening and targeted distress interventions, distress screening has become a required standard of the American College of Surgeons Commission on Cancer Accreditation. The National Comprehensive Cancer Network has also published Distress Management Guidelines. According to these guidelines, the standard of care is regular screening of the level and nature of distress as well as management of distress according to clinical practice guidelines. One of the primary challenges in implementation of these standards is the selection of an instrument that is brief, but comprehensive enough to capture the most distressing needs of cancer survivors to facilitate triage to psychosocial, spiritual and palliative care providers.

Drs. Sharla Wells-Di Gregorio and Emily Porensky, in collaboration with a team of supportive care providers and James Cancer Hospital administration, have developed the 45-item Supportive Care Screening including six domains: (1) Emotional Concerns, (2) Physical Symptoms, (3) Social and Practical Problems, (4) Spiritual Problems, (5) Cognitive Concerns and (6) Health Care Decision-Making/Communication Issues. This measure is designed for use by cancer centers implementing distress management processes in their own institutions. The next phase of this research involves translating this measure to an electronic format to be utilized in several ambulatory oncology clinics in order to evaluate the utility of this measure for triage, referral and outcomes assessment.

Current studies

Cognitive-behavioral intervention for insomnia and worry

Patients with advanced cancer frequently experience multiple overlapping psychological and physical symptoms (pain, fatigue, insomnia, anxiety, depression). The most common approach to managing these symptoms is to focus on individual symptoms – at times to the exclusion of other more pressing symptoms. Two of the most common and stressful symptoms of patients with advanced disease are insomnia and worry. Individuals with cancer frequently spend many sleepless nights with uncontrolled symptoms and anxiety about these symptoms or the impact of the disease on their family. This study examines the impact of a cognitive-behavioral “symptom cluster” intervention on patient biobehavioral outcomes (uncertainty, sleep, immunity).

Palliative care needs assessment

Despite the benefits of palliative care in reducing symptoms and improving overall quality of life for patients with advance disease, in most cancer centers referral to such services tends to be low. Palliative care is often confused with hospice care – so referrals often come late in the disease process, when patients and families are experiencing symptom crises. This project examines the rates and predictors of referrals for palliative care services across multiple types of cancer. This study also examines predictors of distress among patients with different sites and phases of disease in order develop clinical-research collaborations to tailor palliative care services to patients who might need it most.

Journal Articles

Barrett T. Congestive Heart Failure in Hospice and Palliative Medicine. ISBN: 978-1-945872-23-5. In Ferris FD, Gustin J (eds). Palliative Care Interdisciplinary Curriculum. Copyright © 2016 Frank D Ferris. PCIC ISBN: 978-0-9884318-1-2.
 
Barrett T. Withdrawal of LVAD. ISBN: 978-1-945872-40-2. In Ferris FD, Gustin J (eds). Palliative Care Interdisciplinary Curriculum. Copyright © 2016 Frank D Ferris. PCIC ISBN: 978-0-9884318-1-2. 

Barrett T., Brill s. Education. (Freeman). (2017). OSU MedNet21 https://ccme.osu.edu/WebCastDetail.aspx 

Landzaat LH, Barnett MD, Buckholz GT, Gustin J, Hwang JM, Levine SK, Okon T, Radwany S, Yang HB, Encandela J, Morrison LJ. Development of Entrustable Professional Activities for Hospice and Palliative Medicine Fellowship Training in the United States. Journal of Pain and Symptom Management (in press). 

Patel PM, Knepel SA, Miller CC, Azimi A, Gustin JL, Hartman A. Evaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients with Acute Pain. Journal of Pain and Symptom Management (in press). 

Alghothani L, Gustin JL. Oxycodone Induced Neurotoxicity Secondary to Concurrent Voriconazole Use in a Cancer Patient. Journal of Opioid Management (in press). 

Risaliti C, Gustin J. Palliative Tracheostomy at the End of Life: Utilization in a Patient with Metastatic Cancer. Journal of Palliative Medicine (in press). 

Pedraza SL, Culp S, Knestrick M, Falkenstine EC, Moss AH. Association of POLST form use with end-of-life care quality metrics in cancer patients. Journal of Oncology Practice. 2017. Accepted 
 
Wells-Di Gregorio, S.M. & Shepard, K. (February, 2008). Comparison of four strategies for diagnosing depression among advanced cancer patients with severe pain. American Psychosocial Oncology Society Annual Meeting, Irvine, California

Wells-Di Gregorio, S.M.  & Shepard, K. (November, 2008). Diagnosing depression among advanced cancer patients with severe pain. American Psychosomatic Medicine Annual Meeting, Miami, Florida

Wells-Di Gregorio, S.M. & Shepard, K. (February, 2009). Major depression, generalized anxiety, pain severity and pain interference among palliative care patients. American Psychosocial Oncology Society Annual Meeting, Charlotte, North Carolina

Wells-Di Gregorio, S.M.  (February, 2009). oncology electronic medical record: Patient preferences for disclosure of supportive care information. American Psychosocial Oncology Society Annual Meeting, Charlotte, North Carolina

von Gunten,Charles,F; Gafford,Ellin. "Treatment of Non-Pain-Related Symptoms." CANCER JOURNAL. Vol. 19, no. 5. (Sep 2013): 397-404. (3.66)

Johnson RF, Gustin J, “Acute Lung Injury and Acute Respiratory Distress Syndrome Requiring Tracheal Intubation and Mechanical Ventilation in the Intensive Care Unit:  Impact on Managing Uncertainty for Patient-Centered Communication”  American Journal of Hospice and Palliative Medicine.  (September 2013)  30:569-75. PMID: 23015728

Gafford,Ellin,F; Luckhardt,Angela,J; Swetz,Keith,M. "Deactivation of a Left Ventricular Assist Device at the End of Life #269." JOURNAL OF PALLIATIVE MEDICINE. Vol. 16, no. 8. (Aug 2013): 980-982. (1.85)

Swetz,Keith,M; Stulak,John,M; Dunlay,Shannon,M; Gafford,EF "Management of advanced heart failure in the elderly: ethics, economics, and resource allocation in the technological era." Cardiology research and practice. Vol. 2012, (Jan 2012): 524961

Johnson,Robert,F; Gustin,Jillian. "Acute Renal Failure Requiring Renal Replacement Therapy in the Intensive Care Unit: Impact on Prognostic Assessment for Shared Decision Making." JOURNAL OF PALLIATIVE MEDICINE. Vol. 14, no. 7. (Jul 2011): 883-889. (1.85) (Published). Citation Count: 2

Gustin JL, Tulsky JA. "Effective "On-Boarding": Transitioning from Trainee to Faculty." Journal of Palliative Medicine. Vol. 13, (Jan 2010): 1279-1283. (Published). PMID: 20942762
50% Authorship. Co-authored with Dr. J Tulsky

National Presentations

Barnett MD, Buckholz GT, Gustin JL, Hwang JM, Landzaat L, Levine SK, Morrison LJ, Okon T, Radwany S, Yang H. Adding your Voice: Vetting the Curricular Milestones for HPM Physicians in Training. Presented at the American Academy of Hospice and Palliative Medicine Annual Assembly. Phoenix AZ Februay 2017. 

DeLima Thomas J, Back AL, Bates Cain M, Gustin JL, Jackson VA, Jacobsen J, Landzaat L, Levine SK, Neri V, Periyakoil V. HPM Fellowship Directors Program: Building a Community of Educators. Presented at the American Academy of Hospice and Palliative Medicine Annual Assembly. Phoenix, AZ. February 2017. 

Patel PM, Goodman LF, Knepel SA, Miller CC, Azimi A, Phillips G, Gustin JL, Hartman A. Evaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients with Acute Pain. Presented at the American Academy of Hospice and Palliative Medicine Annual Assembly. Phoenix, AZ. February 2017. 

Kale, S.S., Snapp, J., Heuser, E. Implementation of NCCN Adult Cancer Pain Management Guidelines into Oncology Clinics. Poster presentation at NCCN National Conference, March 2017 (Orlando, Fl). 

Alamgir MA, Wen S, Craig M, Pedraza SL. Early palliative care interventions in patients with hematologic malignancies prior to hematopoietic cell transplantation. 2017 ASCO Annual Meeting. J Clin Oncol 35, 2017 (suppl; abstr e21634). Poster, online. 

Pedraza SL AAHPM (American Academy of Hospice and Palliative Medicine) Annual Assemble/ 2017- “Association of POST form use with quality end-of-life care metrics in cancer patients: Update from the West Virginia registry”. February 24, 2017. Oral Presentation. 

Pedraza SL AAHPM (American Academy of Hospice and Palliative Medicine) Annual Assemble/ 2017- “Is Rapid Opioid De-escalation in Cancer-induced Bone Pain Achievable with Acupuncture?”. February 24, 2017. Oral Presentation 

Wells-Di Gregorio, S.M. & Shepard, K. (February, 2008). Comparison of four strategies for diagnosing depression among advanced cancer patients with severe pain. American Psychosocial Oncology Society Annual Meeting, Irvine, California

Wells-Di Gregorio, S.M. & Shepard, K. (November, 2008). Diagnosing depression among advanced cancer patients with severe pain.  American Psychosomatic Medicine Annual Meeting, Miami, Florida

Wells-Di Gregorio, S.M. & Shepard, K. (February, 2009). Major depression, generalized anxiety, pain severity and pain interference among palliative care patients. American Psychosocial Oncology Society Annual Meeting, Charlotte, North Carolina

Wells-Di Gregorio, S.M.  (February, 2009). Oncology electronic medical record: Patient preferences for disclosure of supportive care information. American Psychosocial Oncology Society Annual Meeting, Charlotte, North Carolina

Publications

Hritz CM, Barrett TA, Gustin JL. Palliative Care in Heart in eds (Baliga RR, Abraham WTA). Color Atlas and Synopsis of Heart Failure, McGraw Hill 2017 (in press) 

Pedraza, S, Barrett T, Hritz C. Frailty in Heart Failure. Encyclopedia of Cardiovascular Research and Medicine, Elsevier 2017 

Gustin J, Nausea and Vomiting. ISBN: 978-1-945872-07-5. In Ferris FD, Gustin J (eds). Palliative Care Interdisciplinary Curriculum. Copyright © 2016 Frank D Ferris. PCIC ISBN: 978-0-9884318-1-2. 

Pedraza S, Yennurajalingam S, Balachandran D. Sleep Disorders. Frailty in Heart Failure in Textbook of Palliative Medicine, Second Edition Bruera E, Higginson I, Von Gunten C, Morita T editors. 2016. 

Gustin J, Introduction to Patient Assessment. ISBN: 978-1-945872-10-5. In Ferris FD, Gustin J (eds). Palliative Care Interdisciplinary Curriculum. Copyright © 2016 Frank D Ferris. PCIC ISBN: 978-0-9884318-1-2. 

Gustin J, Prognostication. ISBN: 978-1-945872-11-2. In Ferris FD, Gustin J (eds). Palliative Care Interdisciplinary Curriculum. Copyright © 2016 Frank D Ferris. PCIC ISBN: 978-0-9884318-1-2. 

Wells-Di Gregorio, S.M. (2008).  Family End of Life Decision-Making.  In J. Werth & D. Blevins (Eds). Decision-Making Near the End of Life:  Recent Developments and Future Directions. Routledge Publishing

Scholarly Presentations

Barrett Heart Failure Palliative Care – Cardiothoracic Surgery Fellows 

Barrett International Society of Heart Lung Transplant Consensus meeting for frailty in thoracic transplant. 

Ansari H, Lorenz A, Mears J, Scott E, Gustin JL, Goodman L. Survey on Typical vs. Best Practices in Safe and Effective Transitions from Hospital to Hospice. Poster presented at The Ohio State University College of Medicine Trainee Research Day (April 2016). 

Mears J, Gustin JL, Hartman A. Conversion of Intrathecal to Systemic Analgesia: A case Report of Ketamine Use.” Poster presented at The Ohio State University College of Medicine Trainee Research Day (April 2016). 

Kale, S.S. Palliative Medicine in the Era of Epidemic Opioid Abuse. August 2016 

Kale, S.S. Best Opioid Prescribing Practices for the Palliative Clinician. August 2016 

Kale, S.S. Pain Management in Long Term Cancer Survivors. November 2016 

Kale, S.S., Abel, S. Methadone and Buprenorphine Management for the Palliative Care Patient. January 2017. 

Miller, CC.ASCO regional presentation, 2017 ASCO update re: Palliative Medicine 6/17/17

Norton, K. Essentials of Neurocritical Care: Translating Research to Clinical Practice Palliative Care 5.31.17 

Ellin Gafford, MD, Erin Donaho and Ann Laramee, Presenter. "Heart Failure Palliative Care: Critical Issues." Presented at 18th Annual Scientific Meeting of the Heart Failure Society of America, Peers within Field. Caesar's Palace, Las Vegas, NV (Sep 2014)

Ellin Gafford, MD, Erin Donaho and Ann Laramee, Presenter. "How to 6: How to Approach Difficult Conversations with Heart Failure Patients: Hoping for the Best, Planning for the Worst." Presented at 18th Annual Scientific Meeting of the Heart Failure Society of America, Peers within Field. Caesar's Palace, Las Vegas, NV (Sep 2014)

Ellin Gafford, MD, Presenter. "We Can do TAVR but Should We?." Presented at The Ohio State University's Second Annual Valve and Structural Heart Disease Conference: Transcatherter Managment of Aortic Valve Disease, Peers within Field. The Ohio State University's Ohio Union, Columbus, Ohio (May 2014)

Ellin Gafford, MD, Presenter. "Palliative/Hospice Care in Advanced/End-stage Cardiac Disease." Presented at 7th Annual Ohio-ACC Spring Summit Ritz-Carlton, Cleveland, OH (Apr 2014)

Gustin J, Way D, McCallister J, Validation of a Family Meeting Behavioral Skills Instrument.  Invited presentation at the Ottaway Conference. Ottawa, Canada (April 2014)

KellAnn Light-McGroary, MD; Sarah Goodlin, MD; Ellin Gafford, MD; Pam Barrett, LBSW, Presenter. "Heart Failure Bootcamp: Developing A Better Understanding of the Disease and Creating Effective Palliative Strategies for Management." Presented at 2014 AAHPM & HPNA Annual Assembly, San Diego, CA (Mar 2014)

Gustin J, Presenter, Interactive Educational Exchange:  Family Meeting Behavioral Skills Instrument.  Invited presentation at the American Academy of Hospice and Palliative Medicine Annual Assembly. San Diego, CA (March 2014)

Ellin Gafford, MD; Mary Lou Hauenstein, MBA, BSN, RN, Lecturer. "Managing real World Expectation for the Patient and Professional." Presented at Transplantation in 2013: Review of Best Practices, Peers within Field. The Ohio State University, Columbus, Ohio, United States. (Oct 2013)

KellyAnn Light-McGroary, MD; Ellin Frair Gafford, MD, Lecturer. "An Exploration into the Symptom Burden of Heart Failure Throughout the Continuum of Care: How Can Palliative Care Providers Change the Face of Advanced Heart Failure?." Presented at 17 Annual Interdisciplinary Conference on Supportive Care, Hospice and Palliative Medicine MD Anderson Cancer Center, Houston, TX (Oct 2013)

Ellin Gafford, MD; Ernest Mazzaferri, MD, Lecturer. "The Art of Endof Life Communication with Cardiac Patients." Presented at FIFTH ANNUAL STEMI UPDATE: FACING THE TOUGH QUESTIONS, Peers within Field. The Ohio State University, Scioto Country Club, Columbus, Ohio, United States. (Sep 2013)

Ellin Gafford, MD, Kelly-Ann Light-McGroary, MD, Robin Vachon-Kraut, CNP, Maggie Disch, RN CNL, Presenter. "Is Palliative Care Part of the Solution for 30-Day Readmissions for Heart Failure?" Presented at AAHPM Annual Assembly 2013, Peers within Field. New Orleans Convention Center, New Orleans, Louisiana, United States. (Mar 2013)

Buckholz G, Gustin J, Levine S, Periyakoil VJ, Ross J, Sanchez-Reilly S (March 2013). Fellowship directors forum – Looking 10 years into the future.  Invited workshop at the American Academy of Hospice and Palliative Medicine Annual Assembly. New Orleans, LA

Morrison L, Gustin J, Carey E, Otis-Green S (October 2012). Giving feedback to palliative care learners. Accepted presentation at the 19th International Congress on Palliative Care. Montréal, Canada

Gustin J, Petersen D (September 2012).  What is satisfaction to a grieving family? Invited presentation at the Multidisciplinary Advances in the Treatment of the Critically Ill Hospitalized Patient (MATCH) conference. Columbus, OH

Gustin J, Wood G, Childers J, Jacobsen J & DeLima Thomas J (March 2012). Becoming a clinician educator in Palliative Care: Finding a path. Accepted presentation for SIG Symposia at American Academy of Hospice and Palliative Medicine Annual Assembly. Denver, CO

Gustin J, Johnson R, & Hartman A (March 2012). Advanced pulmonary hypertension: Considerations for care planning at the end-of-life. Accepted presentation at the American Academy of Hospice and Palliative Medicine Annual Assembly. Denver, CO

Gustin JL, Lucarelli M, Johnson R (April 2011). Challenging conversations: Role play as a technique for IM residency communication skills training.  Invited workshop at the Association of Program Directors in Internal Medicine Annual Meeting, Las Vegas, Nevada

Wells-DiGregorio S, DeWood M, Hartman A & Gustin J (February 2011). Effectiveness of antidepressant medication use among a convenience sample of cancer patients referred to Palliative Care. Paper presented at the American Academy of Hospice and Palliative Care, Vancouver, British Columbia

Gustin JL & McCallister J (December 2010). Patient-centered communication in the MICU: Facilitating a family meeting. Invited presentations for the Division of Pulmonary and Critical Care Medicine at Loma Linda University and University of Southern California. Los Angeles, CA

Gustin JL (April 2010). Communication skills: Training Pulmonary/Critical Care fellows. Invited presentation at the sixth Association of Pulmonary and Critical Care Medicine Program Directors Conference and Workshop. Fort Lauderdale, FL

Contact

Division of Palliative Medicine

Monica Scranton
Division Administrator
Monica.Scranton@osumc.edu
Phone: 614-293-8723
Fax: 614-293-2957

Division’s office:
5th Floor McCampbell Hall
1581 Dodd Drive
Columbus, OH 43210