Rachelle Bernacki

Rachelle Bernacki
Harvard Medical School | HMS · Department of Medicine

MD, MS

About

138
Publications
34,488
Reads
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3,096
Citations
Citations since 2016
87 Research Items
2937 Citations
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Introduction
Rachelle Bernacki currently works at the Department of Psychosocial Oncology and Palliative Care at Dana Farber Cancer Institute, Mass General Brigham. Rachelle played a key role in developing the Serious Illness Care Program at Ariadne Labs with Dr. Susan Block. This program nationally scales communication, implementation, and training efforts in order to strengthen health systems with innovative and comprehensive solutions in serious illness care that have a sustained impact.
Additional affiliations
August 2008 - present
Dana-Farber Cancer Institute
Position
  • Director of Quality Inititatives
August 2008 - present
Brigham and Women's Hospital
Position
  • Medical Doctor
August 2008 - present
Dana-Farber Cancer Institute
Position
  • Director of Quality Initiatives

Publications

Publications (138)
Article
Introduction Older patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) have worse survival rates compared to younger patients, and experience more intense inpatient healthcare at the end of life (EOL) compared to patients with solid tumors. Advance care planning (ACP) has been shown to limit aggressive and burdensome care...
Article
Context Advance care planning (ACP) intends to support person-centered medical decision-making by eliciting patient preferences. Research has not identified significant associations between ACP and goal-concordant end-of-life care, leading to justified scientific debate regarding ACP utility. Objective To delineate ACP's potential benefits and mis...
Article
Objective: This study explored surgical oncologists' perspectives on factors influencing adoption of quality standards in patients with advanced cancer. Summary background data: The American College of Surgeons Geriatric Surgery Verification Program includes communication standards designed to facilitate goal-concordant care, yet little is known...
Article
Outcomes 1. Become familiar with unique challenges in integrating palliative care into surgery 2. Become aware of existing research gaps in palliative care integration in surgery Importance The American College of Surgeons Geriatric Surgery Verification Program includes standards for preoperative communication between patients and clinicians to fa...
Article
Background: Older adults comprise an increasing proportion of emergency general surgery (EGS) admissions and face high morbidity and mortality. We created a geriatric surgical service with geriatric and palliative expertise to mitigate risks of hospitalization most hazardous to older patients. We sought to identify geriatric surgical service inter...
Article
Background: Patients with limited English proficiency (LEP) experience lower quality end-of-life (EOL) care. This inequity may have been exacerbated during the COVID-19 pandemic. Objective: Compare health care utilization, EOL, and palliative care outcomes between COVID-19 decedents with and without LEP during the pandemic's first wave in Massachus...
Article
Objectives 1. By the end of the session, participants will be able to define microaggressions, discuss data on the prevalence and impact of microaggressions, and delineate barriers to responding to microaggressions. 2. By the end of the session, participants will be able to use the Microaggression Response Toolkit to generate at least three potenti...
Article
Outcomes 1. Describe the evidence-based benefits of and barriers to pediatric advance care planning conversations 2. Describe a framework for advance care planning conversations in pediatrics 3. Describe elements and impact of a curriculum to teach interprofessional clinicians advance care planning communication Original Research Background Early...
Article
Importance: The psychological symptoms associated with having a family member admitted to the intensive care unit (ICU) during the COVID-19 pandemic are not well defined. Objective: To examine the prevalence of symptoms of stress-related disorders, primarily posttraumatic stress disorder (PTSD), in family members of patients admitted to the ICU...
Chapter
The goal of palliative care is to support the best possible quality of life for patients and their families, regardless of prognosis, stage of disease, or the need for other therapies. Palliative care assists increasing numbers of people with debilitating and life‐limiting illnesses. Hospice care is a subset of palliative care that is offered to pa...
Article
Full-text available
Objectives To compare survival and pneumonia risk among hospitalized patients with advanced dementia on nasogastric tube feeding (NGF) vs careful hand feeding (CHF) and to examine outcomes by feeding problem type. Design Retrospective cohort study. Setting and Participants Advanced dementia patients aged ≥60 years with indication for tube feeding...
Article
Objectives: To determine the 30- and 90-day outcomes of COVID-19 patients receiving tracheostomy and percutaneous endoscopic gastrostomy (PEG). Design: Retrospective observational study. Setting: Multisite, inpatient. Patients: Hospitalized COVID-19 patients who received tracheostomy and PEG at four Boston hospitals. Interventions: Tracheo...
Article
Introduction Older adults account for an increasing proportion of emergency surgical procedures and have longer hospital lengths of stay than their elective counterparts. Identifying those at greatest risk of discharge to a postacute care facility would improve postoperative planning. We aimed to examine the role of preoperative cognitive and funct...
Article
Full-text available
Background: The Serious Illness Care Program (SICP) is a communication intervention that builds clinician capacity to have earlier, more values-based conversations about goals of care with patients experiencing life-limiting illness. We report the impact of its implementation on hospital wards.Methods: In this quality improvement initiative on the...
Article
Background Older adults face high mortality following resuscitation efforts for in-hospital cardiac arrest. Less is known about the role of frailty in survival to discharge after in-hospital cardiopulmonary resuscitation. Objective To investigate whether frailty, measured by the Clinical Frailty Scale, is associated with mortality after cardiopulmo...
Article
Full-text available
Background: Older adults may have new care needs and functional limitations after surgery. Many rely on informal caregivers (unpaid family or friends) after discharge but the extent of informal support is unknown. We sought to examine the role of informal postoperative caregiving on transitions of care for older adults undergoing routine surgical...
Article
American Society of Anesthesiologists guidelines recommend that anesthesiologists revisit do-not-resuscitate orders preoperatively and revise them if necessary based on patient preferences. In patients without do-not-resuscitate orders or other directives limiting treatment however, “full code” is the default option irrespective of clinical circums...
Article
Full-text available
Background Poor communication with hospitalized patients facing serious, life-limiting illnesses can result in care that is not consistent with patients’ values and goals. The Serious Illness Care Program (SICP) is a communication intervention originally designed for the outpatient oncology setting that could address this practice gap. MethodsA mul...
Chapter
Dementia is caused by a variety of disorders that result in a progressive loss of both cognitive and functional abilities. Despite the heterogeneity of disorders, there is a common set of problems that patients and families face living with this syndrome. Pain, eating difficulties, depression, apathy, and behavioural symptoms are common. As the dis...
Preprint
Full-text available
Importance Discussions about goals of care with patients who are seriously ill typically occur infrequently and late in the illness trajectory, are of low quality, and focus narrowly on the patient’s resuscitation preferences (ie, code status), risking provision of care that is inconsistent with patients’ values. The Serious Illness Care Program (S...
Article
Context : Communities of Practice (CoP) can help geographically separated individuals who share a joint enterprise, mutual engagement, and a repertoire of tools to gain, maintain, and implement new skills, including serious illness communication. Objectives : To investigate the health system uptake, implementation and outcomes of the Serious Illne...
Article
Background Early conversations about patients’ goals and values in advancing serious illness (serious illness conversations) can drive better healthcare. However, these conversations frequently happen during acute illness, often near death, without time to realize benefits of early communication. Methods The Speaking About Goals and Expectations (...
Article
PURPOSE As part of a larger effort to integrate palliative care into a cancer center, we identified barriers to palliative care referral for patients with breast or gynecologic cancer and developed a pilot program to improve access to palliative care services. METHODS We developed a multidisciplinary steering committee to uncover barriers to palli...
Article
Full-text available
Background/Objectives: The serious illness conversation (SIC) is an evidence-based framework for conversations with patients about a serious illness diagnosis. The objective of our study was to develop and validate a novel tool, the SIC-evaluation exercise (SIC-Ex), to facilitate assessment of resident-led conversations with oncology patients. Desi...
Article
Background/objectives: Identifying surgical patients at risk for discharge to a post-acute facility has the potential to reduce hospital length of stay, improve postoperative planning, and increase patient satisfaction. We sought to examine the association between a positive response to a preoperative patient-reported frailty screen and non-home d...
Article
Context Optimal surgical care for older adults with life-threatening conditions, with high risk of poor perioperative outcomes and morality in the months after surgery, should incorporate an understanding of the patient's treatment goals and preferences. However, little research has explored the patient perspective of decision making and advanced c...
Article
Objectives: To develop a generalizable advance care planning ACP intervention for children and children, adolescents, and young adults with serious illness using a multi-stage stakeholder driven approach. Study design: We first convened an expert panel of multidisciplinary HCPs, researchers, and parents to delineate key ACP intervention elements...
Article
Context The prevalence of chronic pain in cancer survivors is double that of the general US population. Opioids have been the foundation of cancer pain management for decades; however, there is a paucity of literature on long-term opioid therapy (LTOT) in cancer survivors. An understanding of factors related to LTOT use in cancer survivors is neede...
Article
To prepare for the increasing numbers of older adults undergoing surgery, the American College of Surgeons (ACS) has recently launched the Geriatric Surgery Verification Program with the goal of encouraging the creation of centers of geriatric surgery. Meanwhile, the Society for Perioperative Assessment and Quality Improvement (SPAQI) has published...
Article
Collaborative team-based practice can achieve all four components of the quadruple aim. But teamwork in health care has an identity crisis. Health care professionals refer to their teams as ‘‘multidisciplinary,’’ ‘‘interdisciplinary,’’ ‘‘interprofessional,’’ or the newest phrase, ‘‘transprofessional.’’ These terms are often used interchangeably and...
Article
Full-text available
With the palliative care workforce shortage and changes in advance care planning reimbursement, many institutions are requesting that palliative care specialists provide serious illness communication training across their institution's workforce. Based on our experience training clinicians to use the Partners Serious Illness Conversation Guide, a s...
Article
Full-text available
Background: Serious illness conversations are part of advance care planning (ACP) and focus on prognosis, values, and goals in patients who are seriously ill. To be maximally effective, such conversations must be documented accurately and be easily accessible. Objectives: The two coprimary objectives of the study were to assess concordance between...
Article
Objective: Develop quality indicators that measure access to and the quality of primary PC delivered to seriously ill surgical patients SUMMARY OF BACKGROUND DATA:: PC for seriously ill surgical patients, including aligning treatments with patients' goals and managing symptoms, is associated with improved patient-oriented outcomes and decreased he...
Article
The quality of hospice care remains highly variable in the United States. Patients, providers, and healthcare systems lack a comprehensive method of measuring the quality of care provided by an individual hospice. Partners HealthCare sought to assess hospice quality based on objective and quantitative criteria obtained directly from hospices and th...
Article
Full-text available
Context Many consider goal-concordant care (GCC) to be the most important of advance care planning and palliative care. Researchers face significant challenges in attempting to measure this outcome. We conducted a randomized controlled trial to assess the effects of a system-level intervention to improve serious illness communication on goal-concor...
Preprint
Background At a population level, conversations between clinicians and seriously ill patients exploring patients’ goals and values can drive high-value healthcare, improving patient outcomes and reducing spending. Methods We examined the impact of a quality improvement intervention to drive better communication on total medical expenses in a high-...
Article
Full-text available
Background/objective Oncology guidelines recommend earlier communication with patients about prognosis and goals‐of‐care in serious illness. However, current evidence leaves gaps in our understanding of the experience of these conversations. This analysis evaluates the patient and clinician experience of a conversation using a Serious Illness Conve...
Article
Full-text available
Background: Seriously ill patients in hospital have indicated that better communication with practitioners is vital for improving care. The aim of this study was to assess whether the quality of conversations about serious illness improved after implementation of the Serious Illness Care Program (SICP). Methods: In this retrospective chart revie...
Chapter
As a clinician involved in caring for patients with serious illness, one frequently is tasked with helping patients and their families navigate various points of the patient’s illness trajectory. Excellent communication is required to ensure that the care provided is patient centered and aligns with the patient’s values and preferences. Clinicians...
Article
Objectives: To determine the effect of the Serious Illness Care Program on health care utilization at the end of life in oncology. Design: Analysis of the secondary outcome of health care utilization as part of a cluster-randomized clinical trial that ran from 2012 to 2016. Clinicians in the intervention group received training, coaching, and syst...
Conference Paper
Background Advance care planning (ACP) and goals of care (GCD) discussions with patients align with the tenets of patient-centred shared decision-making central to family medicine (FM). We sought to determine whether a multidisciplinary pathway is feasible in family medicine to enable effective ACP conversations. This pathway reorders Ariadne Lab’s...
Article
Full-text available
The quality of hospice care in the United States varies significantly, yet healthcare systems lack methods to comprehensively evaluate and stimulate quality improvement in organizations that serve their patients. Partners HealthCare, an integrated healthcare system located in Eastern Massachusetts, sought to create a high-quality hospice collaborat...
Article
Full-text available
Importance The accuracy of mortality assessment by emergency clinicians is unknown and may affect subsequent medical decision-making. Objective To determine the association of the question, “Would you be surprised if your patient died in the next one month?” (known as the surprise question) asked of emergency clinicians with actual 1-month mortali...
Article
Objectives Having early discussions with seriously ill patients about their priorities and values can improve their peace of mind and family outcomes during bereavement; however, physicians and medical students report feeling underprepared to hold serious illness conversations. We evaluated the impact of the Serious Illness Care Program clinician t...
Article
Full-text available
Background Communication about priorities and goals improves the value of care for patients with serious illnesses. Resource constraints necessitate targeting interventions to patients who need them most. Objective To evaluate the effectiveness of a clinician screening tool to identify patients for a communication intervention. Design Prospective...
Article
Introduction: A structured and intentional approach to quality improvement is critical for clinicians specializing in palliative care and is a required component of training programs. Methods: We present a multimodal, comprehensive curriculum for teaching quality improvement to interdisciplinary trainees in palliative care. Results: The curric...
Article
Importance High-quality conversations between clinicians and seriously ill patients about values and goals are associated with improved outcomes but occur infrequently. Objective To examine feasibility, acceptability, and effect of a communication quality-improvement intervention (Serious Illness Care Program) on patient outcomes. Design, Setting...
Article
Importance: Earlier clinician-patient conversations about patients' values, goals, and preferences in serious illness (ie, serious illness conversations) are associated with better outcomes but occur inconsistently in cancer care. Objective: To evaluate the efficacy of a communication quality-improvement intervention in improving the occurrence,...
Article
Full-text available
BACKGROUND: Conversations with seriously ill patients about their values and goals have been associated with reduced distress, a better quality of life, and goal-concordant care near the end of life. Yet, little is known about how such conversations are conducted. OBJECTIVE: To characterize the content of serious illness conversations and identify...
Article
Older adults with cognitive impairment face many healthcare challenges, chief among them participating in medical decision‐making about their own health care. Advance care planning (ACP) is the process whereby individuals communicate their wishes for future care with their clinicians and surrogate decision‐makers while they are still able to do so....
Article
Clinicians know that they should discuss goals of care with their seriously ill patients, but questions arise about the right time to start the discussion and the right words to use. Yet patients with serious illness often receive care that does not match their goals, and evidence demonstrates that patients who have these conversations are more lik...
Article
Background and objectives: The purpose of this study is to compare treatment preferences of patients to those of surrogates on the Physician Orders for Life-Sustaining Treatment (POLST) forms. Research design and methods: Data were collected from a sequential selection of 606 Massachusetts POLST (MOLST) forms at 3 hospitals, and corresponding el...
Article
Full-text available
Background: Early, high-quality serious illness (SI) conversations are critical for patients with glioblastoma (GBM) but are often mistimed or mishandled. Objective: To describe the prevalence, timing, and quality of documented SI conversations and evaluate their focus on patient goals/priorities. Design/participants: Thirty-three patients wit...
Article
Objective: Despite caring for patients near the end-of-life (EOL), surgeons and anesthesiologists report low confidence in their ability to facilitate EOL conversations. This discrepancy exists despite competency requirements and professional medical society recommendations. The objective of this systematic review is to identify articles describin...
Article
Full-text available
Improving communication about goals and values for patients with advancing serious illness nearing the end of life is a key opportunity to improve the value of care. The Serious Illness Care Program, implemented at primary care clinics affiliated with Brigham and Women's Hospital in Boston, Massachusetts, is a multicomponent intervention designed t...
Article
Background: There is a pressing workforce shortage and leadership scarcity in palliative care to adequately meet the demands of individuals with serious illness and their families. To address this gap, the Cambia Health Foundation launched its Sojourns Scholars Leadership Program in 2014, an initiative designed to identify, cultivate, and advance...
Article
Rationale: The chronically critically ill have survived acute critical illness but require prolonged mechanical ventilation. These patients are frequently transferred from acute care to long-term acute care hospitals (LTACHs) for prolonged recovery, yet many suffer setbacks requiring readmission to acute care. The patient's relatively improved con...
Article
Full-text available
Dialysis-dependent ESRD is a serious illness with high disease burden, morbidity, and mortality. Mortality in the first year on dialysis for individuals over age 75 years old approaches 40%, and even those with better prognoses face multiple hospitalizations and declining functional status. In the last month of life, patients on dialysis over age 6...
Article
49 Background: Conversations about serious illness care goals are often inadequate and fail to address key elements of high-quality discussions. Methods: As part of a cluster-randomized trial of a multi-component communication intervention, we conducted a retrospective chart review of 147 deceased oncology patients to assess frequency and timing of...
Article
Full-text available
This study assesses the potential of the “surprise” question to identify patients who might benefit from palliative care. Palliative care improves the value of care for seriously ill patients, but resource constraints necessitate targeting palliative care interventions to patients who need them most.¹ The “surprise” question (SQ)—“Would you be surp...
Article
Objective: Chronically critically ill patients have recurrent infections, organ dysfunction, and at least half die within 1 year. They are frequently cared for in long-term acute care hospitals, yet little is known about their experience in this setting. Our objective was to explore the understanding and expectations and goals of these patients an...
Article
Full-text available
Importance: The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satis...