Faculty

Dr. Dena Schulman-Green

Dena Schulman-Green

Associate Professor

1 212 998 5786

433 1st Ave.
New York , NY 10010
United States

Accepting PhD students

Dena Schulman-Green's additional information

Dena Schulman-Green, PhD, is an associate professor at NYU Rory Meyers College of Nursing. Her program of research focuses on the timely integration of palliative care into patient and family management of 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 Self- and Family Management Framework to guide research on patient and family management of chronic illness. Other research interests include addressing health disparities in palliative care, use of telehealth in palliative care, and tailoring research methods for vulnerable populations. Schulman-Green consults on qualitative and mixed methods research 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. invested in mentorship and leadership development, Schulman-Green supervises PhD and postdoctoral research trainees. 

Prior to joining NYU Meyers, Schulman-Green conducted research and taught and advised in the PhD and DNP programs at Yale School of Nursing for 18 years. She was also faculty for 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 Yale School of Nursing through a US Army Department of Defense Breast Cancer Research Program Training Grant under the mentorship of Drs. Ruth McCorkle and Elizabeth Bradley.

PhD, University of Massachusetts Boston
MS, University of Massachusetts Boston
EdM, Columbia University, Teachers College
MA, Columbia University, Teachers College
BA, Boston University

Palliative care
Chronic disease
Gerontology
Global

American Academy of Hospice and Palliative Medicine
Palliative Care Research Cooperative Group
Eastern Nursing Research Society
Gerontological Society of America
American Psychosocial Oncology Society

Faculty Honors Awards

Suzanne Feetham Nurse Scientist Family Research Award, Eastern Nursing Research Society (2019)
Annie W. Goodrich Award for Excellence in Teaching, Yale School of Nursing (2017)
American Academy of Hospice and Palliative Medicine Poster Award (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)

Publications

Communication strategies to mitigate fear and suffering among COVID-19 patients isolated in the ICU and their families

Akgün, K. M., Shamas, T. L., Feder, S. L., & Schulman-Green, D. (2020). Heart and Lung, 49(4), 344-345. 10.1016/j.hrtlng.2020.04.016

New Delirium Severity Indicators: Generation and Internal Validation in the Better Assessment of Illness (BASIL) Study

Vasunilashorn, S. M., Schulman-Green, D., Tommet, D., Fong, T. G., Hshieh, T. T., Marcantonio, E. R., Metzger, E. D., Schmitt, E. M., Tabloski, P. A., Travison, T. G., Gou, Y., Helfand, B., Inouye, S. K., & Jones, R. N. (2020). Dementia and Geriatric Cognitive Disorders, 49(1), 77-90. 10.1159/000506700
Abstract
Abstract
Background: Delirium is a common and preventable geriatric syndrome. Moving beyond the binary classification of delirium present/absent, delirium severity represents a potentially important outcome for evaluating preventive and treatment interventions and tracking the course of patients. Although several delirium severity assessment tools currently exist, most have been developed in the absence of advanced measurement methodology and have not been evaluated with rigorous validation studies. Objective: We aimed to report our development of new delirium severity items and the results of item reduction and selection activities guided by psychometric analysis of data derived from a field study. Methods: Building on our literature review of delirium instruments and expert panel process to identify domains of delirium severity, we adapted items from existing delirium severity instruments and generated new items. We then fielded these items among a sample of 352 older hospitalized patients. Results: We used an expert panel process and psychometric data analysis techniques to narrow a set of 303 potential items to 17 items for use in a new delirium severity instrument. The 17-item set demonstrated good internal validity and favorable psychometric characteristics relative to comparator instruments, including the Confusion Assessment Method-Severity (CAM-S) score, the Delirium Rating Scale Revised 98, and the Memorial Delirium Assessment Scale. Conclusion: We more fully conceptualized delirium severity and identified characteristics of an ideal delirium severity instrument. These characteristics include an instrument that is relatively quick to administer, is easy to use by raters with minimal training, and provides a severity rating with good content validity, high internal consistency reliability, and broad domain coverage across delirium symptoms. We anticipate these characteristics to be represented in the subsequent development of our final delirium severity instrument.

Palliative care advanced practice nursing in Israel: bridging creation and implementation

Collett, D., Feder, S., Aaron, E., Haron, Y., & Schulman-Green, D. (2020). International Nursing Review, 67(1), 136-144. 10.1111/inr.12555
Abstract
Abstract
Aim: To describe Israel's development of the palliative care advanced practice registered nurse as a foundation for the development of the advanced practice registered nurse role in other specialties. Background: Palliative care centres on alleviating physical, emotional, social and spiritual distress associated with life-limiting illness. In 2009, Israel introduced the palliative care advanced practice nurse role, that is, registered nurses with specialized training in palliative care, to address increasing palliative care needs. Introduction: While there has been investment in its development, full implementation of the advanced practice nurse has not yet been achieved. Methods: In this qualitative descriptive study, we conducted a document analysis (n = 11) and key informant interviews (n = 11), extracted themes using qualitative content analysis and triangulated data sets. Results: Documents reflected growing palliative care needs and uniform requirements for advanced practice nurse training. Interviews uncovered a perceived lack of awareness of palliative care, the need for increased role definition and practice authority for advanced practice nurses, and barriers to entry and training for this role. Discussion: Findings highlight ongoing needs in palliative care and advanced practice nursing and a trajectory of growth. Conclusions: The challenges Israel faces in implementation of the palliative care advanced practice nurse role inform development of other advanced practice nursing roles in Israel and other countries. Implications for Nursing Practice: Streamlining training pathways and resolving scope of practice issues will assist in implementation of advanced practice nursing roles. Implications for Health Policy: Our data offer targets for policymakers advocating the advanced practice nurse role, including training requirements and scope of practice.

Palliative care strategies offer guidance to clinicians and comfort for COVID-19 patient and families

Feder, S. L., Akgün, K. M., & Schulman-Green, D. (2020). Heart and Lung, 49(3), 227-228. 10.1016/j.hrtlng.2020.04.001

Patient and Family Caregiver Considerations When Selecting Early Breast Cancer Treatment: Implications for Clinical Pathway Development

Schulman-Green, D., Cherlin, E., Capasso, R., Mougalian, S. S., Wang, S., Gross, C. P., Bajaj, P. S., Eakle, K., Patel, S., Douglas, K., & Adelson, K. (2020). Patient, 13(6), 683-697. 10.1007/s40271-020-00426-7
Abstract
Abstract
Background: While clinical pathways have been widely adopted to decrease variation in cancer treatment patterns, they do not always incorporate patient and family caregiver perspectives. We identified shared patient and family caregiver considerations influencing treatment preferences/decision making to inform development of a shared decision pathway. Methods: We conducted qualitative interviews with women who completed initial definitive treatment for stage I–III breast cancer and their family caregivers. As part of a broader interview, we asked participants what they considered when choosing a treatment option for themselves/their loved one. We coded transcribed interviews, analyzed patient and family caregiver datasets separately, and compared findings. Findings Patients’ (n = 22) mean age was 55.7 years, whereas family caregivers’ (n = 20) mean age was 59.5 years, with most (65%) being patients’ spouses/partners. Considerations reported by both groups included cancer status, treatment issues, physical/psychosocial/family consequences, and provider/health care system issues. Data revealed three key tensions that arise during treatment decision making: (1) having enough information to set expectations but not so much as to be overwhelming; (2) balancing the highest likelihood of cure with potential physical/emotional/social/financial consequences of the chosen treatment; and (3) wanting to make data-driven decisions while having a personalized treatment plan. Discussion: Patients and family caregivers identified several considerations of shared relevance reflecting different perspectives. Efforts to balance considerations can produce tensions that may contribute to decision regret if unaddressed. Conclusion: Clinical pathways can increase exposure to decision regret if treatment options are selected without consideration of patients’ priorities. A shared decision pathway that incorporates patient-centeredness could facilitate satisfactory decision making.

Sustaining frontline ICU healthcare workers during the COVID-19 pandemic and beyond

Akgün, K. M., Collett, D., Feder, S. L., Shamas, T., & Schulman-Green, D. (2020). Heart and Lung, 49(4), 346-347. 10.1016/j.hrtlng.2020.05.012

The Better Assessment of Illness Study for Delirium Severity: Study Design, Procedures, and Cohort Description

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Abstract
Abstract
Background/Objectives: To describe the design, procedures, and cohort for the Better ASsessment of ILlness -(BASIL) study, which is conducted to develop and test new delirium severity measures, compare them with existing measures, and examine related clinical outcomes. Methods: Prospective cohort study with 1 year follow-up of study participants at a large teaching hospital in Boston, Massachusetts. After brief cognitive testing and the Delirium Symptom Interview, delirium and delirium severity were rated daily in the hospital using the Confusion Assessment Method (CAM) and CAM-Severity score, the Delirium Rating Scale-Revised-98 (DRS-R-98), and the Memorial Delirium Assessment Scale (MDAS). Other key study variables included comorbidity, physical function (basic and instrumental activities of daily living [ADL]), ratings of subjective health and well-being, and clinical outcomes (length of stay, 30 day rehospitalization, nursing home admission, healthcare utilization). Follow-up interviews occurred at 1- and 12-month with patients and families. In 42 patient interviews, inter-rater reliability for key variables was assessed. Results: Of 768 eligible patients approached, 469 were screened and 352 enrolled, yielding an overall study response rate of 67% for potentially eligible participants. The mean participant was 80.3 years old (SD 6.8) and 203 (58%) were female. The majority of patients were medically complex with Charlson Comorbidity Scores ≥2 (192 patients, 55%), and 102 (29%) met criteria for dementia. Inter-rater reliability assessments (n = 42 pairs) were high for overall ratings of presence or absence of delirium by CAM (κ = 1.0), delirium severity by DRS-R-98 and MDAS (weighted kappa, κ = 1.0 for each) and for ADL impairment (κ = 1.0). For eligible participants at each time point, 278 out of 308 (90%) completed the 1-month follow-up and 132 out of 256 (53%) have completed the 12-month follow-up to date, which is still in progress. Among those who completed interviews, there was only 1-3% missing data on most major outcomes (delirium, basic ADL, and readmission). Conclusion: The BASIL study presents an innovative effort to advance the conceptualization and measurement of delirium severity. Unique strengths include the diverse cohort with complete high quality data and longitudinal follow-up, along with detailed collection of multiple delirium measures daily during hospitalization.

Delirium Burden in Patients and Family Caregivers: Development and Testing of New Instruments

Racine, A. M., D’Aquila, M., Schmitt, E. M., Gallagher, J., Marcantonio, E. R., Jones, R. N., Inouye, S. K., Schulman-Green, D., Tommet, D., Abrantes, T., Armstrong, B., Bertrand, S., Butters, A., D’Aquila, M., Gallagher, J., Kettell, J., Nee, J., Parisi, K., Vella, M., Xu, G., Weiner, L., Fong, T., Hshieh, T., Marcantonio, E. R., Racine, A., Schmitt, E. M., Schulman, D. G., Tabloski, P. A., Travison, T., Inouye, S. K., & Jones, R. N. (2019). Gerontologist, 59(5), e393-e402. 10.1093/geront/gny041
Abstract
Abstract
Background and Objectives Delirium creates distinct emotional distress in patients and family caregivers, yet there are limited tools to assess the experience. Our objective was to develop separate patient and family caregiver delirium burden instruments and to test their content and construct validity. Research Design and Methods Two hundred forty-seven patients and 213 family caregivers were selected from an ongoing prospective cohort of medical-surgical admissions aged ≥70 years old. New patient and family caregiver delirium burden instruments were developed and used to measure the subjective experiences of in-hospital delirium. Delirium and delirium severity were measured by the Confusion Assessment Method (CAM) and CAM-Severity (long form). Results Both Delirium Burden (DEL-B) instruments consist of eight questions and are measured on a 0 - 40 point scale. Final questions had good clarity and relevancy, as rated by the expert panel, and good internal consistency (Cronbach's α = .82-.86). In the cohort validation, Patient DEL-B (DEL-B-P) was 5.1 points higher and Family Caregiver DEL-B (DEL-B-C) was 5.8 points higher, on average, for patients who developed delirium compared to those who did not (p < .001). Test-retest reliability of DEL-B-C at baseline and 1 month was strong (correlation = .73). Delirium severity was mildly-moderately correlated with DEL-B-P (correlation = .34) and DEL-B-C (correlation = .26), suggesting contribution of other factors. Discussion and Implications We created instruments to reliably measure and evaluate the burden of delirium for patients and their family caregivers. Although additional validation is indicated, these instruments provide a key first step toward measuring and improving the subjective experience of delirium for patients and their families.

Four Approaches for Determining Composite Scores for the Measurement of Transition in Cancer Scale

Jeon, S., Schulman-Green, D., McCorkle, R., & Dixon, J. K. (2019). Nursing Research, 68(1), 57-64. 10.1097/NNR.0000000000000318
Abstract
Abstract
Background We created the Measurement of Transitions in Cancer Scale to assess patients' perceptions of the extent of change they experience with cancer-related transitions and how well they feel they are managing these transitions. For some transitions, we found that the more change that was reported, the worse management was reported; however, the benchmark by which patients assess how well they have managed may vary with the extent of change. Objectives The aim of the study was to identify approaches to combine reports of extent and management of change. Methods Among women with breast cancer, we explored relationships of composite measures (arithmetic and geometric means, subtractive and proportional need for improvement) with other indicators of well-being (symptoms, anxiety, depression, uncertainty, self-efficacy, knowledge of care options, medical communication competence). We examined statistical significance using false rate discovery for multiple tests on correlations with clinical outcomes. Results Greater extent and less management were significantly associated with higher total symptoms, anxiety, depression, uncertainty, and less self-efficacy in Personal Transitions, but not in Care Transitions. The arithmetic and geometric means had weak correlations with clinical outcomes, whereas the subtractive and proportional need for improvement had significant correlations with most clinical outcomes both in Personal and Care Transitions. The combined proportional need for improvement in Personal Transitions was significantly associated with total symptoms, anxiety, depression, uncertainty, and self-efficacy. The Care Transitions score was also significantly associated with total symptoms, anxiety, uncertainty, and self-efficacy. Discussion These approaches can be applied to other aspects of self-management that require assessment of the extent and management of an experience. The four approaches yield different results. We recommend the need for improvement composites to capture correlations with the clinical outcomes.

Paradoxical lucidity: A potential paradigm shift for the neurobiology and treatment of severe dementias

Mashour, G. A., Frank, L., Batthyany, A., Kolanowski, A. M., Nahm, M., Schulman-Green, D., Greyson, B., Pakhomov, S., Karlawish, J., & Shah, R. C. (2019). Alzheimer’s and Dementia, 15(8), 1107-1114. 10.1016/j.jalz.2019.04.002
Abstract
Abstract
Unexpected cognitive lucidity and communication in patients with severe dementias, especially around the time of death, have been observed and reported anecdotally. Here, we review what is known about this phenomenon, related phenomena that provide insight into potential mechanisms, ethical implications, and methodologic considerations for systematic investigation. We conclude that paradoxical lucidity, if systematically confirmed, challenges current assumptions and highlights the possibility of network-level return of cognitive function in cases of severe dementias, which can provide insight into both underlying neurobiology and future therapeutic possibilities.