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
Facilitators and barriers to oncologists’ conduct of goals of care conversations
AbstractSchulman-Green, D., Lin, J. J., Smith, C. B., Feder, S., & Bickell, N. A. (2018). Journal of Palliative Care, 33(3), 143-148. 10.1177/0825859718777361AbstractIntroduction: Goals of care (GoC) conversations optimally begin early in the course of cancer care, yet most happen near the end of life. We sought to describe oncologist-reported facilitators of and barriers to GoC conversations with patients who have advanced cancer. Methods and Materials: We conducted individual, semistructured qualitative interviews with oncologists from 4 academic, community, municipal, and rural hospitals in New York and Connecticut. Interview topics included approach to GoC conversations, facilitators, barriers, and organizational influences. We analyzed data using interpretive description. We collected demographic and practice information and surveyed oncologists on their communication skills training. We calculated descriptive statistics for quantitative data. Results: Oncologists (n = 21) had a mean age of 46 years (range: 34-68), 67% were male, 71% were White, 24% were Asian, 10% were Hispanic, and 5% were Black. They reported an average of 20 years in practice (range: 8-42), and 62% had received training on having GoC conversations. Facilitators included patient’s poor functional status, patient’s high health literacy, family understanding and acceptance, oncologist’s practice experience, and a supportive practice environment. Barriers included certain patient demographic and clinical characteristics, patient religion and culture, patient’s denial, and lack of time. Conclusion: GoC conversations may be facilitated by enabling oncologists to conduct these conversations despite difficult circumstances and emotional reactions by activating patients and family via increased health literacy and by advancing palliative-informed practice environments.Federal Funding for Mixed Methods Research in the Health Sciences in the United States: Recent Trends
AbstractCoyle, C. E., Schulman-Green, D., Feder, S., Toraman, S., Prust, M. L., Plano Clark, V. L., & Curry, L. (2018). Journal of Mixed Methods Research, 12(3), 305-324. 10.1177/1558689816662578AbstractAlthough investigators in health sciences are increasingly interested in using mixed methods, greater adoption requires funding opportunities. Funding allocations can signal recognition of a particular methodology and proficiency of investigators in using such methods. We examined trends in prevalence of mixed methods research funded by federal agencies in the United States. We reviewed abstracts to describe the content and terminology related to mixed methods. The number of self-identified mixed methods awards (n = 535; 2009-2014) increased modestly from previous trends (n = 226; 1997-2008). Abstracts were highly variable in their depth of description and use of mixed methods terminology. We propose five elements to address when developing a scientific abstract for a mixed methods study to facilitate clear description of study design and methods.How skilled do Israeli nurses perceive themselves to be in providing palliative care? Results of a national survey
AbstractFeder, S. L., Collett, D., Conley, S., Schulman-Green, D., Meron, T., & Cherny, N. (2018). International Journal of Palliative Nursing, 24(2), 56-63. 10.12968/ijpn.2018.24.2.56AbstractBACKGROUND: In Israel, palliative care (PC) services are limited. This study assessed Israeli nurses' perceived competencies and educational needs in providing PC.DESIGN: Online administration of the End-of-Life Professional Caregiver Survey (EPCS).SETTING/SUBJECTS: Oncology and PC nurses were identified through the Israel Ministry of Health and Oncology Nurses' Society.MEASUREMENTS: Demographic and practice data were analysed using analysis of variance tests to determine differences between nurse characteristics by EPCS domains.RESULTS: The sample (n=105) was 94% female, had a mean age of 48 years (SD=10.5) and 83% were Jewish Israeli. Thirty-nine percent reported PC training in nursing school and 42% felt their workplace provided little to no PC education and resources to nurses. Those with advanced degrees and those who received post-graduate PC training had higher mean scores across EPCS domains (p<0.05 for all).CONCLUSIONS: Nursing education and workplace support in PC for Israeli nurses are limited. It is hoped that these findings may inform future PC nursing education and policy in Israel.Integrating Family Caregivers into Palliative Oncology Care Using the Self- and Family Management Approach
AbstractSchulman-Green, D., & Feder, S. (2018). Seminars in Oncology Nursing, 34(3), 252-263. 10.1016/j.soncn.2018.06.006AbstractObjective: To describe the integration of family caregivers into palliative oncology care using the Self- and Family Management Framework. Data Sources: Peer-reviewed journal articles. Conclusion: The role of family caregivers in palliative oncology includes focusing on illness needs, activating resources, and living with cancer. Several factors may serve as facilitators of or barriers to these activities. A growing number of interventions support family caregivers’ involvement in palliative oncology care. Implications for Nursing Practice: Nurses should identify who the family caregiver is, confirm ability and willingness, discuss patients’ and family caregivers’ goals for cancer care, activate resources, and promote ongoing communication to support changing needs.Oncologists’ and Patients’ Perceptions of Initial, Intermediate, and Final Goals of Care Conversations
AbstractSchulman-Green, D., Smith, C. B., Lin, J. J., Feder, S., & Bickell, N. A. (2018). Journal of Pain and Symptom Management, 55(3), 890-896. 10.1016/j.jpainsymman.2017.09.024AbstractContext: Although recommendations are for goals of care (GoC) conversations to happen early and often, their timing and content over the disease course remain unclear. Objectives: To describe perceptions of the timing and content of GoC conversations among oncologists and patients with advanced cancer. Methods: Semi-structured interviews with oncologists and patients at four hospitals in New York and Connecticut. We analyzed data using interpretive description. Results: Oncologists (n = 21) were 67% male, averaged 46 years old (range 34–68 years), and had a mean 20 years (range 8–42 years) in practice. Advanced cancer patients (n = 39) were 59% female with a mean age of 58 years (range 26–88 years). Oncologists and patients viewed GoC conversations along an initial, intermediate, and final continuum. Oncologists reported having initial GoC conversations to build rapport, provide disease information, and clarify and consider treatment intent and options. Intermediate conversations focused on changes in treatment and side effects. Final conversations occurred when patients were hospice-eligible and covered the shift to comfort care, a treatment summary, and advance directives. Timing and content were influenced by cancer type, disease status, and emotional state. Patients supported beginning GoC conversations early, but had different preferences for content of initial conversations. Some wanted complete information; others found this overwhelming. Patients felt intermediate GoC conversations should occur at decision points with time for processing. Content of intermediate and final conversations was dependent on patients’ prognosis, questions, and treatment decisions. Conclusion: Although GoC conversations should follow individual patient preferences, our findings offer structure for their timing and content.Patients' and oncologists' views on family involvement in goals of care conversations
AbstractLin, J. J., Smith, C. B., Feder, S., Bickell, N. A., & Schulman-Green, D. (2018). Psycho-Oncology, 27(3), 1035-1041. 10.1002/pon.4630AbstractObjective: Family members can significantly impact advanced cancer patients' treatment and are important participants in goals of care (GoC) conversations. Yet, research on patient and physician perspectives about family involvement and influence on GoC conversations is limited. Our purpose was to describe patients' and oncologists' perspectives about family involvement and influence on GoC conversations among patients with advanced cancer. Methods: We conducted semi-structured interviews at academic, community, and municipal hospitals (n = 4) with patients with advanced cancer (n = 39) and their oncologists (n = 21). Interviews were audiotaped and transcribed. We analyzed data using interpretive description. Three coders independently coded transcripts, compared codes, and resolved discrepancies. Results: We identified 4 themes common to patients and oncologists regarding family involvement in GoC conversations: (1) Presence and Duration of Family Involvement; (2) Family Expectations; (3) Protecting patients'/Family Members' Feelings; and (4) Patient-Family Disagreement. For patients, we identified 2 additional themes: (1) Family and Oncologist Relationship and (2) Effects of Cancer on Family. Both patients and oncologists emphasized the importance of family support for the patient's understanding of their illness and on patients' emotions. We also identified ways in which family involvement may benefit or prove challenging to GoC conversations. Conclusions: Patients and oncologists have similar views about family involvement in GoC conversations. Learning how to communicate with family members should be a critical component of physician education in palliative care.Validation of the ICD-9 Diagnostic Code for Palliative Care in Patients Hospitalized With Heart Failure Within the Veterans Health Administration
AbstractFeder, S. L., Redeker, N. S., Jeon, S., Schulman-Green, D., Womack, J. A., Tate, J. P., Bedimo, R. J., Budoff, M. J., Butt, A. A., Crothers, K., & Akgün, K. M. (2018). American Journal of Hospice and Palliative Medicine, 35(7), 959-965. 10.1177/1049909117747519AbstractBackground: Patients with heart failure (HF) are at increased risk of unmet palliative care needs. The International Classification of Diseases, Ninth Revision (ICD-9) code, V66.7, can identify palliative care services. However, code validity for specialist palliative care in the Veterans Health Administration (VHA) has not been determined. Objective: To validate the ICD-9 code for specialist palliative care and determine common reasons for specialist palliative care consultation among VHA patients hospitalized with HF. Design: Electronic health record review of data from the Veterans Aging Cohort Study. Setting/Participants: The sample included 100 patients hospitalized with HF from 2003 to 2012. Measurements: Data from 50 patients with V66.7 were matched by age, race, site of care, hospital length of stay, intensive care unit admission, and fiscal year of study discharge to 50 patients with HF without V66.7 who had died within a year of hospitalization. We calculated positive and negative predictive values (PPV, NPV), sensitivity, and specificity. Results: All patients included in the sample were male, 66% black ethnicity, and mean age = 65 years (standard deviations [SD] ± 10.5 for cases; SD ± 9.8 for matches). Specialist palliative care was documented for 49 of 50 patients with V66.7 (PPV = 98%, 95% confidence interval [CI]: 88-99) and 9 of 50 patients without the code (NPV = 82%, 95% CI: 68-91). Sensitivity was 84% (95% CI: 72-92), and specificity was 98% (95% CI: 86-99). Establishing goals of care was the most frequent reason for palliative care consultation (43% of the sample). Conclusion: The ICD-9 code V66.7 identifies specialist palliative care for hospitalized patients with HF in the VHA. Replication of findings in other data sources and populations is needed.Chaplains working in palliative care: Who they are and what they do
AbstractJeuland, J., Fitchett, G., Schulman-Green, D., & Kapo, J. (2017). Journal of Palliative Medicine, 20(5), 502-508. 10.1089/jpm.2016.0308AbstractBackground: Palliative care (PC) programs utilize chaplains to address patients' spiritual care needs; however, there is no comprehensive description of chaplaincy in PC programs nationally. Objective: To describe chaplains working in PC across the United States, including their integration on the PC team and visit content. Design: National online survey conducted February-April 2015. Subjects: We invited participation from hospital-based chaplains belonging to four national professional chaplain associations who spent 15% or more of their working hours with PC teams. Measure(s): We developed a 41-item survey to investigate main outcomes of chaplain demographics, practice information, integration into the PC team, and visit content. Results: 531 valid responses were received. We report on respondents who were full-time chaplains (n = 382). Almost half were women (46%), and the majority was Protestant (70%). The average number of PC patients seen per day was 5.2 (SD = 3.5, range 1-30). Half (52%) reported frequently participating in PC rounds. Primary chaplain activities were relationship building (76%), care at the time of death (69%), and helping patients with existential issues or spiritual distress (49%). Over half (55%) reported addressing goals of care 60% of the time or more. Discussion: This survey provides the first description of chaplains working in PC across the United States. We describe chaplains' critical role in attending to relationship building, care for the dying, and goals of care conversations. Our results highlight how the chaplains' level of involvement in PC affects the content of their visits. Our study suggests that when chaplains are more involved in PC teams, they provide more comprehensive support to PC patients and their families.Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement
AbstractGarner, K. K., Dubbert, P., Lensing, S., Sullivan, D. H., Aslakson, R. A., Ast, K., Elk, R., Garner, K. K., Gramling, R., Grudzen, C., Kamal, A. H., Lamba, S., LeBlanc, T. W., Rhodes, R. L., Roeland, E., Schulman-Green, D., & Unroe, K. T. (2017). Journal of Pain and Symptom Management, 53(1), 1-4. 10.1016/j.jpainsymman.2016.10.356AbstractContext The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. Objectives To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. Methods Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. Results Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. Conclusions Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers.The Implementation of Measuring What Matters in Research and Practice: Series Commentary
Failed generating bibliography.AbstractAbstractThe Measuring What Matters (MWM) initiative identified 10 indicators of high-quality palliative and hospice care. Members of the AAHPM Research Committee, through a special series of articles, examined applications of the MWM quality indicators in research and practice settings. Many themes were present in these articles, including the important role of electronic health records in quality measurement, challenges and strategies for implementing and tracking measures over time, and the importance of identifying new measures. This article is the final commentary of the series and includes recommendations for next steps in quality measurement.