Sydney Dy

Sydney Dy

About

263
Publications
33,495
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9,409
Citations
Additional affiliations
January 2003 - December 2010
Johns Hopkins Medicine

Publications

Publications (263)
Article
Context: Assessment tools are data collection instruments that are completed by or with patients or caregivers and which collect data at the individual patient or caregiver level. Objectives: To (1) summarize palliative care assessment tools completed by or with patients or caregivers, and (2) identify needs for future tool development and evalu...
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Context: Though critical for improving patient outcomes, palliative care quality indicators are not yet widely used. Better understanding of facilitators and barriers to palliative care quality measurement and improvement might improve their use and program quality. Objectives: Development of a survey tool to assess palliative care team perspect...
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Objectives: To examine the use of step therapy, prior authorization, and Part D formulary exclusion by 4 large Medicare Advantage (MA) insurers to manage 20 physician-administered drugs with the highest total Medicare expenditures (top 20 drugs). Study design: We collected data for United Healthcare, CVS/Aetna, Humana, and Kaiser plans to create...
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Background: Advance care planning (ACP) and involving family are particularly important in dementia, and primary care is a key setting. The purpose of this trial is to examine the impact and implementation of SHARING Choices, an intervention to improve communication for older adults with and without dementia through proactively supporting ACP and...
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Although most health care occurs in the ambulatory setting, limited research examines how providers and patients think about and enact ambulatory patient safety. This multimethod qualitative study seeks to identify perceived challenges and strategies to improve ambulatory safety from the perspectives of clinicians, staff, and patients. Data include...
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Experts in the field of palliative care in the United States (U.S.) have defined competence, or “good,” mainly for programs, trainees, or providers of primary palliative care. Our interprofessional workgroup of palliative care specialists proposes that setting a standard for clinical excellence, or “great,” applicable to palliative care specialists...
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Purpose: To perform a mixed methods review to evaluate the effectiveness and implementation of models for integrating palliative care into ambulatory care for US adults with noncancer serious chronic illness. Methods: We searched 3 electronic databases from January 2000 to May 2020 and included qualitative, mixed methods studies and randomized a...
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Objective Examine whether Medicare Advantage (MA) coverage is associated with more efficient prescribing of Part B drugs than traditional Medicare (TM) coverage. Data Sources 20% sample of 2016 outpatient and carrier TM claims and MA encounter records and Master Beneficiary Summary File data. Study Design We analyzed whether MA enrollees compared...
Article
55 Background: To date, drugs used for CACS have limited efficacy and may have unwanted side effects. Despite this, clinicians commonly prescribe certain drugs for CACS, adding financial burden to patients through out-of-pocket costs near or at the end of life. We sought to describe the range of costs of the multiple drugs commonly used to manage C...
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PURPOSE The financial toxicity of anticancer drugs is well-documented, but little is known about the costs of drugs used to manage cancer-associated symptoms. METHODS We reviewed relevant guidelines and compiled drugs used to manage seven cancer-associated symptoms (anorexia and cachexia, chemotherapy-induced peripheral neuropathy, constipation, d...
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Patients’ perspectives on patient safety have rarely been incorporated into quality initiatives in primary care. Our objective was to understand the patient perspective on patient safety in patient-centered medical homes (PCMHs). We conducted 12 patient focus groups/interviews in nine sites with 65 patients at a geographically diverse sample of Nat...
Article
Objectives Access to early palliative care (EPC) for all patients with metastatic lung cancer is yet to be achieved in spite of recommendations. This quality improvement (QI) project was initialized to improve the rates of such referrals from the thoracic oncology clinic for all new outpatients in a premier cancer center in India. Materials and Me...
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The article collates the narratives of experiences of the international faculty who mentored the quality improvement teams from India since 2017.
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Although most patient-clinician interactions occur in ambulatory care, little research has addressed measuring ambulatory patient safety or how primary care redesign such as the patient-centered medical home (PCMH) addresses patient safety. Our objectives were to identify PCMH standards relevant to patient safety, construct a measure of patient saf...
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Background: Social ties between health care workers may be an important driver of job satisfaction; however, research on this topic is limited. Purpose: We used social network methods to collect data describing two types of social ties, (a) instrumental ties (i.e., exchange of advice that enables work) and (b) expressive ties (i.e., exchange of...
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A man in his 80s with advanced colon cancer and malignant ascites presented to the oncology clinic to discuss next steps. He reported weight loss (approximately 15 kg in 2 months), and his daughter commented on his limited appetite, weakness, and that he was “just bones.” Recent computed tomography staging scans had demonstrated progression of the...
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Background: Opioid-induced constipation (OIC) remains the most common adverse event associated with opioid use. Treatment with more novel and costly agents (such as peripheral μ-opioid receptor antagonists [PAMORAs]) may be indicated in patients with laxative-refractory OIC. Three PAMORAs are U.S. Food and Drug Administration approved for managing...
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Importance Nearly all initiatives to improve care for individuals with opioid use disorder (OUD) have focused on improving OUD identification and treatment. Whether individuals with OUD have lower quality of care than individuals without OUD remains unclear. Objective To measure quality of non-OUD preventive and chronic illness care and care coord...
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Aim: The aim of this study was to characterize quality of buprenorphine care for opioid use disorder (OUD) by quantifying buprenorphine initiation, engagement, and maintenance for individuals in a large, diverse, real-world cohort in the United States. Design: This was a retrospective cohort analysis. Setting: OUD treatment in the outpatient s...
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Objective: Despite increasing use of hematopoietic stem cell transplantation (HSCT) for adults with sickle cell disease (SCD), little is known about pain management experiences throughout this process. The objective of this study was to explore patients' experiences with pain and pain management during and after HSCT for SCD. Methods: We conduct...
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Importance Improved survival in patients with advanced cancer has increased the need for better understanding of how to manage common symptoms that they may experience, such as breathlessness. Objective To assess the benefits and harms associated with pharmacologic interventions for breathlessness in adults with advanced cancer. Data Sources PubM...
Article
Importance: Quality measures of palliative and end-of-life care relevant to patients with advanced cancer have been developed, but few are in routine use. It is unclear which of these measures are most important for providing patient- and family-centered care and have high potential for improving quality of care. Objective: To prioritize process q...
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Context Shared decision-making tools can facilitate advance care planning and goals of care conversations in non-cancer serious illness. More information on integrating these tools in ambulatory care could better support clinicians and patients/caregivers in these conversations. Objectives We evaluated effectiveness and implementation of integrati...
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We examined the effects of a communication intervention to engage family care partners on patient portal (MyChart) use, illness understanding, satisfaction with cancer care, and symptoms of anxiety in a single-blind randomized trial of patients in treatment for breast cancer. Patient-family dyads were recruited and randomly assigned a self-administ...
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Context The 3-Act Model, a narrative approach to goals of care (GOC) discussions centered on patients’ individual stories, has proven to be effective as measured by objective skill improvement among medical trainees. This study describes the adaptation of the in-person curriculum to a streamlined, online format, in the setting of the Covid19 pandem...
Article
Context Few advance care planning (ACP) interventions proactively engage family or address the needs of older adults with and without cognitive impairment in the primary care context. Objectives To pilot a multicomponent intervention involving: an introductory letter describing a new clinic initiative and inviting patients to complete a patient-fa...
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Importance Breathlessness is a frequent and debilitating symptom in patients with advanced cancer. Often, in the context of breathlessness, aggressive cancer treatment is not beneficial, feasible, or aligned with goals of care. Targeted symptom-focused interventions may be helpful in this scenario. Objective To evaluate the advantages and harms of...
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Increasingly, adolescent, young adult, and adult children are relied upon as donors for their parents undergoing blood and marrow stem cell transplant. How family functioning impacts donors’ decision-making and whether haploidentical donor children have unique supportive care needs is unknown. In this qualitative research study, we conducted 15 sem...
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Introduction: Patient safety in primary care is an emerging priority, and experts have highlighted medications, diagnoses, transitions, referrals, and testing as key safety domains. This study aimed to (1) describe how frontline clinicians, administrators, and staff conceptualize patient safety in primary care; and (2) compare and contrast these c...
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PURPOSE Monitoring and improving the quality of palliative and end-of-life cancer care remain pressing needs in the United States. Among existing measures that assess the quality of palliative and end-of-life care, many operationalize similar concepts. We identified existing palliative care process measures and synthesized these measures to aid sta...
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Mentors at seven United States and Australian academic institutions partnered with seven leading Indian academic palliative care and cancer centers to undertake a program combining remote and in-person mentorship, didactic instruction, and project-based learning in quality improvement. From its inception in 2017 to 2020, the Promoting Assessment an...
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Objectives: The patient-centered medical home (PCMH) may provide a key model for ambulatory patient safety. Our objective was to explore which PCMH and patient safety implementation and social network factors may be necessary or sufficient for higher patient safety culture. Methods: This was a cross-case analysis study in 25 diverse U.S. PCMHs....
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Background The challenges of supporting the end-of-life preferences of patients and their families have often been attributed to poor understanding of the patient’s condition. Understanding how physicians, as patients, communicate their end-of-life care preferences to their families may inform shared decision making at end of life. Objectives The...
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New models of primary care include patient-reported outcome measures (PROMs) to promote patient-centered care. PROMs provide information on patient functional status and well-being, can be used to enhance care quality, and are proposed for use in assessing performance. Our objective was to identify a short list of candidate PROMs for use in primary...
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Objective: Increased treatment options and longer survival for lung cancer have generated increased interest in patient preferences. Previous studies of patient preferences in lung cancer have not fully explored preference heterogeneity. We demonstrate a method to explore preference heterogeneity in the willingness of patients with lung cancer and...
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Context The 3-Act Model is an innovative narrative approach to goals of care (GOC) discussions centered on patients’ unique stories. Prior studies have demonstrated the effectiveness of the 3-Act Model training in enhancing trainees’ skills objectively in role plays with standardized patients. This study moves beyond the classroom to the clinical s...
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Objective To examine perceptions of facilitators and barriers to quality measurement and improvement in palliative care programs and differences by professional and leadership roles. Methods We surveyed team members in diverse US and Canadian palliative care programs using a validated survey addressing teamwork and communication and constructs for...
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Purpose We established the Primary Care for Cancer Survivor (PCCS) Clinic in 2015 to address transition and care delivery challenges unique to cancer survivors. We describe the clinical program, detail patients from the first 4 years of implementation, and discuss lessons learned during the process. Methods We abstracted relevant patient informati...
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Family caregivers are at the forefront of managing dementia but are not routinely included in discussions about prognosis and are often poorly prepared to engage in surrogate decision-making. Few interventions target advance care planning in primary care, which is where most persons with dementia are initially diagnosed and medically managed. SHARI...
Article
Oncology has made significant advances in standardizing how clinical research is conducted and reported. The advancement of such research that improves oncology practice requires an expansion of not only our research questions but also the research methods we deploy to address them. In particular, there is increasing recognition of the value of qua...
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Purpose Family is often overlooked in cancer care. We developed a patient–family agenda setting intervention to engage family in cancer care communication. Methods We conducted a pilot randomized controlled trial (NCT03283553) of patients on active treatment for breast cancer and their family “care partner.” Intervention dyads (n = 69) completed a...
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Context: Innovative patient-centered approaches to goals of care (GOC) communication training are needed. Teaching a narrative approach, centered on the patient's unique story, is conceptually sound but has not been evaluated with respect to objective skills attainment. We developed a curriculum based on a novel, easily-remembered narrative approa...
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11614 Background: Family is often overlooked in cancer care. Little is known about the patient preferences for involving family in communication, whether preferences may be elicited and supported at the point of care, and impact on care quality. Methods: We conducted a two-group pilot randomized controlled trial (NCT03283553) of patients on active...
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Context: Little is known about how to prepare older patients for advance care planning (ACP) discussions in primary care. Objectives: The objective of the study was to explore older patients' perspectives and experiences on ACP discussions with family members and/or primary care clinicians. Methods: We conducted a qualitative interview study w...
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Purpose:: To evaluate the reliability, content validity, and variation among sites of a survey to assess facilitators and barriers to quality measurement and improvement in palliative care programs. Methods:: We surveyed a sample of diverse US and Canadian palliative care programs and conducted postcompletion discussion groups. The survey includ...
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Context: Family caregivers play critical and demanding roles in the care of persons with dementia through the end of life. Objectives: The objective of this study was to determine whether caregiving strain increases for dementia caregivers as older adults approach the end of life, and secondarily, whether this association differs for nondementia...
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Background: Using objectively collected physical activity (PA) data from the Baltimore Longitudinal Study of Aging, the authors tested whether patterns of daily activity and sedentary time differed by cancer survivorship in older adults. Methods: In total, 659 participants (mean age ± standard deviation, 71 ± 10 years; 51% women) who had self-re...
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Objective: To systematically assess benefits and harm of non-pharmacologic interventions for diabetic peripheral neuropathy (DPN) symptoms. Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from 1966 to May 24, 2016 for randomized controlled trials. Two reviewers evaluated studies for eligibility, serial...
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Background: Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. Objective: To explore older patients' perspectives on the quality of serious illness care in primary care. Design: Qualitative interview study....
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Objective: Incorporating the patient perspective into lung cancer research, policy and treatment is becoming increasingly recognized as important. This project sought to create an engagement partnership with lung cancer patient advocates and to explore their views on transforming lung cancer healthcare systems, treatment, and policy to be more pati...
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Background: Fatigue is prevalent and distressing among cancer survivors, but its subjective nature makes it difficult to identify. Fatigability, defined as task-specific fatigue, and endurance performance may be useful supplemental measures of functional status in cancer survivors. Methods: Fatigability, endurance performance, and cancer history...
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Background: The way patients and providers communicate with one another outside of the clinic is changing. However, little is known about primary care provider perspectives and experiences of these changes and whether these provider behaviors correlate with patient satisfaction. This study examines provider patterns of communication with patients o...
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Background: Little is known about the longitudinal association of hospital Magnet status (an indicator of nursing excellence) and nurse-staffing level with inpatient care experience. Objectives: To examine temporal trends in hospital performance on patient experience measured using the Hospital Consumer Assessment of Healthcare Providers and Sys...
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The palliative care approach for survivors begins with comprehensive assessment of communication and advance care planning needs and the physical, psychological and psychiatric, social, spiritual and religious, and cultural domains. Communication and decision-making about difficult issues should include responding to emotions, planning for future c...
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PURPOSE Understanding individuals’ preferences for participating in health care decisions is foundational to delivering person-centered care. We aimed to (1) explore preferences for health care decision making among older adults, and (2) identify multimorbidity profiles associated with preferring less active, ie, passive, participation among older...
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Introduction: Life expectancy is important to inform a number of clinical decisions in primary care but its communication is challenging for clinicians. Methods: This qualitative interview study with 40 community-dwelling older adults explored their perspectives on how and when to discuss life expectancy in primary care. Results: Most participants...
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Background: Patient and family engagement (PFE) is critical for patient safety. We systematically reviewed types of PFE strategies implemented and their impact on medication safety. Methods: We searched MEDLINE, EMBASE, reference lists and websites to August 2016. Two investigators independently reviewed all abstracts and articles, and articles...
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Background: We sought to increase advance care planning completion at an academic internal medicine clinic through an electronic health record. Measures: Number of eligible patients who completed a form of advance care planning. Intervention: Multidisciplinary team approach with engagement from providers and clinic staff; implemented informati...
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Objective: We assessed the effect of searching ClinicalTrials.gov on the conclusions of a systematic review. Study design and setting: We conducted this case study concurrently with a systematic review. We searched ClinicalTrials.gov on March 9, 2016 to identify trial records eligible for inclusion in the review. Two independent reviewers screen...
Poster
Measuring and improving the quality of care of palliative care (PC) programs is essential for improving outcomes for patients with serious and advanced illnesses.
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Introduction: The objective of this project was to engage survivor-advocates by describing their experiences living with lung cancer in an era of increasing treatment options. Methods: This was a qualitative engagement project with participants from a lung cancer advocacy organization's survivor advisory board. Interviews were conducted, transcr...
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Importance Older adults with limited life expectancy are frequently screened for cancer even though it exposes them to risks of screening with minimal benefit. Patient preferences may be an important contributor to continued screening. Objective To examine older adults’ views on the decision to stop cancer screening when life expectancy is limited...
Article
Objective: To systematically assess the effect of pharmacologic treatments of diabetic peripheral neuropathy (DPN) on pain and quality of life. Methods: We searched PubMed and Cochrane Database of Systematic Reviews for systematic reviews from 2011 to October 12, 2015, and PubMed, Embase, and the Cochrane Central Register of Controlled Trials fo...
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41Background: Patients often face challenges in transitioning to the survivorship stage of cancer care and coordinating with primary care. Prior research has highlighted the uncertainty in who provides survivorship care, leaving patients “lost in transition”. Integrating primary care providers (PCP) into cancer care offers one potential solution. E...
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Background and aims: There are guidelines for the medical management of cirrhosis and associated quality indicators (QIs), but QIs focusing on standards for palliative aspects of care are needed. Methods: We convened a 9-member, multidisciplinary expert panel and used RAND/UCLA modified Delphi methods to develop palliative care quality indicator...
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Significant pain and suffering are frequent at the end-of-life, and opioids are often essential for relief. Although opioids must be readily available when appropriate, particularly for unbearable physical pain, some of the same issues causing current reconsideration of aggressive opioid guidelines for chronic pain1 also apply at the end of life. T...
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Background: Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would improve care for injured pat...