Dena Schulman-Green
PhD
Associate Professor
Director of the Florence S. Downs PhD Program
dena.schulman-green@nyu.edu
1 212 998 5786
Associate Professor
Director of the Florence S. Downs PhD Program
433 First Ave
New York, NY 10010
United States
Accepting PhD students
Dena Schulman-Green's additional information
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Dena Schulman-Green, PhD, is an associate professor at NYU Rory Meyers College of Nursing. Her program of research focuses on the integration of palliative care into patient and family management of serious, chronic illness. She designed Managing Cancer Care as an intervention to help women with breast cancer and their family caregivers to manage cancer collaboratively with clinicians. Schulman-Green is well known for her role in developing the Middle Range Theory of Self- and Family Management of Chronic Illness to guide research on patient and family management of chronic illness. Schulman-Green’s work is rooted in her belief that healthcare goals should reflect personal goals and values.
Additional research interests include health-illness transitions, psychosocial issues in cancer survivorship, and tailoring research methods for vulnerable populations. Schulman-Green consults on qualitative and mixed methods studies nationally. Her work has been funded by the American Cancer Society, the National Institutes of Health, the National Palliative Care Research Center, and the Palliative Care Research Cooperative, among others. She is active in the American Academy of Hospice and Palliative Medicine and serves on the Editorial Board of the Journal of Pain and Symptom Management. Invested in mentorship and leadership development, Schulman-Green supervises PhD and postdoctoral research trainees.
Prior to joining NYU Meyers, Schulman-Green was faculty at the Yale School of Nursing for 18 years, initially as a Research Scientist and later as an Associate Professor. She also served as faculty for the Yale School of Medicine’s Palliative Medicine Fellowship and Interprofessional Palliative Care Education programs. She was instrumental in developing palliative care research and providing qualitative and mixed methods research support university-wide.
Schulman-Green received a PhD and an MS in gerontology from the University of Massachusetts Boston, an MA and EdM in counseling psychology from Columbia University, and a BA in psychology and religion from Boston University. She completed a post-doctoral fellowship in breast cancer and palliative care at the Yale School of Nursing under the mentorship of Drs. Ruth McCorkle and Elizabeth Bradley.
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PhD, University of Massachusetts BostonMS, University of Massachusetts BostonEdM, Columbia University, Teachers CollegeMA, Columbia University, Teachers CollegeBA, Boston University
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Palliative careChronic diseaseGerontologyGlobal
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American Academy of Hospice and Palliative MedicinePalliative Care Research Cooperative GroupEastern Nursing Research SocietyGerontological Society of AmericaAmerican Psychosocial Oncology Society
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Faculty Honors Awards
Suzanne Feetham Nurse Scientist Family Research Award, Eastern Nursing Research Society (2019)American Academy of Hospice and Palliative Medicine Poster Award (2017)Annie W. Goodrich Award for Excellence in Teaching, Yale School of Nursing (2017)American Academy of Hospice and Palliative Medicine Poster Award (2016)American Academy of Hospice and Palliative Medicine Poster Award (2010)Center for Disease Control Success Story Award (2010)Ellison Medical Foundation Aging New Scholar Award Nominee, University of Massachusetts Boston (2006)National Hospice and Palliative Care Organization Research Award (2004)Inducted into Sigma Phi Omega, Gerontology Honor Society (1999)Association for Gerontology in Higher Education/AARP Andrus Foundation Graduate Scholarship in Gerontology (1998)Columbia University General Scholarship Award (1993)Inducted into Psi Chi, Psychology Honor Society (1992) -
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Publications
Interventions and Predictors of Transition to Hospice for People Living with Dementia: An Integrative Review
AbstractMurali, K. P., Gogineni, S., Bullock, K., McDonald, M., Sadarangani, T., Schulman-Green, D., & Brody, A. A. (2025). The Gerontologist. 10.1093/geront/gnaf046AbstractBACKGROUND AND OBJECTIVES: Goal-concordant transition to hospice is an important facet of end-of-life care for people living with dementia. The objective of this integrative review was to appraise existing evidence and gaps focused on interventions and predictors of transition to hospice and end-of-life care for persons living with dementia across healthcare to inform future research.RESEARCH DESIGN AND METHODS: Using integrative review methodology by Whittemore and Knafl, five databases were searched (PubMed, CINAHL, Web of Science, Google Scholar, Cochrane Database for Systematic Reviews) for articles between 2000 and 2023. The search focused on dementia, hospice care, transitions, care management and/or coordination, and intervention studies.RESULTS: Fourteen articles met inclusion criteria after critical appraisal. Most were cross-sectional in design and conducted in nursing homes and hospitals in the U.S. persons living with dementia had multiple chronic conditions including cancer, diabetes, heart disease, and stroke. Interventions included components of hospice decision-making delivered through advance care planning, checklist-based care management for hospice transition, and palliative care for those with severe dementia. Predictors included increasing severity of illness including functional decline, organ failure, intensive care use, and the receipt of palliative care. Other predictors were related to insurance status, race and ethnicity, and caregiver burden. Overall, despite moderate to high-quality evidence, the studies were limited in scope and sample and lacked racial and ethnic diversity.DISCUSSION AND IMPLICATIONS: Prospective, multisite randomized trials and population-based analyses including larger and diverse samples are needed for improved end-of-life dementia illness counseling and hospice care transitions for persons living with dementia and their caregivers.“There Should Be A Nurse On Call”: Complex Care Needs of Low-Income Older Adults in Medicaid-Supported Assisted Living
AbstractMurali, K. P., Lassell, R. K., Brody, A. A., Schulman-Green, D., & David, D. (2025). Journal of Palliative Medicine. 10.1089/jpm.2024.0445AbstractBackground: In the United States, nearly 1 million older adults reside in assisted living facilities, which aim to provide support for safe, autonomous living. However, low-income residents, especially those in Medicaid-supported facilities, experience unmet medical and social complex care needs and limited serious illness communication due to limited resources. Objective: The objective of this study was to explore the complex care needs and serious illness communication challenges experienced by low-income older adults in Medicaid-supported assisted living. Methods: A qualitative secondary framework analysis was conducted on data from a parent qualitative study involving 17 residents aged 60 and older with serious illnesses at a Medicaid-supported facility in New York City. Residents completed the Edmonton Symptom Assessment Scale and participated in semistructured interviews. This study was guided by the National Consensus Project for Quality Palliative Care, focusing on the residents’ experiences, complex care needs, and communication within palliative care domains. Results: Residents were predominantly Black and Hispanic, with nearly one-third having a history of homelessness or shelter use, and they experienced a high symptom burden. Four key themes emerged: (1) compromised quality of life; (2) high symptom burden and limited access to care, with residents reporting pain, fatigue, and emotional distress; (3) communication gaps while navigating health care, resulting in frustration and feelings of being unheard; and (4) fragmented care coordination, which exacerbated feelings of isolation and mistrust in the health care system. Conclusion: The findings reveal that Medicaid-supported assisted living residents encounter substantial challenges related to complex care needs and serious illness communication. There is an urgent need for community-based interventions to enhance care access, improve symptom management, and facilitate effective communication, ultimately supporting the residents’ quality of life and health outcomes. Enhanced training for staff and policy changes are key to addressing these systemic barriers to care.“Who You Are and Where You Live Matters”: Hospice Care in New York City During COVID-19Perspectives on Hospice and Social Determinants: A Rapid Qualitative Analysis
AbstractDavid, D., Moreines, L. T., Boafo, J., Kim, P., Franzosa, E., Schulman-Green, D., Brody, A. A., & Aldridge, M. D. (2025). Journal of Palliative Medicine, 28(1), 59-68. 10.1089/jpm.2024.0124AbstractContext: Social determinants of health (SDOH) impacted the quality of home hospice care provided during the COVID-19 pandemic. Perspectives from professionals who provided care identify challenges and lessons learned from their experience. Objective: To examine hospice professionals’ perspectives of how SDOH affected the delivery of high-quality home hospice care in New York City (NYC) during the COVID-19 pandemic. Methods: We conducted semistructured interviews with 30 hospice professionals who delivered care to home hospice patients during the COVID-19 pandemic in NYC using a qualitative descriptive design. Purposive sampling was used to recruit professionals from a range of disciplines including physicians, advanced practice providers, nurses, social workers, chaplains, and hospice administration and management. Participants worked for one of two large NYC metro hospices and one outpatient palliative care practice serving the five boroughs of NYC and the surrounding suburbs. Rapid qualitative analysis was used to identify themes. Results: Thirty hospice professionals were interviewed, spanning a variety of clinical and administrative roles. Most (21 out of 30) reported that social determinants affected access and/or delivery of equitable hospice care. Two key themes emerged from interviews: (1) SDOH exist and affect the delivery of high-quality care and (2) disparities were exacerbated during the COVID-19 pandemic resulting in barriers to care. Subthemes outline barriers described by hospice professionals: decreased hospice enrollment, telehealth challenges, resulting in deficient patient/family education, shortages of nursing assistants in some neighborhoods, and diminished overall quality of hospice care for some patients. SDOH created barriers to hospice care through neighborhood factors, resource barriers, and system challenges. Conclusion: SDOH provide a context to understand disparity in the provision of hospice care. COVID-19 exacerbated these conditions. Addressing multidimensional barriers created by SDOH is key in creating high-quality and equitable hospice care, particularly during a crisis.Assessing Delirium Severity in Dementia: Item Development and Psychometric Validation for a Delirium Severity Instrument
AbstractHshieh, T., Schulman-Green, D., Fong, T. G., Metzger, E., Arias, F., Helfand, B., Marcantonio, E., Schmitt, E., Tabloski, P., Jones, R. N., & Inouye, S. K. (2024). Journal of Gerontological Nursing, 50(9), 24-30. 10.3928/00989134-20240809-06AbstractPURPOSE: Despite the importance of measuring delirium severity in patients with Alzheimer’s disease and related dementias (ADRD), no validated instrument currently exists. Our goal was to generate items for use in such an instrument. METHOD: An interdisciplinary expert panel developed items to assess seven domains and 21 subdomains of delirium severity. Nursing experts provided input on items. RESULTS: Experts achieved consensus on 21 items, including best respondents for each item, and appropriate look-back periods. Nursing experts emphasized the need for educating nursing staff and obtaining information from caregivers. CONCLUSION: Careful, nuanced identification of distinguishing features is key for generating items for measuring delirium severity in persons with ADRD. Once developed, engaging nurses will be essential to facilitate adoption and relevance of the tool.Family Management Skills Reported by Parents of Preterm Infants in the NICU Using the Self- and Family Management Framework (SFMF)
AbstractWeber, A., Bakas, T., Schulman-Green, D., Voos, K. C., Rice, J. B., Bailey, R., Reigel, A., Oudat, Q., Holmes, M., Tubbs-Cooley, H. L., & Kaplan, H. C. (2024). Advances in Neonatal Care, 24(2), 119-131. 10.1097/ANC.0000000000001140AbstractBackground: Across the globe, family-integrated care (FICare) has become an evidence-based standard in which parents deliver the majority of infant care in the neonatal intensive care unit (NICU). Because of extensive barriers to parent presence, adaptations to FICare may be required for successful implementation. Family management theory may provide structure to the Parent Education of FICare and help nurses guide parents’ skill development as equal care members. Purpose: To identify family management skills employed by NICU parents using the Self- and Family Management Framework (SFMF). Methods: We conducted secondary analyses of qualitative interview data from NICU parents (n = 17) who shared their experiences of using family management skills to care for their infant. We categorized skills according to 3 main self- and family management processes: Focusing on Infant Illness Needs; Activating Resources; and Living With Infant Illness. Results: Parents reported several family management skills currently identified in the SFMF, as well as new skills such as conflict management, power brokerage, and addressing resources related to social determinants of health. Parent activation of resources was critical to sustaining parent focus on the infant’s illness needs. Implications for Practice and Research: By teaching skills that parents reported as helping them manage infant care, neonatal nurses may better facilitate parent integration into the care team. Future researchers can incorporate the skills identified in this study into the design of family management interventions that facilitate FICare implementation in the United States.Lessons Learned Establishing the Palliative Care Research Cooperative's Qualitative Data Repository
AbstractMeghani, S. H., Mooney-Doyle, K., Barnato, A., Colborn, K., Gillette, R., Harrison, K. L., Hinds, P. S., Kirilova, D., Knafl, K., Schulman-Green, D., Pollak, K. I., Ritchie, C. S., Kutner, J. S., & Karcher, S. (2024). Journal of Pain and Symptom Management, 68(3), 308-318. 10.1016/j.jpainsymman.2024.05.027AbstractData sharing is increasingly an expectation in health research as part of a general move toward more open sciences. In the United States, in particular, the implementation of the 2023 National Institutes of Health Data Management and Sharing Policy has made it clear that qualitative studies are not exempt from this data sharing requirement. Recognizing this trend, the Palliative Care Research Cooperative Group (PCRC) realized the value of creating a de-identified qualitative data repository to complement its existing de-identified quantitative data repository. The PCRC Data Informatics and Statistics Core leadership partnered with the Qualitative Data Repository (QDR) to establish the first serious illness and palliative care qualitative data repository in the U.S. We describe the processes used to develop this repository, called the PCRC-QDR, as well as our outreach and education among the palliative care researcher community, which led to the first ten projects to share the data in the new repository. Specifically, we discuss how we co-designed the PCRC-QDR and created tailored guidelines for depositing and sharing qualitative data depending on the original research context, establishing uniform expectations for key components of relevant documentation, and the use of suitable access controls for sensitive data. We also describe how PCRC was able to leverage its existing community to recruit and guide early depositors and outline lessons learned in evaluating the experience. This work advances the establishment of best practices in qualitative data sharing.Navigating a "good Death" during COVID-19: Understanding Real-Time End-of-Life Care Structures, Processes, and Outcomes Through Clinical Notes
AbstractFranzosa, E., Kim, P. S., Moreines, L. T., McDonald, M. V., David, D., Boafo, J., Schulman-Green, D., Brody, A. A., & Aldridge, M. D. (2024). Gerontologist, 64(10). 10.1093/geront/gnae099AbstractBackground and Objectives: The coronavirus disease 2019 (COVID-19) pandemic severely disrupted hospice care, yet there is little research regarding how widespread disruptions affected clinician and family decision-making. We aimed to understand how the pandemic affected structures, processes, and outcomes of end-of-life care. Research Design and Methods: Retrospective narrative chart review of electronic health records of 61 patients referred and admitted to hospice from 3 New York City geriatrics practices who died between March 1, 2020, and March 31, 2021. We linked longitudinal, unstructured medical, and hospice electronic health record notes to create a real-time, multiperspective trajectory of patients' interactions with providers using directed content analysis. Results: Most patients had dementia and were enrolled in hospice for 11 days. Care processes were shaped by structural factors (staffing, supplies, and governmental/institutional policies), and outcomes were prioritized by care teams and families (protecting safety, maintaining high-touch care, honoring patient values, and supporting patients emotionally and spiritually). Processes used to achieve these outcomes were decision-making, care delivery, supporting a "good death,"and emotional and spiritual support. Discussion and Implications: Care processes were negotiated throughout the end of life, with clinicians and families making in-the-moment decisions. Some adaptations were effective but also placed extraordinary pressure on paid and family caregivers. Healthcare teams' and families' goals to meet patients' end-of-life priorities can be supported by ongoing assessment of patient goals and process changes needed to support them, stronger structural supports for paid and family caregivers, incentivizing relationships across primary care and hospice teams, and extending social work and spiritual care.Patient experiences with tissue-based genomic testing during active surveillance for prostate cancer
AbstractLeapman, M. S., Sutherland, R., Gross, C. P., Ma, X., Seibert, T. M., Cooperberg, M. R., Catalona, W. J., Loeb, S., & Schulman-Green, D. (2024). BJUI Compass, 5(1), 142-149. 10.1002/bco2.277AbstractBackground: Tissue-based gene expression (genomic) tests provide estimates of prostate cancer aggressiveness and are increasingly used for patients considering or engaged in active surveillance. However, little is known about patient experiences with genomic testing and its role in their decision-making. Methods: We performed a qualitative study consisting of in-depth, semi-structured interviews of patients with low- or favourable-intermediate-risk prostate cancer managed with active surveillance. We purposively sampled to include patients who received biopsy-based genomic testing as part of clinical care. The interview guide focused on experiences with genomic testing during patients' decision-making for prostate cancer management and understanding of genomic test results. We continued interviews until thematic saturation was reached, iteratively created a code key and used conventional content analysis to analyse data. Results: Participants' (n = 20) mean age was 68 years (range 51–79). At initial biopsy, 17 (85%) had a Gleason grade group 1, and 3 (15%) had a grade group 2 prostate cancer. The decision to undergo genomic testing was driven by both participants and physicians' recommendations; however, some participants were unaware that testing had occurred. Overall, participants understood the role of genomic testing in estimating their prostate cancer risk, and the test results increased their confidence in the decision for active surveillance. Participants had some misconceptions about the difference between tissue-based gene expression tests and germline genetic tests and commonly believed that tissue-based tests measured hereditary cancer risk. While some participants expressed satisfaction with their physicians' explanations, others felt that communication was limited and lacked sufficient detail. Conclusion: Patients interact with and are influenced by the results of biopsy-based genomic testing during active surveillance for prostate cancer, despite gaps in understanding about test results. Our findings indicate areas for improvement in patient counselling in order to increase patient knowledge and comfort with genomic testing.Towards a Crisis Management Playbook: Hospice and Palliative Team Members’ Views Amid COVID-19
AbstractSchulman-Green, D., David, D., Moreines, L. T., Boafo, J., Franzosa, E., Kim, P., McDonald, M. V., Brody, A. A., & Aldridge, M. D. (2024). Journal of Pain and Symptom Management, 68(6), 573-582.e1. 10.1016/j.jpainsymman.2024.09.012AbstractContext: The critical role of hospice and palliative care in response to the COVID-19 pandemic is well recognized, but there is limited evidence to guide healthcare leadership through future crises. Objectives: Our goal was to support future organizational resilience by exploring hospice and palliative team members’ perspectives on crisis leadership during the COVID-19 pandemic in New York City (NYC). Methods: This qualitative descriptive study used individual, semi-structured interviews of purposively sampled interdisciplinary team members. Enrollment sites were two large NYC metro hospice care organizations and one outpatient palliative care practice. We asked participants to complete a demographic form and a 45–60 minute interview. We used descriptive statistics and thematic analysis, respectively, for data analysis. We triangulated the data by presenting preliminary study findings to a group of clinicians (n=21) from one of the referring organizations. Results: Participants (n=30) were professionally diverse (e.g., nurses, physicians, social workers, chaplains, administrators), experienced (mean=17 years; 10 years in hospice), and highly educated (83% ≥ master's degree). About half (n=15) self-identified as white, non-Hispanic, and nearly half (n=13) self-identified as being from a racial/ethnic minoritized group. Two (n=2) did not wish to self-identify. We identified four themes that reflected challenges and adaptive responses to providing care during a crisis: Stay Open and Stay Safe; Act Flexibly; Lead Adaptively; and Create a Culture of Solidarity. Conclusion: While additional work is indicated, findings offer direction for a crisis management playbook to guide leadership in hospice, palliative care, and other healthcare settings in future crises.‘It Just Makes Sense to Me’: A qualitative study exploring patient decision-making and experiences with prostate MRI during active surveillance for prostate cancer
AbstractSutherland, R., Gross, C. P., Ma, X., Jeong, F., Seibert, T. M., Cooperberg, M. R., Catalona, W. J., Ellis, S. D., Loeb, S., Schulman-Green, D., & Leapman, M. S. (2024). BJUI Compass, 5(6), 593-601. 10.1002/bco2.351AbstractIntroduction: Although prostate magnetic resonance imaging (MRI) is commonly used in the diagnosis, staging and active surveillance of prostate cancer, little is known about patient perspectives on MRI. Methods: We performed a qualitative study consisting of in-depth, semi-structured interviews of patients with low- and intermediate-risk prostate cancer managed with active surveillance. Interviews focused on experiences with and knowledge of prostate MRI and MRI-ultrasound fusion biopsy during active surveillance. We purposively sampled patients who received prostate MRI as part of their clinical care, conducted interviews until reaching thematic saturation and performed conventional content analysis to analyse data. Results: Twenty patients aged 51–79 years (mean = 68 years) participated in the study. At diagnosis, 17 (85%) had a Gleason grade group 1, and three (15%) had a grade group 2 tumour. Overall, participants viewed prostate MRI as a valuable tool that accurately localizes and monitors prostate cancer over time, and they considered prostate MRI central to active surveillance monitoring. We identified five thematic categories related to MRI use: (1) the experiential aspects of undergoing an MRI scan; (2) the experience of visualizing one's own prostate and prostate cancer; (3) adequacy of provider explanations of MRI results; (4) confidence in prostate MRI in decision-making; and (5) the role of prostate MRI in longitudinal follow-up, including an interest in using MRI to modify the timing of, or replace, prostate biopsy. Conclusion: Patients value prostate MRI as a tool that enhances their confidence in the initial diagnosis and monitoring of prostate cancer. This work can inform future studies to optimize patient experience, education and counselling during active surveillance for prostate cancer.