Multiple chronic conditions (MCC), defined as two or more co-occurring chronic conditions, occur frequently in vulnerable adult patients such as those living in nursing homes or with end-stage renal disease. Vulnerable adult populations with MCC have worse health outcomes and higher utilization of all types of health services compared to those who do not have chronic conditions, and they are at higher risk of receiving inappropriate and/or burdensome services (e.g., procedures, treatments, and hospitalizations) that are inconsistent with their preferences. Medical complexity alone does not explain these differences; the issues vary on many characteristics including race/ethnicity, acculturation, and living location.
Furthermore, while most palliative care is currently provided in acute care, it is recommended that interdisciplinary palliative care begin early for any serious illness and be delivered across the continuum of health care settings. There are knowledge gaps in key palliative care areas including how best to support symptom management, communication, and care coordination; these knowledge gaps must be addressed to provide effective innovative interdisciplinary care models in multiple health care settings for vulnerable adult patients with MCC to ensure they receive appropriate care that is consistent with their preference.
The Center for Improving Palliative Care for Vulnerable Adults with MCC (CIPC) is an interdisciplinary collaboration at Columbia University School of Nursing that is supported by a 5-year National Institute of Nursing Research (NINR) grant (P20NR018072-01), which will build infrastructure and interdisciplinary research teams led by nurse scientists, to address these gaps. This Exploratory Center is led by Patricia Stone, PhD, RN, FAAN and Jingjing Shang, PhD, RN (Multiple Principal Investigators) and is being conducted in partnership with the Center for Home Care Policy and Research of the Visiting Nurse Service of New York.
The specific aims of CIPC are to:
- Develop a sustainable infrastructure that supports interdisciplinary researchers to develop into transdisciplinary teams that conduct biobehavioral, palliative care research across health care settings for vulnerable adults with MCC;
- Develop new programs of biobehavioral, palliative care research for vulnerable adults with MCC led by nurse scientists;
- Enhance the knowledge and skills of participating investigators on transdisciplinary, biobehavioral, palliative care research methods across health care settings for vulnerable adults with MCC and disseminate new knowledge to relevant stakeholders; and
- Evaluate the Center’s inputs, outputs, and outcomes on an ongoing and annual basis and refine processes as needed.
The CIPC is uniquely poised to develop research capacity in this area. The partnership between Columbia University School of Nursing and the Visiting Nurse Service of New York increases access of pilot project investigators to vulnerable urban dwelling adults with MCC. The Enrichment Plan activities, which are informed by leading interdisciplinary palliative care clinicians, along with support from the Pilot Administrative Core with vast scientific expertise (e.g., mixed methods biobehavioral research in adults with MCC and biostatistics) and expert consultation with the Palliative Care Research Cooperative, provide an excellent foundation in best practices for biobehavioral, palliative care research. This foundation coupled with the robust research environment and strong Administrative Core increases the likelihood of the CIPC meeting its important aims which are consistent with NINR’s strategic theme “End-of Life and Palliative Care: The Science of Compassion.”
To achieve the aims of the CIPC, the Administrative and Pilot Projects Cores are complemented by an Enrichment Core. Through its cores, CIPC will use its outstanding institutional resources and proposed research activities to improve palliative care for vulnerable adults with MCC.
- Administrative Core
- Pilot Core
- Enrichment Core
- Patricia W. Stone PhD, RN, FAAN (Co-Principal Investigator)
- Jingjing Shang, PhD, RN (Co-Principal Investigator)
- Max Topaz, PhD RN (Site PI)
- Tonda Hughes, PhD, RN, FAAN (Enrichment Core Director)
- Suzanne Bakken, PhD, RN, FAAN, FACMI
- Walter Bockting, PhD
- Bevin Cohen, PhD, MS, MPH, RN
- Maureen George, PhD, RN, AE-C, FAAN
- Elaine Larson, PhD, RN, FAAN, CIC
- Jacqueline Merrill, PhD, MPH, RN, FAAN, FACMI
- Lusine Poghosyan, PhD, MPH, RN, FAAN
- Rebecca Schnall, PhD, RN
Expert Palliative Care Clinicians
- Marlene McHugh, DNP, DCC, FNP-BC, ACHPN, FPCN
- Karol DiBello, DNP, FNP-BC, ACHNP
- Mary Ellen Tresgallo, DNP, MPH, FNP-BC
- Debra Miller-Saultz, DNP, FNP-BC
- Penelope Buschman, MS, FAAN