Dena Schulman-Green

Faculty

Dena Schulman-Green Headshot

Dena Schulman-Green

PhD FAAHPM

Associate Professor
Director of the Florence S. Downs PhD Program

1 212 998 5786

433 First Ave
New York, NY 10010
United States

Accepting PhD students

Dena Schulman-Green, MA, EdM, MS, PhD, FAAHPM is Director of the Florence S. Downs PhD Program in Nursing Research and Theory Development and Associate Professor at NYU Rory Meyers College of Nursing. Her 20+ years in clinical nursing research are grounded in an interdisciplinary background of psychology, gerontology, and palliative care. Prof. Schulman-Green’s scholarship centers on self- and family management of serious chronic illness, with an emphasis on early integration of palliative care. She is a lead developer of the internationally recognized Middle Range Theory of Self- and Family Management of Chronic Illness and co-developed the Managing Cancer Care intervention with women and family caregivers facing breast and ovarian cancer. Her funders include the National Institutes of Health, the American Cancer Society, and the National Palliative Care Research Center.

Currently, Schulman-Green leads and collaborates on various studies related to cancer, dementia, and palliative care. A recognized expert in qualitative and mixed methods research, she consults widely. Schulman-Green is deeply committed to mentorship, routinely involving PhD students and postdoctoral fellows in her work. She serves on the Leadership Development Committee of the American Academy of Hospice and Palliative Medicine and on the Editorial Board of the Journal of Pain and Symptom Management.

Prior to joining NYU Meyers, Schulman-Green was first a Research Scientist and later an Associate Professor at Yale School of Nursing, where she also directed the Qualitative and Mixed Methods Core of the Center for Biobehavioral Health. Additionally, she held faculty roles in the Palliative Medicine Fellowship Program and the Interprofessional Palliative Care Education Program at Yale School of Medicine and was instrumental in strengthening Yale’s palliative care research infrastructure.

Among her many honors, Schulman-Green has received the National Hospice and Palliative Care Organization Research Award, the Suzanne Feetham Nurse Scientist Family Research Award, the Yale School of Nursing’s Annie W. Goodrich Award for Excellence in Teaching, and NYU Meyers’ Dean’s Excellence in Mentoring Award. She has also been recognized among the World’s Top 2% of Scientists by Stanford University/Elsevier and is a Fellow of the American Academy of Hospice and Palliative Medicine and the New York Academy of Medicine.

Post-doctorate in Breast Cancer & Palliative Care, Yale School of Nursing
PhD in Gerontology, University of Massachusetts Boston
MS in Gerontology, University of Massachusetts Boston
EdM in Counseling Psychology, Columbia University
MA in Counseling Psychology, Columbia University
BS in Psychology and Religion, Boston University

Chronic disease
Gerontology
Global Health
Health Disparities
Mixed Methods Research
Oncology
Palliative care
Qualitative Research
Research methods
Serious illness
Self and Family Management
Theoretical and conceptual models
Women's health

American Academy of Hospice and Palliative Medicine
Eastern Nursing Research Society
Gerontological Society of America

Dean’s Excellence in Mentoring Award, NYU Rory Meyers College of Nursing (2025)
Fellow, New York Academy of Medicine (2025)
World’s Top 2% of Scientists, Stanford University/Elsevier (2024)
World’s Top 2% of Scientists, Stanford University/Elsevier (2023)
Fellow, American Academy of Hospice and Palliative Medicine (2023)
World’s Top 2% of Scientists, Stanford University/Elsevier (2022)
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)
Poster Award, American Academy of Hospice and Palliative Medicine (2017)
Poster Award, American Academy of Hospice and Palliative Medicine (2016)
Success Story Award, Center for Disease Control (2010)
Poster Award, American Academy of Hospice and Palliative Medicine (2010)
Ellison Medical Foundation Aging New Scholar Award Nominee, University of Massachusetts Boston (2006)
Research Award, National Hospice and Palliative Care Organization (2004)
Gerontology Dissertation Book Award, University of Massachusetts Boston (2002)
Sigma Phi Omega Honor Society, University of Massachusetts Boston (1999)
Association for Gerontology in Higher Education/AARP Andrus Foundation Graduate Scholarship in Gerontology (1998)
Margaret Clark Student Paper Award, Association for Anthropology and Gerontology (1998)
Student Paper Award, Massachusetts Gerontology Association (1998)
General Scholarship Award, Columbia University (1993)
Golden Key Honor Society, Boston University (1992)
Inducted into Psi Chi, Psychology Honor Society (1992)

Managing Cancer Care : a psycho-educational intervention to improve knowledge of care options and breast cancer self-management

Schulman-Green, D., & Jeon, S. (2017). (Vols. 26, Issues 2, pp. 173-181). 10.1002/pon.4013
Abstract
Abstract
Objective: We tested the feasibility and acceptability of a psycho-educational self-management intervention, Managing Cancer Care: A Personal Guide (MCC), to improve knowledge of care options (curative, palliative, and hospice care) among a range of breast cancer self-management skills. Methods: We conducted a one-group, pre-post-test study among women with non-metastatic breast cancer (n = 105). We gave participants the printed, self-guided, seven-module intervention following enrollment. At baseline and 2 months, we measured knowledge of care options, desired and actual role in self-management, medical communication skills, experience and management of transitions, anxiety, depression, uncertainty, and self-efficacy. We conducted interviews to obtain module ratings and qualitative data on strengths and limitations of MCC. Results: Knowledge of care options (δ = 0.40 (1.11), p = 0.0005) and desired role in self-management (δ = −0.28 (1.08), p = 0.0177) significantly improved. Less skilled medical communicators significantly improved their communication (δ = 3.47, standard deviation = 6.58, p = 0.0449). Multivariate modeling showed that changes in our primary outcomes of medical communication and management of transitions seemed to drive positive changes in our secondary outcomes of anxiety, depression, uncertainty, and self-efficacy. Participants highly rated MCC and reported the importance of understanding care options despite non-metastatic disease. Conclusions: MCC is a feasible and acceptable means of improving knowledge of care options and other aspects of breast cancer self-management. The combination of modules offered in MCC appears to have beneficial interactive effects. We are currently testing MCC more rigorously in a randomized controlled trial to explore mediating and moderating relationships.

The measurement of transitions in cancer scale

Schulman-Green, D., Jeon, S., McCorkle, R., & Dixon, J. (2017). (Vols. 25, Issue 1, pp. 103-120). 10.1891/1061-3749.25.1.103
Abstract
Abstract
Background and Purpose: Health-illness transitions are changes in life phase, situation, or status related to shifts between health and illness. We report on the development and psychometric evaluation of the Measurement of Transitions in Cancer Scale (MOT-CA), a 7-item instrument that assesses extent and management of a range of transitions experienced by cancer patients. Methods: We identified content domains, developed operational definitions, generated items, conducted expert review (n = 7) and cognitive interviews (n = 13), and tested MOT-CA with our target population (n = 105). Results: MOT-CA has content and convergent validity and a 2-factor structure consisting of Personal Transitions (physical, emotional, social, spiritual; eigenvalue = 2.994) and Care Transitions (cancer status, treatment, approach to care; eigenvalue = 1.444). Conclusion: Although additional testing is indicated, the MOT-CA is valid, brief, and acceptable.

Operationalizing the Measuring What Matters Spirituality Quality Metric in a Population of Hospitalized, Critically Ill Patients and Their Family Members

Schulman-Green, D. (2017). (Vols. 53, Issues 3, pp. 650-655). 10.1016/j.jpainsymman.2016.12.323
Abstract
Abstract
Context Measuring What Matters (MWM) quality indicators support measurement of the percentage of patients who have spiritual discussions, if desired. Objectives The objective of this study was to 1) determine the ease of, and barriers to, prospectively collecting MWM spirituality quality measure data and 2) further explore the importance of spirituality in a seriously ill, hospitalized population of critically ill patients and their family members. Methods Electronic medical record (EMR) review and cross-sectional survey of intensive care unit (ICU) patients and their family members from October to December 2015. Participants were in four adult ICUs totaling 68 beds at a single academic, urban, tertiary care center which has ICU-assigned chaplains and an in-house, 24-hour, on-call chaplain. Results All patients had a “Spiritual Risk Screen” which included two questions identifying patient religion and whether a chaplain visit was desired. Approximately 2/3 of ICU patients were eligible, and there were 144 respondents (50% female; 57% patient and 43% family member), with the majority being Caucasian or African American (68% and 21%, respectively). Common religious identifications were Christian or no faith tradition (76% and 11%, respectively). Approximately half of patients had an EMR chaplain note although it did not document presence of a “spiritual discussion.” No study patients received palliative care consultation. A majority (85%) noted that spirituality was “important to them” and that prevalence remained high across respondent age, race, faith tradition, or admitting ICU. Conclusion Operationalizing the MWM spirituality quality indicator was challenging as elements of a “spiritual screening” or documentation of a “spiritual discussion” were not clearly documented in the EMR. The high prevalence of spirituality among respondents validates the importance of spirituality as a potential quality metric.

Adherence to Measuring What Matters Items When Caring for Patients With Hematologic Malignancies Versus Solid Tumors

LeBlanc, T. W., Ritchie, C. S., Friedman, F., Bull, J., Kutner, J. S., Johnson, K. S., Kamal, A. H., Aslakson, R. A., Ast, K., Elk, R., Garner, K. K., Gramling, R., Grudzen, C., Lamba, S., Rhodes, R. L., Roeland, E., Schulman-Green, D., & Unroe, K. T. (2016). (Vols. 52, Issues 6, pp. 775-782). 10.1016/j.jpainsymman.2016.09.004
Abstract
Abstract
Context Measuring What Matters (MWM) prioritizes quality measures in palliative care practice. Hematologic malignancy patients are less likely to access palliative care, yet little is known about their unique needs. Differences in MWM adherence may highlight opportunities to improve palliative care in hematology. Objectives To assess adherence to MWM measures by palliative care clinicians caring for patients with hematologic malignancies, compared to those with solid tumors. Methods We used the Quality Data Collection Tool to assess completion of MWM measures across nine sites. Results We included data from 678 patients' first visits and various care settings; 64 (9.4%) had a hematologic malignancy, whereas 614 (90.6%) had a solid tumor. Hematology patients were more likely to be seen in a hospital (52 or 81.3% vs. 420 or 68%), whereas solid tumor patients were more frequently seen at home or in clinics (160 or 26% vs. 7 or 10.9%). Of the nine MWM measures we assessed, high adherence (>90%) was seen regardless of tumor type in measures #3 (Pain Treatment), #7 (Spiritual Concerns), #8 (Treatment Preferences), and #9 (Care Consistent With Preferences). Clinicians seeing hematology patients were significantly less likely to meet measures #2 (Screening for Physical Symptoms; 57.8% vs. 84.2%, P < 0.001), and #5 (Discussion of Emotional Needs; 56.3% vs. 70.0%, P = 0.03). Conclusion MWM adherence regarding symptom assessment and meeting emotional needs was lower for patients with hematologic malignancies compared to those with solid tumors. This finding suggests two key areas for quality improvement initiatives in palliative care for patients with hematologic malignancies.

Assessing Emotional Suffering in Palliative Care : Use of a Structured Note Template to Improve Documentation

Berlin, A., Goett, R., Ponce, C. B., Holland, B., Walther, S., 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. (2016). (Vols. 52, Issue 1, pp. 1-7). 10.1016/j.jpainsymman.2016.01.017
Abstract
Abstract
Context Documentation of the emotional or psychological needs of seriously ill patients receiving specialty palliative care is endorsed by the “Measuring What Matters” project as a quality performance metric and recommended for use by hospice and palliative care programs for program improvement. Objectives The aim of this study was to increase the proportion of inpatient palliative care team encounters in which emotional or psychological needs of patients and family members were documented and to qualitatively enrich the nature of this documentation. Methods This is a mixed-methods retrospective study of 200 patient charts reviewed before and after implementation of a structured note template (SmartPhrase) for palliative care encounters. Patterns of documentation of emotional needs pre- and post-implementation were assessed quantitatively and qualitatively using thematic analysis. Results A total of 158 of 200 pre-intervention charts and 185 of 200 post-intervention charts included at least one note from the palliative care team. Documentation of emotional assessment increased after SmartPhrase implementation (63.9% [101 of 158] vs. 74.6% [138 of 185]; P < 0.03). Qualitative analysis revealed a post-intervention reduction in the use of generic phrases (“emotional support provided”) and an increase in the breadth and depth of emotion-related documentation. Conclusion A structured note template with a prompt for emotional assessment increases the overall quantity and richness of documentation related to patient and family emotions. However, this documentation remains mostly descriptive. Additional prompting for documentation of recommendations to address identified emotional needs, and the use of screening tools for depression and anxiety, when appropriate, may be necessary for clinically meaningful quality improvements in patient care.

Concordance of Advance Care Plans With Inpatient Directives in the Electronic Medical Record for Older Patients Admitted From the Emergency Department

Schulman-Green, D. (2016). (Vols. 51, Issues 4, pp. 647-651). 10.1016/j.jpainsymman.2015.12.318
Abstract
Abstract
Context Measuring What Matters identified quality indicators to examine the percentage of patients with documentation of a surrogate decision maker and preferences for life-sustaining treatments. Objectives To determine the rate of advance care planning in older adults presenting to the emergency department (ED) and translation into medical directives in the electronic medical record (EMR). Methods A convenience sample of adults 65 years or older was recruited from a large urban ED beginning in January 2012. We administered a baseline interview and survey in English or Spanish, including questions about whether patients had a documented health care proxy or living will. For patients admitted to the hospital who had a health care proxy or living will, chart abstraction was performed to determine whether their advance care preferences were documented in the EMR. Results From February 2012 to May 2013, 53.8% (367 of 682) of older adults who completed the survey in the ED reported having a health care proxy, and 40.2% (274 of 682) had a living will. Of those admitted to the hospital, only 4% (4 of 94) of patients who said they had a living will had medical directives documented in the EMR. Similarly, only 4% (5 of 115) of patients who had a health care proxy had the person's name or contact information documented in their medical record. Conclusion About half of the patients 65 years or older arriving in the ED have done significant advance care planning, but most plans are not recorded in the EMR.

Developing and Evaluating a Self-Management Intervention for Women With Breast Cancer

Goldberg, J., Hinchey, J., Feder, S., & Schulman-Green, D. (2016). (Vols. 38, Issues 10, pp. 1243-1263). 10.1177/0193945916650675
Abstract
Abstract
Reports of self-management interventions usually focus on efficacy and do not detail processes of intervention development and evaluation. We describe the development and evaluation of Managing Cancer Care: A Personal Guide, a patient-oriented cancer self-management intervention consisting of seven modules on the topics of self-management, care options, transitions, communication, symptom management, and self-efficacy. We developed and evaluated the intervention in stages by partnering with women with breast cancer. Stages were as follows: individual interviews (n = 25), intervention design, focus group (n = 6), pilot testing with metastatic patients (n = 23), and population testing with non-metastatic patients (n = 105). We used interpretive description and content analysis for qualitative analyses and used descriptive statistics to analyze module ratings and frequency of use. We report results of each stage and discuss the challenges of creating a self-management intervention that has broad appeal without taking a one-size-fits-all approach and implementing a self-management intervention in a real-world versus research setting.

Feeling Heard and Understood : A Patient-Reported Quality Measure for the Inpatient Palliative Care Setting

Gramling, R., Stanek, S., Ladwig, S., Gajary-Coots, E., Cimino, J., Anderson, W., Norton, S. A., Aslakson, R. A., Ast, K., Elk, R., Garner, K. K., Grudzen, C., Kamal, A. H., Lamba, S., Leblanc, T. W., Rhodes, R. L., Roeland, E., Schulman-Green, D., & Unroe, K. T. (2016). (Vols. 51, Issues 2, pp. 150-154). 10.1016/j.jpainsymman.2015.10.018
Abstract
Abstract
Context As endorsed by the palliative care "Measuring What Matters" initiative, capturing patients' direct assessment of their care is essential for ongoing quality reporting and improvement. Fostering an environment where seriously ill patients feel heard and understood is of crucial importance to modern health care. Objectives To describe the development and performance of a self-report field measure for seriously ill patients to report how well they feel heard and understood in the hospital environment. Methods As part of a larger ongoing cohort study of inpatient palliative care, we developed and administered the following point-of-care item: "Over the past two days, how much have you felt heard and understood by the doctors, nurses and hospital staff?" (completely, quite a bit, moderately, slightly, not at all). Participants completed the measure before and the day after palliative care consultation. For the postconsultation version, we changed the time frame from "past two days" to "today." Results One hundred sixty patients with advanced cancer completed the preconsultation assessment, and 87% of them completed the postconsultation version. Responses encompassed full use of the ordinal scale, did not exhibit ceiling or floor effects, and showed improvement from preassessment to postassessment. The item was quick to administer and easy for patients to complete. Conclusion The "Heard & Understood" item is a promising self-report quality measure for the inpatient palliative care setting.

Integrating palliative care into self-management of breast cancer : Protocol for a pilot randomized controlled trial

Schulman-Green, D., Linsky, S., Jeon, S., Kapo, J., Blatt, L., & Chagpar, A. (2016). (Vols. 48, pp. 133-138). 10.1016/j.cct.2016.04.009
Abstract
Abstract
Background: Despite evidence that palliative care increases quality and length of life, many patients and families remain uninformed about its nature and benefits. The purpose of this study is to test a psycho-educational intervention, Managing Cancer Care: A Personal Guide (MCC), intended to improve breast cancer patients' knowledge of palliative care and to facilitate its timely integration into cancer self-management. Methods: Aims are to: 1) evaluate the effects of MCC on patients' knowledge of palliative care; 2) examine preliminary effects of MCC on patients' behaviors (role in self-management, engagement in goals of care conversations, medical communication, management of transitions, health care utilization), and feelings (self-efficacy, anxiety, depression, uncertainty); and 3) evaluate protocol feasibility and acceptability. An exploratory aim is to investigate how demographic and clinical factors may moderate intervention effects, with emphasis on differences in use and outcomes among minority participants. We plan to enroll 60 patients and their family caregivers with 50% minority participation. The intervention group receives MCC; the attention-control group receives a Symptom Management Toolkit. We collect data at baseline, one, and three months. Discussion: This study will inform a large scale trial of MCC. It is challenging for patients with breast cancer, their family caregivers, and providers to make choices that include palliation alone or in combination with potentially curative treatment. MCC may help address this challenge by giving patients the information, skills, and confidence to better self-manage breast cancer. Results may help to establish palliative care as a mainstay of self-management interventions targeting serious illness. Trial registration: ClinicalTrials.gov Identifier NCT02148575 (date registered: 5.21.14; date. first patient enrolled: 7.15.14).

Knowledge of Cancer Stage among Women with Nonmetastatic Breast Cancer

Hinchey, J., Goldberg, J., Linsky, S., Linsky, R., Jeon, S., & Schulman-Green, D. (2016). (Vols. 19, Issues 3, pp. 314-317). 10.1089/jpm.2015.0133
Abstract
Abstract
Background: Discrepancies may exist between what oncologists communicate and what patients understand about their cancer stage and its implications. Objective: We explored patients' ability to identify their stage of breast cancer. Methods: As part of a study testing a cancer self-management intervention we asked women to identify their stage of disease and compared responses to the electronic medical record (EMR) for validation. The sample included women with recently diagnosed nonmetastatic (stage I-III) disease. We calculated descriptive statistics and used logistic regression to examine relationships between knowledge of stage, demographic and clinical variables, and study outcomes. Measurement instruments were the Control Preferences Scale (CPS), Knowledge of Care Options Test (KOCO), Measurement of Transitions Scale (MOT), Medical Communication Competence Scale (MCCS), Chronic Disease Self-Efficacy Scale (CDSE), Uncertainty in Illness Scale (MUIS-C), and Hospital Anxiety and Depression Scale (HADS). Results: Participants (n = 98) had a mean age of 52.3 years (range 27-72). Per the EMR, 19 participants (19.4%) had stage I breast cancer, 56 (57.1%) had stage II, and 23 (23.5%) had stage III. Of the 28 participants (28.6%) unable to identify their stage of cancer correctly, 11 (39.3%) provided vague responses, 11 (39.3%) reported an incorrect stage, and 6 (21.4%) did not know their stage. Younger age (p = 0.0412) and earlier cancer stage (p = 0.0136) were predictive of correctly identifying stage. Participants who at baseline had a greater knowledge of care options (curative, palliative, and hospice care) were more likely to correctly identify their stage (KOCO, p = 0.0345). Conclusions: Clinicians should revisit conversations about cancer stage and care options to ensure patients' understanding and support self-management.