Year One Scholars
Erin Blakeney, PhD, RN
Project Abstract: Heart failure (HF) care is costly, complex and often fragmented which impacts quality of care, safety, and other outcomes. Structured interprofessional bedside rounds (SIBR)—a model that was developed to bring together different disciplines using a structured format to collaboratively arrive at a plan of care at the patient’s bedside—have been associated with improvements in care team communication and may provide an opportune context in which to implement clinical pathways (CPW). A growing body of evidence associates SIBR with improvements in care team communication and relationships that help reduce fragmentation of care. Despite these positive findings, an evidence gap exists as to whether SIBR is acceptable and appropriate to patients and providers. Further exploration of both benefits and unintended consequences of SIBR are warranted as they influence effectiveness and sustainability of SIBR. SIBR may also provide a supportive or enabling context for clinical pathway (CPW) implementation. CPW uptake and sustainment are underutilized in HF care. Systematic reviews have found that features of the care context, like those found in SIBR, are influential in CPW implementation and adherence. To address these knowledge gaps, the proposed K12 project has two goals that leverage a timely opportunity to: 1) study HF patient and provider perspectives on SIBR using surveys and interviews and, 2) to carry out the first known study of HF CPW implementation in a SIBR context (adoption/penetration and limited efficacy) to determine whether SIBR provides a supportive or enabling context for clinical pathway implementation at the University of Washington Medical Center.
Biography: Dr. Blakeney is a Research Assistant Professor in the Department of Biobehavioral Nursing and Health Informatics in the School of Nursing at the University of Washington. Her clinical background is in nursing with a focus on chronic illness prevention and management across the care continuum from home care to inpatient solid organ transplant. Academically, Dr. Blakeney has degrees in Politics/Environmental Studies (BA), Nursing (BS), International Education with a focus on cross-cultural training (MA), and Nursing Science (PhD). Her program of research up to now has focused on developing and testing interprofessional education (IPE) and collaborative practice (CP) interventions to improve team dynamics, care delivery, and patient outcomes. How healthcare is organized and delivered by teams directly impacts clinical outcomes, patient satisfaction, and healthcare utilization. As Dr. Blakeney enters the field of implementation science she is looking forward to learning how best to disseminate and implement evidence-based IPE/CP interventions into practice. She is specifically interested in studying patient and provider perspectives on implementation of structured interprofessional bedside rounds (SIBR) in inpatient hospital settings; she will also be examining whether a SIBR provides a supportive or enabling context for successful clinical pathway implementation.
Cara McDermott, PharmD, PhD
Project Abstract: Dr. McDermott’s K12 project will investigate ways to reduce polypharmacy and potentially inappropriate medication (PIM) use in a vulnerable population of older adults—those with advanced lung cancer, multiple chronic conditions, and limited life expectancy. Due to physiological changes that accompany aging, older adults are more susceptible to adverse events from medications; this risk is heightened when anticancer therapies are coupled with medications for multiple chronic conditions. Polypharmacy, or the use of multiple medications, occurs in most older adults and is associated with adverse drug-related events and decreased quality of life. With polypharmacy, patients are often taking PIMs, and the risk associated with such medications exceeds benefits from use. Using principles of geriatric assessment has been demonstrated to reduce polypharmacy and PIM use among older adults, but geriatric assessment is not a routine part of cancer care delivery. In this study, I will investigate barriers and facilitators to implementing an adapted pharmacist-led de-prescribing intervention at local oncology clinics. Dr. McDermott will conduct semi-structured interviews with older adults with advanced cancer and multiple chronic conditions, their caregivers, oncologists, primary care providers, and clinical pharmacists. During interviews she will elicit barriers, facilitators and key strategies to de-prescribing PIMs, utilizing geriatric assessment, and enhancing shared decision making around medication use. She will use the Consolidated Framework for Implementation Research (CFIR) to guide analyses to identify factors related to the intervention, settings, processes, and individuals, then incorporate study findings into a future pilot randomized trial to establish the feasibility and acceptability of the de-prescribing intervention.
Biography: Cara McDermott, PharmD, PhD is an Acting Instructor with the Cambia Palliative Care Center of Excellence at the University of Washington School of Medicine and an Affiliate Investigator with the Hutchinson Institute for Cancer Outcomes Research. Her research examines care delivery, medication use, and healthcare utilization among older adults with multiple chronic conditions. In recent projects she investigated the impact of depression on cancer treatment and end-of-life care for older adults with lung cancer, healthcare-associated out-of-pocket costs for patients with cancer at end of life, and healthcare utilization at end of life among commercially insured adults with cancer. Dr. McDermott holds a BA from Princeton University and a PharmD from the University of Washington. She received her MSc and PhD degrees from the Comparative Health Outcomes, Policy and Economics Institute at the University of Washington School of Pharmacy, where she focused on geriatric oncology, infectious disease, and comparative effectiveness research. She completed a TL-1 predoctoral fellowship in translational research with the Institute of Translational Health Sciences at the University of Washington, and a T32 post-doctoral research fellowship with the Cambia Palliative Care Center of Excellence.
Laura J. Spece, MD, MSc
Project Abstract: Care delivery for patients with COPD is poor across the spectrum of detection, diagnosis, treatment, and health behavior modification. Successful implementation of interventions to improve care delivery for patients with COPD requires a detailed formative pre-implementation assessment that crosses multiple levels of evidence. During her time as a K12 ISTP scholar, Dr. Spece will identify patient, provider and health system-level characteristics associated with delivery of guideline concordant care in COPD within the Veterans Affairs health system. Dr. Spece will also perform semi-structured interviews with key stakeholders to understand the barriers and knowledge gaps for high-quality COPD care delivery. She will then apply conceptual implementation science frameworks (such as CFIR and RE-AIM) using these data to form a feasible pilot intervention to improve COPD care.
Biography: Dr. Spece graduated from the University of Pennsylvania and the Pennsylvania State College of Medicine. She is a member of the Alpha Omega Alpha Honor Society. Dr. Spece completed internship and residency training in Internal Medicine, followed by fellowship in Pulmonary & Critical Care Medicine at the University of Washington. She currently sees patients at the University of Washington and Harborview Medical Centers in Seattle, WA. During her fellowship, she completed an MS in Epidemiology. Dr. Spece was awarded an NRSA F32 award and a Loan Repayment Program award from the NIH NHLBI to examine the quality of COPD care and patient adherence to medications in the setting of patient and health system complexity. Dr. Spece’s research has been recognized at the American Thoracic Society International Conference.
Year Two Scholars
Nancy Lau, MA, PhD
Project Abstract: Adolescents and young adults (AYAs) with cancer are at high risk of poor quality of life and negative psychosocial outcomes. Recent research has focused on the development of psychosocial interventions for pediatric cancer patients. One such promising, brief, 1:1 intervention is “Promoting Resilience in Stress Management” (PRISM; PI: Dr. Abby Rosenberg), the first of its kind for AYAs with cancer, and based on iterative research within the AYA and pediatric chronic illness population, stress and coping theory, and successful interventions in the literature. However, progress in translating evidence-based treatments into routine clinical care has been slow. 25,26A potential solution is leveraging technological advances and digital media to deploy behavioral health interventions. Internet-based interventions confer the advantages of instant availability, anonymity, self-pacing, the ability to reach patients in remote areas, and cost-effectiveness due to reduced personnel and infrastructure requirements. Dr. Lau’s proposed project will evaluate implementation outcomes associated with a newly developed mHealth intervention (mPRISM) delivered via a smartphone app to help AYAs with cancer develop coping skills and bolster resilience. Project aims are to assess patient and provider stakeholder perspectives, conduct usability testing to evaluate digital user patterns and preferences, and to explore the level of human support necessary for successful implementation. Ultimately, this project and future investigations will leverage technological advances to facilitate targeted access to psychosocial services for pediatric chronic illness populations, in turn improving outcomes and alleviating the burdens of illness.
Biography: Dr. Nancy Lau is a postdoctoral research fellow with the University of Washington Cambia Palliative Care Center of Excellence’s T32 program and a Senior Fellow in the Department of Pediatrics and Seattle Children’s Research Institute. Prior to fellowship, she completed her master’s degree and doctorate in clinical psychology at Harvard University and completed her psychology residency training at the University of Washington and Seattle Children’s Hospital. Her research background is in developmental psychopathology, family-based coping, and evidence-based interventions for youth anxiety and depression. Dr. Lau has learned firsthand the importance and challenges of psychosocial treatment research, and the obstacles to implementing effective treatments in resource-constrained clinical settings. On fellowship, her primary mentors are Dr. Abby Rosenberg and Dr. Elizabeth McCauley. Dr. Lau’s research broadly focuses on palliative care in pediatric chronic illness populations. Specifically, she is interested in leveraging technological advances to improve availability and access to evidence-based supportive care for youths with chronic illnesses via novel eHealth and mHealth delivery platforms. In September of 2019, Dr. Lau will begin an Acting Assistant Professor position in the University of Washington School of Medicine’s Department of Psychiatry and Behavioral Sciences. Her K12 Program mentorship team consists of Dr. Abby Rosenberg, Dr. Randall Curtis, Dr. Elizabeth McCauley, Dr. Tonya Palermo, Dr. Bryan Weiner, and Dr. Chuan Zhou.
Robert Y. Lee, MD
Project Abstract: Patients with chronic life-limiting illness are frequently and increasingly receiving intensive care and mechanical ventilation near the end of life. While such care is desired by some patients, others with chronic life-limiting illness may prefer a more palliative approach that prioritizes symptom relief over life extension. Advance care planning efforts have sought to improve concordance between patients’ goals and their medical care; one popular approach is the Physician Orders for Life-Sustaining Treatment (POLST) form, a portable physician order that specifies treatment limitations for emergency care. The POLST form has been widely adopted in most states. However, despite widespread implementation, POLST orders that limit medical interventions for the chronically ill often fail to decrease the intensity of care delivered near the end of life. Our preliminary data shows that over one in three patients with treatment-limiting POLST orders nevertheless receive intensive care near the end of life, reflecting an implementation failure of the POLST.
Dr. Lee’s research objectives are: (1) to identify characteristics of the POLST intervention, settings, individuals, and process measures that are associated with implementation failure of POLST orders; (2) to identify barriers and facilitators to effective implementation of POLST orders near the end of life; and ultimately, (3) to design an intervention to improve implementation of POLST orders when appropriate, and conduct a pilot trial designed to improve the delivery of goal-concordant care.
Biography: Robert (“Bob”) Y. Lee is a senior fellow in pulmonary and critical care medicine at the University of Washington. He received his B.S. Chemistry from Carnegie Mellon University in 2006; his M.D. from the University of Colorado School of Medicine in 2011; and, he completed his residency in internal medicine at the University of California, San Francisco (UCSF) in 2014. He was awarded a research fellowship with the University of Washington Palliative Care T32 Research Fellowship in 2016, during which he investigated the long-term psychological outcomes of patients with acute respiratory distress syndrome (ARDS) and their family members. He is presently funded on an NHLBI NRSA (F32) award conducting research in goal-discordant care in patients with acute respiratory failure under the mentorship of Drs. Erin Kross and J. Randall Curtis. Dr. Lee’s long-term goal is to pursue a career in academic medicine, with an emphasis on patient-oriented research that focuses on the intersection between palliative care and critical care. Dr. Lee’s current research projects surround the implementation and delivery of palliative care interventions for critically ill patients, with particular focus on advance care planning and decision-making near the end of life for patients with serious illness and their families.