Welcome to the Palliative Care Research Program.
Palliative Care is a relatively new field in healthcare that attends to the needs of seriously ill patients and their caregivers. In addition to a growing cadre of clinicians who provide palliative care, there is a growing community of scientists who are helping to understand the experience of patients with serious illness and the impact of serious illness care upon caregivers, as well as improving the evidence base for palliative medicine. The University of Michigan is proud to house one of the few formal research programs in this field. Feel free to learn about us and the important research we do, and to contact us if you are interested in being a part of our community or helping to support our work!
Who We Are
The Palliative Care Research Program is a multidisciplinary group of clinician scientists from the University of Michigan committed to collaborating with one another to understand the experience of patients with serious illness and the impact of serious illness care upon caregivers, as well as improving the evidence base for palliative medicine. We “hail” from various departments across the UM Schools of Medicine, Nursing, and Pharmacy.
What We Do
We conduct qualitative, quantitative, and interventional research with patients, caregivers, and providers. Topics include: symptoms, caregiver burden, appropriate and safe use of medications, physician knowledge, and pain mechanisms.
Our interdisciplinary team has been at the forefront of palliative care research. We were established in 2014 by the Adult Palliative Care Executive Steering Committee headed by Drs. John Carethers and Phil Zazove as a way to foster cross-discipline collaboration and synergy around research relevant to patients with serious illness, their caregivers, and their clinicians.
We have strong ties to other research programs across the UM campus including:
Faculty and Trainees
Maria Silveira, MD, MA, MPH is a federally funded researcher and ethicist who was among the first palliative care clinicians to practice at the University of Michigan and Ann Arbor Veteran Affairs Medical Center (VAMC). She grew up in New York City, completed her undergraduate studies at Harvard University, and obtained her medical degree from SUNY Stony Brook. After residency training at Oregon Health and Sciences University in Internal Medicine, she served as a Robert Wood Johnson (RWJ) Clinical Scholar at the University of Washington where she earned her MPH. She has been at the University of Michigan and Ann Arbor VAMC since 2001.
Her research aims to improve the management of symptoms related to cancer. She is the recipient of funding from the Robert Wood Johnson Foundation and Veterans Administration. She is currently site-PI for a PCORI-funded randomized controlled trial of integrated palliative care via telehealth for patients with advanced lung cancer in partnership with researchers at Massachusetts General Hospital.
Her research has been published in JAGS, JAMA, and NEJM. She has held several editorial positions, including Associate Editor for the Journal of Pain and Symptom Management and UpToDate. In 2014, she was awarded fellow status by the AAHPM and was promoted to Associate Professor at the University of Michigan. She currently serves as the Director for Research for the UM’s Palliative Care Program. She teaches ethics, communication, and symptom management to students and trainees at the UM and VA, and mentors fellows, junior faculty, and doctoral candidates in research.
Areas of Interest
- Cancer pain and chronic pain
- Safe use of opioids in palliative care and oncology
Victoria Powell, MD is a clinical researcher in the Division of Geriatric and Palliative Medicine and palliative care physician at the Ann Arbor VA Geriatrics Research, Education, and Clinical Center (GRECC). She is interested in understanding how the physical symptoms of serious illness, such as pain, dynamically interact with an individual’s coping mechanisms, support structure, and comorbidities. Specifically, she focuses on how feelings of loneliness and demoralization contribute to pain and combinations of symptoms (ie., “symptom clusters”) such as pain, fatigue, and depression. Her research also attempts to better understand risk factors and clinical characterization of patients with chronic pain who receive long-term opioid therapy with an aim of developing more effective treatments for this population. Additionally, she serves as the Hospice and Palliative Medicine Fellowship faculty lead for scholarly projects.
Areas of Interest
- Chronic Pain
- Long-term opioid use
- Existential distress
- Opioid-non responsive pain
- Opioid use disorder in serious illness
Lauren Gerlach, DO, MS is a Geriatric Psychiatrist and Assistant Professor in the Department of Psychiatry. Her research is focused on understanding trends and appropriate use of psychotropic medications among older adults including evaluating how psychotropic medications are utilized in end-of-life care. She has used national survey and administrative claims data to evaluate the growth of central nervous system (CNS) medication polypharmacy use among older adults and to understand how health systems respond to warnings (e.g., from the U.S. Food and Drug Administration) for psychotropic medications. Her work aims to inform safe and rationale psychotropic medication prescribing among older adults with mental health and cognitive disorders--including understanding how to best target appropriate treatment to patients that would benefit from treatment the most.
Areas of Interest
- Trends and appropriate use of psychotropic medications among older adults with mental health and cognitive disorders
- End-of-life care for patients with dementia
- Patient, provider, and health system factors that influence the care that older adults receive
Pasithorn Amy Suwanabol, MD, MS is an Assistant Professor of Surgery in the Division of Colorectal Surgery with a clinical practice at the Ann Arbor Veterans Affairs Healthcare System. Dr. Suwanabol received her MD from the University of Wisconsin School of Medicine and Public Health. She completed her General Surgery residency at the University of Wisconsin Hospital and Clinics and her fellowship in Colon and Rectal Surgery at the University of Massachusetts-Memorial Hospital Medical Center. Dr. Suwanabol joined the faculty at U-M in September 2015 and is a core faculty member at the U-M Center for Healthcare Outcomes and Policy. Dr. Suwanabol's research focuses on improving the referral and delivery of palliative care among surgical patients. She is currently funded by the National Institute on Aging (R03) to examine the long-term implications of surgery among older adults and by Agency for Healthcare Research and Quality (K08) to optimize end-of-life care among older adults at high risk of postsurgical death or poor outcomes. She is on the editorial board of Annals of Palliative Medicine and has published her work in Journal of Pain and Symptom Management and Journal of Palliative Medicine among others.
Areas of Interest
- Optimizing palliative and end-of-life care among surgical patients
- Patient-centered outcomes in colorectal cancer surgery
- Quality improvement in colon and rectal surgery
April Bigelow, PhD is an Adult Gerontology Nurse Practitioner who earned her BS, MS, and PhD from the University of Michigan in Ann Arbor. After working for a number of years in higher education and community practice, Dr. Bigelow returned to training and completed a fellowship in Hospice and Palliative Medicine in 2019 through Michigan Medicine. Her current clinical practice is through Packard Health, a federally qualified health center. In this practice she provides vulnerable patients with outpatient palliative care, advance care planning, and complex symptom management as well as primary care. In addition, Dr. Bigelow teaches in the Health Behavior and Biological Sciences Graduate Nurse Practitioner Programs at the University of Michigan School of Nursing. Since 2013, she has led a global clinical immersion experience in rural Thailand. Dr. Bigelow’s research focus includes the integration of palliative care practices and concepts into primary care and chronic disease management. Her most recent study aims to identify the current palliative knowledge of primary care providers. These data will be used to develop educational modules to provide primary care providers with the tools to initiate palliative conversations and interventions closer to the time of diagnosis with severe and life-limiting illnesses, likely improving overall quality of life.
Areas of Interest
- Outpatient palliative care
- Palliative Care in the primary care site
- Palliative Care Education
- Care of chronic illness
Michael Smith, PharmD is a Pain and Palliative Care Clinical Pharmacist, Clinical Associate Professor at the University of Michigan College of Pharmacy, and Program Director for a PGY2 Pain Management and Palliative Care Pharmacy Residency. As a pharmacist-scientist, his research foci include 1) the safe and appropriate use of medications in high risk populations, namely, older adult cancer survivors, and 2) expanding services of clinical pharmacists managing symptoms. His work aims to improve the medication use of high risk populations and the role clinical pharmacists can have in improving symptom management medication use.
Areas of Interest
- Nociplastic pain in older adult cancer survivors
- Improving medication use through standards of care
- Expanding clinical pharmacist services
Rachel Lenko, BSN, RN is a PhD student at the University of Michigan School of Nursing. Her research is focused on understanding how both preferences and health disparities impact advance care planning and end-of-life care among older adults and their families. Her dissertation will use national survey data to examine the relationships between and identify disparities in advance care planning, goal-concordant end-of-life care, and bereavement outcomes. Her work aims to inform improvements in end-of-life care quality and equity among diverse groups of older adults in the United States.
Areas of Interest
- Advance care planning
- End-of-life care outcomes among older adults and their family members
- Health disparities
Current Palliative Care Research
- Lei L, Gerlach LB, Powell VD, Maust DT: Caregiver support and place of death among older adults. J Am Geriatr Soc 69(5): 1221-1230, 2021. PM33590479/PMC8127348
- Lagisetty P, Garpestad C, Larkin A, Macleod C, Antoku D, Slat S, Thomas J, Powell V, Bohnert ASB, Lin LA: Identifying individuals with opioid use disorder: Validity of International Classification of Diseases diagnostic codes for opioid use, dependence and abuse. Drug Alcohol Depend 221: 108583, 2021. PM33662670
- Powell VD, Abedini NC, Galecki AT, Kabeto M, Kumar N, Silveira MJ: Unwelcome Companions: Loneliness Associates with the Cluster of Pain, Fatigue, and Depression in Older Adults. Gerontol Geriatr. Med 7: 2333721421997620, 2021. PM33709010/PMC7907946
- Gerlach LB, Powell V, Zhang L, Bynum JPW, Maust DT: The Most Common Medications Billed to the Medicare Hospice Benefit Among Hospice Beneficiaries in the U.S. J Pain Symptom Manage 62(3): e3-e6, 2021. PM34051294
- Powell VD, Rosenberg JM, Yaganti A, Garpestad C, Lagisetty P, Shannon C, Silveira MJ: Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain: A Systematic Review. JAMA Netw Open 4(9): e2124152, 2021. PM34495339/PMC8427372
- Powell VD, Cigolle CT, Alexander NB, Hogikyan RV, Bigelow AD, Silveira MJ: Characterizing Opioid Response in Older Veterans in the Post-Acute Setting. Federal Practitioner 39(2): e15-22, 2022.
- Powell VD, Galecki AT, Kabeto M, Kumar N, Clauw D, Williams D, Hassett A, Silveira MJ: Bad Company: Loneliness Longitudinally Predicts the Symptom Cluster of Pain, Fatigue, and Depression in Older Adults Journal of the American Geriatrics Society Online ahead of print: 1-10, 2022. 35415848
- Lin LA, Powell VD, Lagisetty P, Garpestad C, Larkin A, Macleod C, Antoku D, Slat S, Thomas J, Bohnert AS: Factors associated with clinician treatment recommendations for patients with a new diagnosis of opioid use disorder Journal of Substance Abuse Treatment. (In Press)
- Powell, V. D., Macleod, C., Sussman, J., Lin, L. A., Bohnert, A. S., & Lagisetty, P. (2022). Variation in Clinical Characteristics and Longitudinal Outcomes in Individuals with Opioid Use Disorder Diagnosis Codes. Journal of General Internal Medicine, 1-8.
- Blumenthal B, Lee CW, Vitous CA, Robbins AJ, De Roo AC, Byrnes M, et al. Barriers to palliative care use among surgical patients: perspectives of practicing surgeons across Michigan. Ann Palliat Med. 2020. Epub 2020/09/15. doi: 10.21037/apm-20-948. PubMed PMID: 32921121.
- Brassil ME, Cheville A, Zheng JY, Smith SR, Tolchin DW, Wittry SA, et al. Top Ten Tips Palliative Care Clinicians Should Know About Physical Medicine and Rehabilitation. J Palliat Med. 2020;23(1):129-35. Epub 2019/09/27. doi: 10.1089/jpm.2019.0440. PubMed PMID: 31556786.
- Brenner AB, Skolarus LE, Perumalswami CR, Burke JF. Understanding End-of-Life Preferences: Predicting Life-Prolonging Treatment Preferences Among Community-Dwelling Older Americans. J Pain Symptom Manage. 2020;60(3):595-601 e3. Epub 2020/05/08. doi: 10.1016/j.jpainsymman.2020.04.010. PubMed PMID: 32376264; PubMed Central PMCID: PMCPMC7483277.
- Cleveland RW, Ullrich C, Slingsby B, Keefer P. Children at the Intersection of Pediatric Palliative Care and Child Maltreatment: A Vulnerable and Understudied Population. J Pain Symptom Manage. 2020. Epub 2020/11/17. doi: 10.1016/j.jpainsymman.2020.11.007. PubMed PMID: 33197523.
- Cousino MK, Miller VA, Smith C, Uzark K, Lowery R, Rottach N, et al. Medical and end-of-life decision making in adolescents' pre-heart transplant: A descriptive pilot study. Palliat Med. 2020;34(3):272-80. Epub 2019/10/28. doi: 10.1177/0269216319874689. PubMed PMID: 31647374.
- Farrell TW, Ferrante LE, Brown T, Francis L, Widera E, Rhodes R, et al. AGS Position Statement: Resource Allocation Strategies and Age-Related Considerations in the COVID-19 Era and Beyond. J Am Geriatr Soc. 2020;68(6):1136-42. Epub 2020/05/07. doi: 10.1111/jgs.16537. PubMed PMID: 32374440; PubMed Central PMCID: PMCPMC7267615.
- Farrell TW, Francis L, Brown T, Ferrante LE, Widera E, Rhodes R, et al. Rationing Limited Healthcare Resources in the COVID-19 Era and Beyond: Ethical Considerations Regarding Older Adults. J Am Geriatr Soc. 2020;68(6):1143-9. Epub 2020/05/07. doi: 10.1111/jgs.16539. PubMed PMID: 32374466; PubMed Central PMCID: PMCPMC7267288.
- Harden K, Price DM, Mason H, Bigelow A. COVID-19 Shines a Spotlight on the Age-Old Problem of Social Isolation. J Hosp Palliat Nurs. 2020;22(6):435-41. Epub 2020/09/15. doi: 10.1097/NJH.0000000000000693. PubMed PMID: 32925489.
- Leith TB, Haas NL, Harvey CE, Chen C, Ives Tallman C, Bassin BS. Delivery of end-of-life care in an emergency department-based intensive care unit. J Am Coll Emerg Physicians Open. 2020;1(6):1500-4. Epub 2021/01/05. doi: 10.1002/emp2.12258. PubMed PMID: 33392556; PubMed Central PMCID: PMCPMC7771771.
- Manu ER, Fitzgerald JT, Mullan PB, Vitale CA. Eating Problems in Advanced Dementia: Navigating Difficult Conversations. MedEdPORTAL. 2020;16:11025. Epub 2020/11/27. doi: 10.15766/mep_2374-8265.11025. PubMed PMID: 33241119; PubMed Central PMCID: PMCPMC7678029.
- Miller SC, Scott WJ, Ersek M, Levy C, Hogikyan R, Periyakoil VS, et al. Honoring Veterans' Preferences: The Association Between Comfort Care Goals and Care Received at the End of Life. J Pain Symptom Manage. 2020. Epub 2020/09/11. doi: 10.1016/j.jpainsymman.2020.08.039. PubMed PMID: 32911038.
- Powell VD, Silveira MJ. What Should Palliative Care's Response Be to the COVID-19 Pandemic? J Pain Symptom Manage. 2020;60(1):e1-e3. Epub 2020/04/02. doi: 10.1016/j.jpainsymman.2020.03.013. PubMed PMID: 32229286; PubMed Central PMCID: PMCPMC7156808.
- Quirk K, Wright J, Marks A, Smith MA. Sublingual Buprenorphine for Pediatric Cancer Pain: A Case Report and Review of the Literature. J Pain Symptom Manage. 2020;60(5):1055-8. Epub 2020/08/03. doi: 10.1016/j.jpainsymman.2020.07.029. PubMed PMID: 32739561.
- Rodgers PE. End-of-Life Care: Serious Illness Progression, Prognostication, and Advance Care Planning. FP Essent. 2020;498:21-5. Epub 2020/11/10. PubMed PMID: 33166103.
- Rosenberg LJ, Butler JM, Caprio AJ, Rhodes RL, Braun UK, Vitale CA, et al. Results From a Survey of American Geriatrics Society Members' Views on Physician-Assisted Suicide. J Am Geriatr Soc. 2020;68(1):23-30. Epub 2019/12/04. doi: 10.1111/jgs.16245. PubMed PMID: 31791113.
- Sedig LK, Spruit JL, Paul TK, Cousino MK, Pituch K, Hutchinson R. Experiences at the End of Life From the Perspective of Bereaved Parents: Results of a Qualitative Focus Group Study. Am J Hosp Palliat Care. 2020;37(6):424-32. Epub 2019/12/31. doi: 10.1177/1049909119895496. PubMed PMID: 31884806.
- Shnayder MM, Montgomery JR, Abrahamse P, Suwanabol PA. Considering self-reported baseline function and cognition in predicting post-operative complications among older adults. Ann Palliat Med. 2020;9(4):1847-50. Epub 2020/06/13. doi: 10.21037/apm-20-816. PubMed PMID: 32527119.
- Smith MA, Quirk KC, Saul DC, Rodgers PE, Silveira MJ. Comparing Methadone Rotation to Consensus Opinion. J Pain Symptom Manage. 2020;59(1):116-20. Epub 2019/09/29. doi: 10.1016/j.jpainsymman.2019.09.014. PubMed PMID: 31560968.
- Suwanabol PA, Vitous CA, Perumalswami CR, Li SH, Raja N, Dillon BR, et al. Surgery Residents' Experiences With Seriously-Ill and Dying Patients: An Opportunity to Improve Palliative and End-of-Life Care. J Surg Educ. 2020;77(3):582-97. Epub 2020/02/18. doi: 10.1016/j.jsurg.2019.12.013. PubMed PMID: 32063510.
- Thiel M, Harden K, Brazier LJ, Marks A, Smith M. Improving the Interdisciplinary Clinical Education of a Palliative Care Program through Quality Improvement Initiatives. Palliat Med Rep. 2020;1(1):270-9. Epub 2020/12/05. doi: 10.1089/pmr.2020.0092. PubMed PMID: 33274342; PubMed Central PMCID: PMCPMC7703493.
- Thiel M, Harden K, Brazier LJ, Marks AD, Smith MA. Evaluation Tools for Interdisciplinary Palliative Care Learning Experiences: A Literature Review. J Palliat Med. 2020;23(5):698-702. Epub 2019/10/17. doi: 10.1089/jpm.2019.0394. PubMed PMID: 31618093.
- Thiel M, Mattison D, Goudie E, Licata S, Brewster J, Montagnini M. Social Work Training in Palliative Care: Addressing the Gap. Am J Hosp Palliat Care. 2020:1049909120960709. Epub 2020/09/25. doi: 10.1177/1049909120960709. PubMed PMID: 32969240.
- Verma M, Tapper EB, Singal AG, Navarro V. Nonhospice Palliative Care Within the Treatment of End-Stage Liver Disease. Hepatology. 2020;71(6):2149-59. Epub 2020/03/14. doi: 10.1002/hep.31226. PubMed PMID: 32167615.
- Waidyaratne G, Zhou S, O'Neil T, Marks A. Management of Wound Myiasis in the Hospice and Palliative Medicine Setting. J Palliat Med. 2020. Epub 2020/10/31. doi: 10.1089/jpm.2020.0441. PubMed PMID: 33121325.
- Walter KS, Gillespie H, Moqbel D, Choe HM, Smith MA. The Impact of Palliative Care Interventions on Medication Regimen Complexity. J Palliat Med. 2020;23(2):156-7. Epub 2020/02/06. doi: 10.1089/jpm.2019.0229. PubMed PMID: 32023191.
- Yan H, Kukora SK, Arslanian-Engoren C, Deldin PJ, Pituch K, Yates JF. Aiding end-of-life medical decision-making: A Cardinal Issue Perspective. Palliat Support Care. 2020;18(1):1-3. Epub 2019/11/30. doi: 10.1017/S1478951519000981. PubMed PMID: 31775941.
- Blumenthal B, Lee CW, Vitous CA, Robbins AJ, De Roo AC, Byrnes M, et al. Barriers to palliative care use among surgical patients: perspectives of practicing surgeons across Michigan. Ann Palliat Med. 2021;10(2):1122-32. Epub 2020/09/15. doi: 10.21037/apm-20-948. PubMed PMID: 32921121.
- Gerlach LB, Kales HC, Kim HM, Zhang L, Strominger J, Covinsky K, et al. Prevalence of psychotropic and opioid prescribing among hospice beneficiaries in the United States, 2014-2016. J Am Geriatr Soc. 2021. Epub 2021/03/09. doi: 10.1111/jgs.17085. PubMed PMID: 33683703.
- Powell VD, Silveira MJ. Palliative Care for Older Adults with Multimorbidity in the Time of COVID 19. J Aging Soc Policy. 2021:1-9. Epub 2021/01/13. doi: 10.1080/08959420.2020.1851436. PubMed PMID: 33430715.
April Bigelow, PhD
- September 2020- Where are the patient advocates? The negative effect of social isolation on older patient care during COVID.
- March 2020 - Clinical Associate Professor April Bigelow is caring for underserved patients as the COVID-19 pandemic evolves.
Maria Silveira, MD
- Maria Silveira interviewed by Wired Magazine about palliative care using Zoom (July 2020) - When Doctors and Patients Talk About Death Over Zoom.
DOIM Palliative Care Grand Rounds
Friday, June 18 | 12:00 – 1:00 pm
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Ann Arbor, MI 48109
Phone: (734) 936-8357