Palliative Care Research Program

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 History
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.

Our Affiliations

We have strong ties to other research programs across the UM campus including:

• Michigan Institute for Clinical Health Research
• Institute for Healthcare Policy and Innovation
• UM Chronic Pain and Fatigue Research Center
• Claude Pepper Center 

Maria Silveira, MD, MA, MPH

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
• Caregiving

Victoria Powell, MD

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
• Loneliness
• Demoralization
• Existential distress
• Opioid-non responsive pain
• Opioid use disorder in serious illness

Lauren Gerlach, DO, MS

Lauren Gerlach, DO, MS 

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)-active 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

Amy Suwanabol, MD, MS

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

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 and Outpatient Palliative Care through University of Michigan Health. In her 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

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
  
   

• Bigelow A, Price D, Mason H, Harden K. Teaching in Times of Crisis Through a Palliative Care Lens. Nurs Educ Perspect. 2022;43(5):335-6.
• 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. 2021;62(1):91-7.
• Cousino MK, Lord BT, Blume ED, Harvard Radcliffe Accelerator Work G. State of the science and future research directions in palliative and end-of-life care in paediatric cardiology: a report from the Harvard Radcliffe Accelerator Workshop. Cardiol Young. 2021:1-6.
• Cousino MK, Yu S, Blume ED, Henderson HT, Hollander SA, Khan S, et al. Circumstances surrounding end-of-life in pediatric patients pre- and post-heart transplant: a report from the Pediatric Heart Transplant Society. Pediatr Transplant. 2022;26(2):e14196.
• Dans M, Kutner JS, Agarwal R, Baker JN, Bauman JR, Beck AC, et al. NCCN Guidelines(R) Insights: Palliative Care, Version 2.2021. J Natl Compr Canc Netw. 2021;19(7):780-8.
• Gerlach LB, Fashaw S, Strominger J, Ogarek J, Zullo AR, Daiello LA, et al. Trends in antipsychotic prescribing among long-term care residents receiving hospice care. J Am Geriatr Soc. 2021;69(8):2152-62.
• 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;69(6):1479-89.
• 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. 2021;62(3):e3-e6.
• Gerlach LB, Zhang L, Strominger J, Kim HM, Teno J, Bynum JPW, et al. Variation in Benzodiazepine and Antipsychotic Prescribing Among Hospice Agencies. J Gen Intern Med. 2022.
• Gerlach LB, Zhang L, Strominger J, Teno J, Bynum JPW, Maust DT. State variation in antipsychotic and benzodiazepine prescribing among hospice beneficiaries in the United States. J Am Geriatr Soc. 2022.
• Giannitrapani KF, Silveira MJ, Azarfar A, Glassman PA, Singer SJ, Asch SM, et al. Cross Disciplinary Role Agreement is Needed When Coordinating Long-Term Opioid Prescribing for Cancer: a Qualitative Study. J Gen Intern Med. 2021;36(7):1867-74.
• Guthrie DM, Williams N, Beach C, Buzath E, Cohen J, Declercq A, et al. A multi-stage process to develop quality indicators for community-based palliative care using interRAI data. PLoS One. 2022;17(4):e0266569.
• Irwin M, Gunther W, Keefer P, Saul D, Singh SA, Wright J, et al. Buprenorphine for Chronic Pain in a Pediatric Patient With Sickle-Cell Disease. J Pain Symptom Manage. 2021;62(5):1086-91.
• Irwin MN, Ellingrod VL, Smith MA. Pharmacogenetics of Methadone for Pain Management in Palliative Care. J Pain Symptom Manage. 2022;63(1):e142-e5.
• Jafri SM, Vitous CA, Suwanabol PA. Palliative care education in surgery. Ann Palliat Med. 2021.
• Kamal AH, Thienprayoon RM, Aldridge M, Bull J, Fazzalaro K, Meier DE, et al. Specialty Palliative Care in COVID-19: Early Experiences from the Palliative Care Quality Collaborative. J Palliat Med. 2021;24(11):1689-96.
• Karlic KJ, Hummel EK, Houchens N, Meddings J. Use of opioids for refractory dyspnoea in hospitalised patients with serious illness: a narrative review. Postgrad Med J. 2021.
• Lei L, Gerlach LB, Powell VD, Maust DT. Caregiver support and place of death among older adults. J Am Geriatr Soc. 2021;69(5):1221-30.
• Luymes N, Williams N, Garrison L, Goodridge D, Silveira M, Guthrie DM. "The system is well intentioned, but complicated and fallible" interviews with caregivers and decision makers about palliative care in Canada. BMC Palliat Care. 2021;20(1):149.
• Mason H, Price DM, Bigelow A, Harden K. Multi-level classroom learning prepares nurses for future collaboration in palliative care: an educational initiative. Int J Palliat Nurs. 2022;28(9):401-5.
• Millis MA, Suwanabol PA. Surgery at the End of Life-Aggressive But Necessary? JAMA Netw Open. 2022;5(7):e2220382.
• Min L, Saul D, Firn J, Chang R, Wiggins J, Khateeb R. Interprofessional geriatric and palliative care intervention associated with fewer hospital days. J Am Geriatr Soc. 2021.
• Powell VD, Rosenberg JM, Yaganti A, Garpestad C, Lagisetty P, Shannon C, et al. Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain: A Systematic Review. JAMA Netw Open. 2021;4(9):e2124152.
• Powell VD, Silveira MJ. Palliative Care for Older Adults with Multimorbidity in the Time of COVID 19. J Aging Soc Policy. 2021;33(4-5):500-8.
• Reich AJ, Perez S, Gazarian P, D'Arcangelo N, Gonzales K, Rodgers P, et al. Is This ACP? A Focus Group Study of Patient Experiences of Advance Care Planning. J Gen Intern Med. 2022;37(6):1484-93.
• Sedig LK, Spruit JL, Southwell J, Paul TK, Cousino MK, McCaffery H, et al. Palliative care is not associated with decreased intensity of care: Results of a chart review from a large children's hospital. Pediatr Blood Cancer. 2022;69(3):e29391.
• Smith A, Hansen J, Colvard M. Impact of a pharmacist-led substance use disorder transitions of care clinic on post discharge medication treatment retention. J Subst Abuse Treat. 2021;130:108440.
• Spreen LA, Dittmar EN, Quirk KC, Smith MA. Buprenorphine initiation strategies for opioid use disorder and pain management: A systematic review. Pharmacotherapy. 2022;42(5):411-27.
• Waidyaratne G, Zhou S, O'Neil T, Marks A. Management of Wound Myiasis in the Hospice and Palliative Medicine Setting. J Palliat Med. 2021;24(5):797-800.

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1500 E Medical Center Dr.
F7896
Ann Arbor, MI 48109
Phone: (734) 936-8357