Kathryn I Pollak

• Duke University Medical Center

Objective: We aimed to characterize parents' perspectives on the value of and opportunities to improve conferences between parents of critically ill infants and the health care team. Background: The parent perspective on the value of family conferences in the intensive care unit is not well characterized. Methods: In this descriptive qualitative st...

BACKGROUND Robust evidence demonstrates inequities in communication during family-centered rounds for families who use a language other than English (LOE) for health care. This study aimed to characterize the type of interpreter alterations occurring on family-centered rounds and identify medical team communication practices associated with alterat...

Introduction Sonographers are required to deliver unexpected news to expectant parents in real time during obstetric ultrasound scans. The complexity of these interactions requires sonographers to conduct the clinical task while communicating their findings and managing the expectant parent’s response within the designated appointment time. Communi...

Background In the US, 1.2 million people live with HIV (PWH). Despite having near-normal life expectancies due to antiretroviral therapy (ART), many PWH seek an HIV cure, even if it means risking their lives. This willingness to take risks for a cure raises questions about “affective forecasting biases,” where people tend to overestimate the positi...

Introduction Smokeless tobacco use remains prevalent in rural and medically underserved populations, leading to increased rates of tobacco-related cancers and chronic disease. While access to effective cessation programs is limited, text-based interventions may offer a delivery approach with broad reach. This two-armed randomized control trial (RCT...

BACKGROUND Web-based advance care (ACP) interventions offer a promising solution to improve ACP engagement. However, there is lack of web-based ACP decision aids tailored for patients with heart failure, incorporating mechanisms to revisit patients’ care goals, and rarely involve caregivers. OBJECTIVE To develop and assess the usability and accept...

Background Web-based advance care planning (ACP) interventions offer a promising solution to improve ACP engagement, but none are specifically designed to meet the needs of patients with heart failure and their caregivers. Objective We aimed to develop and assess the usability and acceptability of a web-based ACP decision aid called “My Voice,” wh...

The Palliative Care Research Cooperative Group (PCRC) formed to lead, catalyze, and empower a community of scientists to build an evidence base to ensure high-quality care and optimal well-being for persons with serious illness and their caregivers. The PCRC grew to 630 members representing 220 distinct sites. The PCRC awarded 44 pilot grant awards...

Background Compared with the general cancer population, people living with HIV (PLWH) and cancer are less likely to receive treatment and have significantly elevated cancer-specific mortality for many common cancer types. Physician recommendations drive the cancer therapy that patients receive, yet there is limited information assessing how cancer...

Objective Obstetric ultrasound scans provide real-time results. In some organisations and countries, the immediate communication of results by sonographers to patients is standard practice, but there is a lack of evidence-based training to support them with this challenging task. This pilot study evaluated a novel communication coaching interventio...

Background: Prior investigators have examined the relationship between neighborhood public transportation access and physical activity among adolescents, but research is lacking on the association with obesity in this age group. This study examines the association between neighborhood public transportation access and adolescent BMI using a national...

Context: Patients with serious illness and their caregivers often face challenging decisions. When faced with these decisions, patients and caregivers may display signs of ambivalence and reluctance toward end-of-life decision making. Methods: We recruited 22 palliative care clinicians to participate in a communication coaching study. Clinicians au...

Objective: Palliative care encounters often involve empathic opportunities conveyed by patients and their care partners. In this secondary analysis, we examined empathic opportunities and clinician responses with attention to how presence of multiple care partners and clinicians shapes empathic communication. Methods: We used the Empathic Commun...

Importance Communication between cardiologists and patients can significantly affect patient comprehension, adherence, and satisfaction. To our knowledge, a coaching intervention to improve cardiologist communication has not been tested. Objective To evaluate the effect of a communication coaching intervention to teach evidence-based communication...

This Viewpoint discusses communication between clinicians and caregivers of racial and ethnic minoritized groups.

Objectives As computational methods for detecting symptoms can help us better attend to patient suffering, the objectives of this study were to develop and evaluate the performance of a natural language processing keyword library for detecting symptom talk, and to describe symptom communication within our dataset to generate insights for future mod...

Purpose: Cancer is now the leading cause of non-AIDS death in the U.S. HIV population. People living with HIV (PLWH) are known to have lower cancer treatment rates and worse cancer outcomes. Disparate cancer treatment is driven by health system, patient, and clinician factors. Little attention has been given to the factors oncologists consider whe...

Introduction Despite widespread recognition that communicating unexpected news during obstetric ultrasound examinations is challenging, there is a dearth of research investigating how to teach evidence-based communication to sonographers. Communication Coaching is a supportive, positive method that has previously been associated with improvements i...

Background and Objectives Clinicians often communicate complex, uncertain, and distressing information about neurologic prognosis to parents of critically ill infants. While communication tools have been developed in other disciplines and settings, none address the unique needs of the neonatal and pediatric neurology context. We aimed to develop a...

Objectives: To evaluate racial and ethnic differences in communication quality during family centered rounds. Methods: We conducted an observational study of family-centered rounds on hospital day 1. All enrolled caregivers completed a survey following rounds and a subset consented to audio record their encounter with the medical team. We applie...

Importance Communication during conversations about death is critical; however, little is known about the language clinicians and families use to discuss death. Objective To characterize (1) the way death is discussed in family meetings between parents of critically ill infants and the clinical team and (2) how discussion of death differs between...

Objectives: Clinician burnout poses risks not just to clinicians but also to patients and the health system. Cardiologists might be especially prone to burnout due to performing high-risk procedures, having to discuss serious news, and treating diseases that incur significant morbidity and mortality. Few have attempted to examine which cardiologist...

Background Implementation mapping (IM) is a promising five-step method for guiding planning, execution, and maintenance of an innovation. Case examples are valuable for implementation practitioners to understand considerations for applying IM. This pilot study aimed to determine the feasibility of using IM within a federally qualified health center...

Smoking during pregnancy and postpartum remains an important public health problem. No known prior study has prospectively examined mutual changes in risk factors and women’s smoking trajectory across pregnancy and postpartum. The objective of this study was to report methods used to implement a prospective cohort (Msgs4Moms), present participant b...

Objective Communication coaching shows promise for improving clinician communication yet few have assessed the feasibility of having peers coach each other. We conducted a proof-of-concept study to test the feasibility and acceptability of a peer-based communication coaching program in an inpatient setting. Methods We trained three clinician commu...

Objectives Clinicians increasingly believe they should discuss costs with their patients. We aimed to learn what strategies clinicians, clinic leaders, and health systems can use to facilitate vital cost-of-care conversations. Methods We conducted focus groups and semi-structured interviews with outpatient clinicians at two US academic medical cen...

Background: Communication challenges in the neonatal intensive care unit include fragmented communication, challenges managing expectations amidst uncertainty, and navigating complex medical information. Social workers are well suited to mitigate these challenges. Objective: In this study, we aimed to characterize the extent and nature of social wo...

Introduction: Smoking during pregnancy can affect infant birthweight. We tested whether an intervention that promoted scheduled gradual reduction improved birth outcomes among pregnant women who smoked. We also examined race differences in birth outcomes. Methods: We conducted a 2-arm randomized controlled trial where pregnant women who smoked r...

Background: Fragmented communication with patients and families during hospitalizations often leaves patients confused about the daily plan. Objective: To pilot a supplemental text message-based platform for improving bidirectional communication about the clinical plan and patients' goals. Design: Randomized controlled trial PARTICIPANTS: Thir...

Parents and clinicians caring for infants with neurologic disease often make high-stakes decisions about infant care. To characterize how these decisions occur, we enrolled infants with neurologic conditions, their parents, and their clinicians in a longitudinal mixed methods study of decision making. We audio recorded family conferences as they oc...

Objectives To characterize decisional satisfaction, regret, and conflict among parents of critically ill infants with neurologic conditions. Study design In this prospective cohort study, we enrolled parents of infants with neurologic conditions in the intensive care unit (ICU). Hospital discharge surveys included the validated Family Satisfaction...

Objective: Despite widespread adoption of family-centered rounds, few have investigated differences in the experience of family-centered rounds by family race and ethnicity. The purpose of this study was to explore racial and ethnic differences in caregiver perception of inclusion and empowerment during family-centered rounds. Methods: We identi...

Background: Social inequity is a primary driver of health disparities, creating multiple barriers to good health. These inequities were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic, with Latinx communities suffering more than others. Grassroots collaborations have long existed to address disparities. Objective: We describe...

Objective The purpose of this paper was to examine changes in situational temptations to smoke among women in early to late pregnancy enrolled in a texting trial to help them quit smoking. We compared changes between (1) intervention arms, (2) those who quit, (3) those who reduced by 50% or more, and (4) those who reduced by less than 50%. We also...

PURPOSE We sought to characterize patient-oncologist communication and decision making about continuing or limiting systemic therapy in encounters after an initial consultation, with a particular focus on whether and how oncologists foster shared decision making (SDM). METHODS We performed content analysis of outpatient oncology encounters at two...

Purpose Cancer survivors are often sedentary. Self-monitoring may promote physical activity through self-activation. We conducted a pilot trial to evaluate whether wearable activity tracker with personalized text message feedback would increase physical activity. Methods We enrolled 30 patients with solid tumor cancers into a non-randomized prospe...

Objectives When patients make cancer treatment decisions, they consider the needs and preferences of family caregivers and clinicians. We examined how much all three triad members agreed about goals of treatment and caregivers’ influence on decision-making. Methods We surveyed 70 triads of patients, caregivers, and oncologists who had recently mad...

Purpose Acute myeloid leukemia (AML) is a hematologic malignancy characterized by a poor prognosis but also a paradoxical possibility of cure. This renders decision-making complex and imminent. Unfortunately, many patients with AML misestimate their prognosis and treatment risk. While decision aids can improve illness understanding and reduce decis...

Importance Early discussion of end-of-life (EOL) care preferences improves clinical outcomes and goal-concordant care. However, most EOL discussions occur approximately 1 month before death, despite most patients desiring information earlier. Objective To describe successful navigation and missed opportunities for EOL discussions (eg, advance care...

Objectives This study aimed to characterize the use and impact of assessments of understanding in parent-clinician communication for critically ill infants. Methods We enrolled parents and clinicians participating in family conferences for infants with neurologic conditions. Family conferences were audio recorded as they occurred. We used a direct...

Background: Many older adults with severe dementia receive potentially life-extending treatments even when caregivers do not wish to prolong their life inappropriately. Objective: Explore factors that influence caregiver preferences for potentially life-extending treatments for older adults with severe dementia, and reasons for discordance betwe...

Background: Electronic health records (EHRs) may help enable reliable, rapid data management for many uses, such as facilitating communication of advance care planning (ACP). However, issues with validity and accuracy of EHRs hinder the use of ACP information for practical applications. Design: We present a cross-sectional pilot study of 433 older...

PURPOSE Insured patients with cancer face high treatment-related, out-of-pocket (OOP) costs and often cannot access financial assistance. We conducted a randomized, controlled trial of Bridge, a patient-facing app designed to identify eligible financial resources for patients. We hypothesized that patients using Bridge would experience greater OOP...

Purpose: To explore the ways in which multiple myeloma affects an individual's life in the modern treatment era. Participants & setting: 15 individuals with multiple myeloma and 10 clinicians were recruited from two academic medical centers in the southeastern United States. Methodologic approach: Semistructured interviews were conducted with...

Given the role of effective communication in improving patient adherence and satisfaction, high quality patient-clinician communication is critical. Building on previous communication interventions in oncology and pediatrics, we developed a tailored communication coaching intervention to improve empathic communication quality and patient-centered c...

Family caregivers of older adults with severe dementia are decisive in use of potentially life-extending interventions for their care recipients. We conducted in-depth interviews with 26 caregivers of community-dwelling older adults with severe dementia in Singapore to assess their preferences for intravenous (IV) antibiotics for a life threatening...

Context Dementia involves suffering. Assessing the experience of suffering among persons with severe dementia is instrumental to delivering quality end-of-life care to them and their caregivers. Objectives We aimed to assess dimensions of suffering from the perspective of family caregivers and the resulting impact on their decisions for the care o...

Introduction Light smoking (smoking ≤ 10 cigarettes per day or on some days) has become increasingly prevalent in the US and increases morbidity and mortality. Many light smokers do not experience significant nicotine withdrawal but instead smoke in response to cues. Minimal evidence exists supporting interventions to help light smokers quit smokin...

Many people living with HIV (PLWHIV) state that they would be willing to take significant risks to be “cured” of the virus. However, how they interpret the word “cure” in this context is not clear. We used a randomized survey to examine whether PLWHIV had a different willingness to take a hypothetical HIV medication if it causes flu-like symptoms,...

Empathy involves understanding other people's situation, perspective, and feelings. In clinical interactions, it helps clinicians establish rapport with a patient and support patient-centered care and decision making. Understanding physician communication through observation of audio-recorded encounters is largely carried out with manual annotation...

7073 Background: Insured cancer patients face high treatment-related, out-of-pocket costs. While philanthropic- and pharmaceutical-sponsored financial assistance programs exist, patients are often unaware of them. We developed “Bridge”, a patient-facing app that identified financial assistance programs for which a patient might be eligible based on...

Introduction Smokeless tobacco (ST) use significantly affects morbidity and mortality and remains disproportionally prevalent in rural and medically underserved communities. Few programs exist for rural smokeless tobacco users. Text-based interventions may increase the reach of cessation interventions; yet, none has tested them in ST users. We eval...

IntroductionMost pregnant women know that smoking poses serious risks to baby and mother, yet many still smoke. We conducted a large randomized controlled trial and found that an SMS text-delivered program helped about 10% of these women quit smoking. In this paper, we describe the feasibility of disseminating a text-based intervention to pregnant...

PURPOSE High-quality end-of-life cancer care requires oncologists to communicate effectively and patients/caregivers to be participatory. However, most communication interventions target either but not both. We aimed to pilot a potentially disseminable combined oncologist-patient/caregiver intervention to improve oncologist empathic responses, disc...

Objective: During a recent trial assessing the effectiveness of an online communication training for community practice oncologists, we encountered multiple barriers. Methods: We asked oncologists to participate through the American Board of Internal Medicine (ABIM) Maintenance of Certification program. Oncologists collected 25 Clinician and Gro...

Many Latino men have multiple risk factors that predispose them to chronic disease morbidity and mortality, yet few have examined patterns in this population. We describe the co-occurrence of daily smoking, binge drinking, and intimate partner violence (IPV) behaviors among Latino expectant fathers and examine factors associated with the co-occurre...

Introduction Light and intermittent smokers (LITS) represent almost 50% of all current smokers. Research is needed to understand smoking motives among adult light smokers. Aims To explore smoking cues and motivators among a racially diverse sample of adult LITS (≤10 CPD). In addition, we explored differences between native (always smoked ≤10), and...

Multiple myeloma (myeloma), is an incurable cancer of the plasma cells that affects many older adults. Over 30,000 new diagnoses and over 12,000 deaths are attributed to myeloma annually in the United States, where the median age of diagnosis is 69 years old. Dramatic improvements in survival over the past fifteen years have transformed myeloma int...

Objective Patient involvement in treatment decisions is recommended in clinician‐patient encounters. Little is known about how oncologists engage patients in shared decision making in non‐Western countries. We assessed the prevalence of shared decision making among Singaporean oncologists and analysed how they discussed prognosis. Methods We audio...

Despite doing well on antiretroviral therapy, many people living with HIV have expressed a willingness to accept substantial risks for an HIV cure. To date, few studies have assessed the specific quantitative maximal risk that future participants might take; probed whether, according to future participants, the risk can be offset by the benefits; a...

Context: Palliative care clinicians often have challenging conversations with patients or family caregivers who express ambivalence about goals or feel reluctant to discuss topics. Motivational Interviewing (MI) has tools to address ambivalence and reluctance. The aim of this pilot was to test the feasibility, acceptability, and preliminary effica...

Introduction: Smoking during pregnancy poses serious risks to baby and mother. Few disseminable programs exist to help pregnant women quit or reduce their smoking. We hypothesized that an SMS text-delivered scheduled gradual reduction (SGR) program plus support texts would outperform SMS support messages alone. Methods: We recruited 314 pregnant...

Context: Many hospitalized patients receive care that is not concordant with their goals. Teaching communication skills that better align goals and treatment can improve the care that patients receive. Objective: To develop and test an innovative approach that encourages hospitalists to engage in goals of care (GOC) conversations with their pati...

Objectives: Pediatrician-adolescent communication can improve adolescent health. We conducted a two-arm design to pilot-test an intervention that randomized adolescents to receive a Feedback Guide to promote engaged conversations. We hypothesized that adolescents who received the Guide would be more participatory. Methods: We recruited 12 pediat...

7040 Background: Many acute myeloid leukemia (AML) patients harbor misunderstandings about their illness, overestimating both their likelihood of cure and risks of intensive therapies. Decision aids (DA) can improve illness understanding and reduce decisional conflict, but are not routinely used in AML. Methods: We developed an AML DA with input fr...

People living with HIV (PLWHIV) can reasonably expect near-normal longevity, yet many express a willingness to assume significant risks to be cured. We surveyed 200 PLWHIV who were stable on antiretroviral therapy (ART) to quantify associations between the benefits they anticipate from a cure and their risk tolerance for curative treatments. Sixty-...

Purpose Many cancer survivors continue to smoke. Further, most survivors also report high levels of persistent pain and smoke in response to pain. The investigators tested the feasibility, acceptability, and preliminary efficacy of a smoking cessation program paired with a pain management program for cancer survivors. Methods The investigators con...

Objective: Including partners in interventions to increase physical activity (PA) could promote better adherence and longer-term effects. In preparation for a future large-scale randomized controlled trial (RCT), this randomized pilot trial tested the acceptability of a novel couple-based PA intervention for breast and prostate cancer survivors an...

Objective: We assessed the accuracy and congruence of recall of weight topics during clinical encounters between adolescent patients with overweight/obesity and physicians (randomized to Motivational Interviewing education vs. control arm). Methods: We audio recorded 357 clinic encounters and coded topics of weight, physical activity (PA), break...

Purpose: The research on cancer treatment decision-making focuses on dyads; the full "triad" of patients, oncologists, and caregivers remains largely unstudied. We investigated how all members of this triad perceive and experience decisions related to treatment for advanced cancer. Methods: At an academic cancer center, we enrolled adult patient...

Many couples tend to report steadily decreasing relationship quality following the birth of a child. However, little is known about the postpartum period for Latino couples, a rapidly growing ethnic group who are notably underserved by mental and physical health caregivers in the United States. Thus, this study investigated whether a brief couples'...

Purpose: Patients with advanced cancer and their caregivers experience many negative emotions. Empathic responses from oncologists can help alleviate their distress. We aimed to assess expressions of negative emotions among patients with advanced cancer and their caregivers and oncologists' empathic responses during consultations in an Asian setti...

Purpose: Electronic medical records increasingly allow patients access to clinician notes. Although most believe that open notes benefits patients, some suggest negative consequences. Little is known about the experiences of patients with cancer reading their medical notes; thus we aimed to describe this qualitatively. Methods: We interviewed 20...

Some physicians may be hesitant to counsel overweight and obese adolescents about weight because of concerns that such counseling may result in extreme weight loss behaviors and the subsequent development of eating disorders. We compared self-reported extreme weight loss behaviors in 535 overweight/obese adolescents prior to receiving weight-relate...

Patient-clinician communication that promotes patient engagement enhances health care quality. Yet, disseminating effective communication interventions to practicing clinicians remains challenging. Current methods do not have large and sustainable effects. In this paper, we argue that both top-down approaches (mandated by institutions) should be co...

Objective: To describe the growth and outcomes of the Palliative Care Research Cooperative Group (PCRC). Background: Despite advances, significant gaps remain in the evidence base to inform care for people with serious illness. To generate this needed evidence and bolster research capacity, the Palliative Care Research Cooperative (PCRC) group w...

Purpose: Patients with acute myeloid leukemia (AML) face a unique, difficult situation characterized by sudden changes in health, complex information, and pressure to make quick treatment decisions amid sizeable tradeoffs. Yet, little is known about patients' experiences with AML. We used qualitative methods to learn about their experiences with d...

Clinical guidelines recommend addressing adolescent alcohol use in primary care; the 5 As (Ask, Advise, Assess, Assist, Arrange) may be a useful model for intervention. We audio-recorded 540 visits with 49 physicians and adolescents, compared alcohol disclosure rates in the encounter with those in a survey, and analyzed conversations for use of the...

Purpose: We tested whether an online intervention combined with a patient feedback report improved physicians' use of motivational interviewing (MI) techniques when discussing weight with overweight and obese adolescents. Methods: We randomized 46 pediatricians and family physicians and audio recorded 527 patient encounters. Half of the physicia...

Objective: We developed an online intervention to teach physicians both MI (addressed in outcomes paper) and the 5 A's (Ask, Advise, Assess, Assist, and Arrange) when discussing weight with overweight/obese adolescents. Methods: We audio recorded 527 encounters between adolescents and physicians and coded the 5 A's during weight/BMI discussions....

Introduction: Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (e.g., had strong inte...

Background: Many patients with AML lack prognostic understanding, which may limit their ability to participate in shared decision-making about treatments. The underlying drivers of this misunderstanding are not well understood, so we sought to characterize the experience of being diagnosed with AML, receiving information, and making a treatment dec...