Improving The Utilization Of Palliative Care Services At Medical City Fort Worth, Gennipher Smith, Shervin Sarji, Maanasa Palani, Samuel Chen, Mary Halm, Kristina Bowman, Morvarid Rezaie

North Texas GME Research Forum 2026

Palliative Care (PC) is a specialized medical care that aims to optimize the quality of life and alleviate the suffering of patients with serious medical illness. Benefits of palliative care include improved symptom management, enhanced quality of life, reduced healthcare utilization, better care alignment, improved communication and support, and financial savings. Hospital Corporation of America (HCA) Medical City Fort Worth (MCFW) has a PC consult service. However, it is underutilized. According to data collected from January 2025 to December 2025, the percentage of PC consults for high risk units, such as oncology and ICU, by day 3 of admission varies …

Case Report: Solitary Adrenal Metastasis From Esophageal Adenocarcinoma, Riddhi Machchhar, Ahmed Dawood Al Mahrizi, Fatima Mossolem, Mariam Abdeen, Ujjwala Jain, Jyotibala Jain, Prashant Desai

Rowan-Virtua School of Osteopathic Medicine Departmental Research

INTRODUCTION: Solitary adrenal metastasis from a primary esophageal malignancy is relatively rare. While there are case reports of aggressive treatment with esophagectomy and adrenalectomy providing long-term survival, the treatment paradigm is not well defined. Complications from esophageal adenocarcinoma and its treatment can significantly impact the patient's quality of life and prognosis.

CASE PRESENTATION: Our patient was treated with systemic therapy and, although he initially had a complete response, he later experienced local disease progression along with the development of additional metastatic sites. The patient began FOLFOX, a standard chemotherapy regimen for esophageal/gastric cancer. He experienced side effects such as fever, …

Interpreting Difficult Conversations In The Virtual World - Interpreter’S Perspective, Joyce Zhang, Bs, Kaitlyn Williams, Ms, Kathleen Mechler, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Medical Interpreters are essential in language discordant patient-family-team interactions
  • Facilitate clear communication
  • Aid in understanding diagnosis, prognosis, and treatment options
• Prior studies highlight range in interpreter comfort with serious illness conversations (SIC) though limited to in-person interpreter experience
• Rise of quick-access virtual interpreter services across the nation in many healthcare setting

Medical Assistance In Dying In A Profit-Driven Health System: Ethical And Equity Challenges In The U.S. Vs. Canada, Joseph A. Zwillenberg, Eric M. Teichner, Jacob Schwell, Cameron Haghshenas, Joseph F. Majdan, Md, Facp, Fcpp

Health Equity and Quality Improvement (HEQI) Summit

Introduction

Medical Assistance in Dying (MAID), legalized in Canada in 2016, now accounts for 4.1% of all deaths nationwide and 6.6% in Quebec as of 2022(1). In Canada’s single-payer system, MAID is integrated as a publicly funded medical service. In contrast, the U.S.’s fragmented, market-driven system is defined by profit maximization, inequitable access, and insurer- driven decision-making. While MAID aims to promote autonomy and compassion, introducing it into the American context raises profound ethical concerns, particularly regarding nonmaleficence and systemic coercion. This poster evaluates the unique risks MAID poses within the U.S. healthcare system, particularly for vulnerable populations.

Integrating Positive Psychology And Spirituality To Foster Meaning And Well-Being In Older Adults, Crystal Morris

Adultspan Journal

This perspective article explores the integration of positive psychology interventions (PPIs) and spirituality in therapy to foster meaning and well-being in older adults. It highlights exercises such as the positive introduction, positive legacy, character strengths, mindfulness, mindful-based yoga, and a manifestation prayer journaling. The interventions presented are tools to support older adults that may experience depression, difficult life transitions, and the search for renewed meaning. Therapists who integrate PPIs and spirituality into therapy can promote a holistic, non-pathological approach to treatment.

Enhancing End Of Life Care Through Recognition & Flagging Of Imminence To Increase Visits, Ali Ahmed, Guru Chinnaraj, Ana Goncalves, Ahad Ahmed, Ezekiel Ijaopo, Joseph Shega, Diana Tren

North Florida Division GME Research Day 2025

No abstract provided.

Finding Grace With Advanced Cirrhosis: Improving Palliative Care Consult Utilization Final Results, Saud Khan, Samuel Kwiatkowski, Anjali Lukose, Amanda T. Rivera Miranda, Priscilla Phan, Ashwini Komarla, Sabiha Kazi, Diana Treu, Amar Mandalia

North Florida Division GME Research Day 2025

No abstract provided.

Has The Elimination Of Mandatory Buprenorphine X-Waiver Increased Presciptions Of This Medication Upon Discharge From The Hospital?, Kendall Moore, Robyn Meadows, Robyn Hoelle, Matthew Calestino

North Florida Division GME Research Day 2025

No abstract provided.

Increasing Serious Illness Conversations In Patients At High Risk Of One-Year Mortality Using Improvement Science: A Quality Improvement Study, Kanishk D. Sharma, Sandip A. Godambe, Prachi P. Chavan, Agatha Parks-Savage, Marissa Galicia-Castillo

Department of Family and Community Medicine Faculty Publications

Background: Serious illness conversation (SIC) in an important skillset for clinicians. A review of mortality meetings from an urban academic hospital highlighted the need for early engagement in SICs and advance care planning (ACP) to align medical treatments with patient-centered outcomes. The aim of this study was to increase SICs and their documentation in patients with low one-year survival probability identified by updated Charlson Comorbidity Index (CCI) scores. Methods: This was a quality improvement study with data collected pre- and post-intervention at a large urban level one trauma center in Virginia, which also serves as a primary teaching hospital to …

Exploring The Reassessment Of Palliative Home Care Clients: A Mixed Methods Study, Maya Canham

Theses and Dissertations (Comprehensive)

Introduction: The timely reassessment of clients receiving palliative home care (HC) is critical for supporting clinicians with care planning and service delivery. However, there is little information on the frequency of reassessments and factors driving reassessment in palliative HC clients.

Objectives: The objectives of this study were to: (i) determine the proportion of palliative HC clients reassessed with the interRAI Palliative Care (interRAI PC) instrument, (ii) calculate the average interRAI PC reassessment interval, (iii) identify the key factors driving interRAI PC reassessment at various intervals, and (iv) explore the factors that influence palliative HC clinicians to reassess their clients in …

A Nurse-Driven Screening Process To Increase Icu Palliative Care Utilization, Sara L. Stock

Doctor of Nursing Practice Final Project Abstract

Purpose

A scholarly project aimed to increase palliative care by 25% for intensive care unit patients in eight weeks by integrating nurse-driven screening process into multidisciplinary rounds.

Background

Palliative care provides valuable mental, emotional, and spiritual support for patients and families. These benefits are available to any patient with a disease process causing symptoms affecting quality of life. Palliative care is falsely equated with hospice care, leading to further delay. The original referral model relied only on intensivist identification of eligibility The project was implemented in a 20-bed medical and surgical ICU in a community hospital in the Houston area. …

Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West

Adultspan Journal

This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …

Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego

Adultspan Journal

The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …

Barriers Primary Care Physician Assistants Face In Referring Patients To Palliative Care Services Early In The Disease Process, Claire Petersen

Theses and Graduate Projects

Background: Medical specialties such as hospice and palliative care have been proven to improve quality of life for patients facing end-of-life and chronic illness. Though increasing awareness of these specialties has resulted in greater availability, it is essential to investigate the barriers clinicians, such as Physician Assistants, face in making these referrals in order to provide quality healthcare to those who need it. Physician Assistants specifically are an essential clinician group to evaluate, as they continue to become more prevalent in the healthcare system.

Purpose: To determine barriers primary care Physician Assistants face when identifying candidates for and referring to …

Honoring Veterans’ Wishes: Efficacy Of An Evidence-Based Shared Decision-Making Tool In Va Icu Goals-Of-Care Discussions, Stephanie Alexander, Anna Astashchanka Md, Venktesh Ramnath Md

Doctor of Nursing Practice Final Manuscripts

Abstract

Introduction: This Doctor of Nursing Practice project aimed to enhance the knowledge and confidence of the San Diego Veterans Health Administration’s (VASD) Intensive Care Unit (ICU) medical providers in goals-of-care discussions (GOCD). Additionally, this project aimed to improve the documentation of these discussions.

Background: Delays in GOCD can lead to futile medical and surgical interventions, inappropriate antibiotic use, and higher rates of mental health conditions in patients and their loved ones. Earlier GOCD are associated with lower ventilation and resuscitation rates, earlier hospice enrollment, reduced ICU admissions, lower financial costs, and better patient and caregiver quality of life. However, …

Increasing Palliative Care Team Involvement In Pediatric Hematopoietic Stem Cell Transplant Patients, Meagan Vacek, Lisa Tarbell, Melissa List, Erin Hall, Jennifer Linebarger, Kelstan Ellis, Gina Jones, Joel Thompson

Research Days

Early implementation of palliative care in pediatric oncology is well established but its role in pediatric hematopoietic stem cell transplant (HSCT) patients is yet to be fully determined. Multiple organizations encourage palliative care involvement in HSCT patients. Our aim was to increase palliative care team consults for patients receiving HSCT for our targeted diagnosis. Though we did not achieve this aim, we were able to increase the palliative care team's involvement in the total cohort of patients undergoing HSCT.

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …

Mortality In Medicine, Maren Dougherty

Honors Projects

Practitioners in the medical field attend to health issues across one’s lifespan from birth to death and everything in between. A common conflict in today’s practice of medicine is establishing the true function of medicine. The complete reliance on medicine to ward off death proliferates the biomedicalization of natural life processes, like death. Biomedicalization is the process in which medical authority and its accompanying technology begin to control other aspects of daily life. With medicine’s ultimate goal being to cure disease and fight death, it interferes with the inevitability of human mortality. End-of-life treatment can be taken too far without …

Eye Care For Corneal Transplant Donors In The Icu: What We Didn’T See Coming, Ashton Lackey, Joey Royea, Alexandra Hartman, Aaron Worthley, Abbi Mason, Bryan Howington, Bharat Meenavalli, George Helmrich, Stephen M. Meyer

South Atlantic Division GME Research Day 2024

No abstract provided.

Establishing A Protocol For Hospice Compassionate Withdrawal Of Ventilatory Support In The Home Setting, Georganna Rosel, Ana Sanchez, Reuben Smith

South Atlantic Division GME Research Day 2024

No abstract provided.

Empirical Insights Into Survivorship Care: A Cross-Sectional Study Of Coc Accredited Hospitals In Kentucky, Amanda M. Beckett

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

ABSTRACT

Background:

Cancer survivorship care programs play a vital role in supporting cancer survivors and improving their quality of life. Understanding the landscape of survivorship and the potential barriers is key to optimizing care delivery.

Methods:

The primary purpose of this cross-sectional study was to explore existing cancer survivorship care programs offered by Commission on Cancer (CoC) accredited hospitals in Kentucky. Data from the Markey Cancer Affiliate Network (MCCAN) from 2022 through 2023 was analyzed. Variables included hospital characteristics such as rural code, types of survivorship services offered, and reported barriers to these services.

Results:

Analysis of n=19 CoC facilities …

The Unequal Distribution Of Social Risk For Black Men Across The Life-Span. A Novel Framework., Waleed Y. Sami

Adultspan Journal

This conceptual overview offers a comprehensive overview of systemic pathways that negatively impact the mental health of Black Men throughout their lives. Our argument highlights the importance for counselors and mental health professionals to utilize a thorough social risk assessment that considers these pathways in order to effectively address the mental health needs of Black Men while fostering positive working relationships. This overview strongly advocates for the use of context and structural determinants when evaluating mental health symptoms. Without an appropriate understanding of social risk and determinants, counselors may inadvertently perpetuate disparities by decontextualizing symptomology, and reproducing racist discourse.

Competency-Based Nursing Education And The Future Of Nursing: Where The Faith Community Nurse Fits In, Mary Lynne Knighten Dnp, Rn, Nea-Bc

International Journal of Faith Community Nursing

Abstract

Two significant nursing landmark reports published in 2021 are enhancing standards and providing guidance for nursing education and practice. The American Association of Colleges of Nursing (AACN) Essentials: Core Competencies of Professional Nursing Education (2021) provides a blueprint for educationally and experientially preparing nurses for practice. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report defines issues such as health disparities and inequities, with recommendations for the role nurses should play in making change to improve the health of the nation.

This paper seeks to explore the intersections of these two reports with the specialty …

Improving Timeliness Of Palliative Care Referrals Within The Intensive Care Unit: A Quality Improvement Project, Stephanie Fiore

DNP Projects

Significance and Background: Palliative care (PC) services are often underutilized in the ICU. There is a lack of understanding of PC by providers, staff, patients, and families which then leads to difficulty obtaining appropriate and adequate referrals to the PC team. In the ICU practice setting, the current process for palliative care referrals (PCRs) has the attending physician as the only individual to initiate a PCR referral. Another element missing from the current process is a criteria trigger tool that other disciplines, including nursing, can use to assess the patient’s need for PCR in the first 48 hours of admission. …

End-Of-Life Care In The Trauma Bay: Six Key Points, Louis Christie Dr

Journal of Geriatric Emergency Medicine

The dominant culture across North America, Europe and Australia has been characterized by workers in hospice and palliative care as ‘death denying’ or ‘death phobic’. The last two decades have seen a significant increase in the number of trauma patients with complex background co-morbidities due to advanced age. Effective end-of-life care in trauma requires physicians to begin careful, balanced and sensitive conversations encompassing goals of care and expectation-setting, in the trauma bay. These pointers will help the reader communicate the principles of these clinical decisions clearly to patients and their families.

Improving Comfort And Confidence With Advance Care Planning In Primary Care, Thomas Krajewski, Donald Courtney, Tyler Kilgore

South Atlantic Division GME Research Day 2023

No abstract provided.

Low Rates Of Structured Advance Care Planning Documentation In Electronic Health Records: Results Of A Single-Center Observational Study, Adela Wu, Robert J Huang, Gabriela Ruiz Colón, Chris Zembrzuski, Chirag B Patel

Faculty, Staff and Student Publications

BACKGROUND: Proper advance care planning (ACP) documentation both improves patient care and is increasingly seen as a marker of high quality by governmental payers. The transition of most medical documentation to electronic health records (EHR) allows for ACP documents to be rapidly disseminated across diverse ambulatory practice settings. At the same time, the complexity and heterogeneity of the EHR, as well as the multiple potential storage locations for documentation, may lead to confusion and inaccessibility. There has been movement to promote structured ACP (S-ACP) documentation within the EHR.

METHODS: We performed a retrospective cohort study at a single, large university …

Asking The Question ‘What Matters To You?’ In A London Intensive Care Unit, Harriet Pittaway, Laura White, Karen Turner, Angelique Mcgillivary

Journal of Patient-Centered Research and Reviews

Purpose: At the heart of the paradigm shift in approach to patient care from paternalism toward shared decision-making lies the international “What Matters To You?” (WMTY) movement. However, WMTY principles are not frequently applied to the critical care setting. The aim of this quality improvement project work was to design and integrate a tool for all patients admitted to the intensive care unit (ICU) that helped answer WMTY.

Methods: Using Plan-Do-Study-Act (PDSA) methodology across 8 cycles, a multidisciplinary team designed and integrated a bedside poster into the ICU. Quantitative and qualitative data were collected via a bedside audit process on …

Literature Review: Palliative Care In The Emergency Department, Alice Chang, James Espinosa, Alan Lucerna, Neelesh Parikh

Rowan-Virtua Research Day

With current medical advances, our patient population continues to age. This poses new challenges for healthcare practitioners to provide for elderly patients with complex and multifactorial medical needs. Particularly, this is a growing challenge in the emergency department (ED), where patients often present towards the last months of their lives. A study conducted by UCSF indicates 75% of patients in their last 6 month of life visited the ED. 56% to 99% of older adults do not have advance directives available at ED presentation. Therefore, ED visits towards the end of life is an opportune teaching moment for physicians to …

Advantages Of Early Utilization Of Palliative Care In The Pediatric Icu: A Scoping Review, Shelby Noel Cain Bsn, Rn, Cpn, Dana Pabalate Zimmerman Msn, Rn, Charis Elizabeth Oji Msn, Aprn, Cpnp-Pc/Ac, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Abstract Purpose/Background Despite the increased use of palliative care in adults, only a tiny percentage of children with life-limiting illnesses or life-threatening conditions receive palliative care before dying. Palliative care has low utilization, and consults are often made late in a child’s hospitalization or diagnosis. Palliative care remains underutilized among hospitalized pediatric patients resulting in unnecessary treatments, costly and lengthy hospitalizations, and deaths occurring in the intensive care unit (ICU) rather than at home. The purpose of this scoping review is to evaluate current literature to determine the use and effect of pediatric palliative care, specifically, whether consultation of palliative …