John Merriman


John Merriman Headshot

John Merriman


Assistant Professor

1 212 998 5375

433 First Ave
Room 426
New York, NY 10010
United States

Accepting PhD students

John Merriman's additional information

John Merriman, PhD, RN, AOCNS is an assistant professor at NYU Meyers College of Nursing. He is interested in changes to cognitive function after a diagnosis of cancer and in biobehavioral correlates, particularly genomic markers and co-occurring symptoms. His program of research incorporates several phenotyping approaches to assess changes in cognitive function, including functional and structural neuroimaging, neuropsychological testing, and patient-reported outcomes.

Prof. Merriman’s study, funded by a K99/R00 award from the National Institute of Nursing Research (NR015473), uses these methods to examine the preliminary efficacy of Mindfulness-Based Stress Reduction versus a health enhancement program to improve cognitive function in postmenopausal women receiving aromatase inhibitor therapy for breast cancer. 

Prior to joining the faculty at NYU, he completed postdoctoral training at the University of Pittsburgh School of Nursing. He completed his PhD and MS in nursing at the University of California, San Francisco School of Nursing.

PhD, Nursing - University of California San Francisco
MS, Nursing - University of California San Francisco
BS, Communication - Mississippi College

Chronic disease
Complementary/integrative health
Women's health

American Nurses Association
American Society of Human Genetics
Eastern Nursing Research Society
International Society of Nurses in Genetics
Oncology Nursing Society
Sigma Theta Tau International

Faculty Honors Awards

Postdoctoral Alumni Award, University of Pittsburgh Postdoctoral Association (2016)
International inductee, Sigma Theta Tau (2006)
Inductee, Mortar Board (1993)


Financial Toxicity in Adolescents and Young Adults With Cancer: A Concept Analysis

Ghazal, L. V., Gormley, M., Merriman, J. D., & Santacroce, S. J. (2021). Cancer Nursing, 44(6), E636-E651. 10.1097/NCC.0000000000000972
BACKGROUND: A cancer diagnosis as an adolescent and young adult (AYA) poses exceptional challenges, including potential greater financial toxicity than older survivors experience who have had more time for career establishment and to build financial assets. Costs to patients have increased more than the past decade; prospects for AYA long-term survival have also increased. A better understanding of what financial toxicity is, how it presents, and the immediate and longer-term implications for AYAs is needed. OBJECTIVE: The aim of this study was to analyze the concept financial toxicity in AYAs diagnosed with cancer. METHODS: We used Rodgers' evolutionary method and articles published between January 2013 and December 2020. RESULTS: We identified key antecedents, attributes, and consequences of financial toxicity in AYAs and review its related terms that have often been used as surrogate terms. Attributes were financial burden, financial distress, and competing financial pressures. Consequences were mostly adverse and persistent and included engaging in various financial problem-solving behaviors, material hardship and poor financial well-being, and deteriorated quality of life. CONCLUSIONS: Results of this analysis clarify financial toxicity and provide guidance for a conceptual framework in the context of AYA cancer survivorship. Its consequences in AYAs with cancer are profound and will continue to evolve over time with changes in health systems and the economy. IMPLICATIONS FOR PRACTICE: Oncology nurses should understand the attributes and consequences of financial toxicity for AYAs throughout the cancer trajectory. Future research on financial toxicity should extend across AYAs living with other chronic illnesses and cancer survivors in other age groups.

An integrative review: Women’s psychosocial vulnerability in relation to paid work after a breast cancer diagnosis

Melnyk, H., Djukic, M., Merriman, J., & Vaughan Dickson, V. (2021). Journal of Advanced Nursing, 77(5), 2144-2154. 10.1111/jan.14730
Aim: The aim of this integrative review was to explore psychosocial vulnerabilities in women after a breast cancer diagnosis that are related to their paid work. Design: The review methodology was guided by Whittemore and Knafl. The Mehnert Cancer Survivorship and Work Model provided a lens through which to view vulnerability in working women with a focus on facilitating interventions to improve both recovery and work outcomes. Data Sources: PUBMED, CINAHL, Web of Science, and PsycNET databases were searched for English language papers published between January 2014–June 2020. Review Methods: Titles and abstracts were screened. Inclusion/exclusion criteria were then applied to full text screen of the remaining articles following PRISMA guidelines. Thirteen studies meeting the inclusion criteria were critically appraised using the Critical Appraisal Skills Programme (CASP) checklist. A constant comparison approach was used to systematically distil findings into categories and assess their fit within the Mehnert Model subdomains. Results: Vulnerabilities coalesced predominantly within the following subdomains: (a) changes in identity and role functioning; (b) social reintegration; (c) coping strategies; and (d) social supports. Patterns and themes within these subdomains were related both positively and negatively to form the contours of a survivor's satisfaction/dissatisfaction with quality of life related to work and breast cancer recovery. Conclusion: Overall, findings highlight the importance of employment and work environments in bolstering women's psychosocial health after a breast cancer diagnosis. Impact: Findings from this review support adapting psychosocial distress screening to include vulnerabilities relating to work life. Nurses are ideally positioned to facilitate this screening and engage clinicians in a dialogue surrounding patient's support needs due to nursing's central role on the interdisciplinary team. Nurses may also foster collective accountability for implementing ongoing multidisciplinary survivorship care plans that include a return to work component.

Latent Class Analysis of Symptom Burden Among Seriously Ill Adults at the End of Life

Murali, K. P., Yu, G., Merriman, J. D., Vorderstrasse, A., Kelley, A. S., & Brody, A. A. (2021). Nursing Research, 70(6), 443-454. 10.1097/NNR.0000000000000549
BACKGROUND: Serious illness is characterized by high symptom burden that negatively affects quality of life (QOL). Although palliative care research has highlighted symptom burden in seriously ill adults with cancer, symptom burden among those with noncancer serious illness and multiple chronic conditions has been understudied. Latent class analysis is a statistical method that can be used to better understand the relationship between severity of symptom burden and covariates, such as the presence of multiple chronic conditions. Although latent class analysis has been used to highlight subgroups of seriously ill adults with cancer based on symptom clusters, none have incorporated multiple chronic conditions. OBJECTIVES: The objectives of this study were to (a) describe the demographic and baseline characteristics of seriously ill adults at the end of life in a palliative care cohort, (b) identify latent subgroups of seriously ill individuals based on severity of symptom burden, and (c) examine variables associated with latent subgroup membership, such as QOL, functional status, and the presence of multiple chronic conditions. METHODS: A secondary data analysis of a palliative care clinical trial was conducted. The latent class analysis was based on the Edmonton Symptom Assessment System, which measures nine symptoms on a scale of 0-10 (e.g., pain, fatigue, nausea, depression, anxiousness, drowsiness, appetite, well-being, and shortness of breath). Clinically significant cut-points for symptom severity were used to categorize each symptom item in addition to a categorized total score. RESULTS: Three latent subgroups were identified (e.g., low, moderate, and high symptom burden). Lower overall QOL was associated with membership in the moderate and high symptom burden subgroups. Multiple chronic conditions were associated with statistically significant membership in the high symptom burden latent subgroup. Older adults between 65 and 74 years had a lower likelihood of moderate or high symptom burden subgroup membership compared to the low symptom burden class. DISCUSSION: Lower QOL was associated with high symptom burden. Multiple chronic conditions were associated with high symptom burden, which underlines the clinical complexity of serious illness. Palliative care at the end of life for seriously ill adults with high symptom burden must account for the presence of multiple chronic conditions.

Limb Volume Changes and Activities of Daily Living: A Prospective Study

Park, J. H., Merriman, J., Brody, A., Fletcher, J., Yu, G., Ko, E., Yancey, A., & Fu, M. R. (2021). Lymphatic Research and Biology, 19(3), 261-268. 10.1089/lrb.2020.0077
Background: Breast cancer-related lymphedema (BCRL) limits the movements of patients' limbs, which leads to a diminished ability to achieve essential activities of daily living (ADLs). The purpose of this study was to examine the associations between limb volume changes from the baseline before breast cancer surgery and self-reported difficulty in performing ADLs at 12 months following cancer surgery. We hypothesized that a positive association existed between limb volume changes from the baseline and self-reported difficulty in performing ADLs at 12 months following breast cancer surgery. Methods and Results: The data of the present study were part of a larger study with 140 breast cancer patients recruited before breast cancer surgery and followed up during their first year of treatment. Patients with more than 10% limb volume increase reported more frequent distress in performing 13 ADL items, compared with patients whose limb volume increased by 5%-10%. Regression analysis showed a significant increase in the odds ratio of reporting difficulty in ADLs compared with the group with less than 5% limb volume increase. Conclusion: Overall, patients with a greater limb volume increase underwent more difficulty performing ADLs. Patients reported more difficulty in performing ADLs even with 5%-10% limb volume increase. Currently, there is no standardized guideline to diagnose BCRL, although previous evidence suggests a limb volume increase greater than 10% as a criterion for BCRL. The findings from the present study suggest a more precise and clinically meaningful criteria for diagnosing BCRL to accommodate those with 5%-10% increase in limb volume.

Multiple Chronic Conditions among Seriously Ill Adults Receiving Palliative Care

Murali, K. P., Yu, G., Merriman, J. D., Vorderstrasse, A., Kelley, A. S., & Brody, A. A. (2021). Western Journal of Nursing Research. 10.1177/01939459211041174
The objective of this study was to characterize multiple chronic conditions (MCCs) among seriously ill adults receiving palliative care at the end of life. A latent class analysis was conducted to identify latent subgroups of seriously ill older adults based on a baseline Charlson comorbidity index (CCI) measurement, a measure of comorbidity burden, and mortality risk. The three latent subgroups were: (1) low to moderate CCI with MCC, (2) high CCI with MCC, and (3) high CCI and metastatic cancer. The “low to moderate CCI and MCC” subgroup included older adults with chronic obstructive pulmonary disease (COPD), cardiovascular disease, congestive heart failure, myocardial infarction, dementia, diabetes, and lymphoma. A “high CCI and MCC” subgroup included individuals with severe illness including liver or renal disease among other MCCs. A “high CCI and metastatic cancer” included all participants with metastatic cancer. This study sheds light on the MCC profile of seriously ill adults receiving palliative care.

Survivors’ Dilemma: Young Adult Cancer Survivors’ Perspectives of Work-Related Goals

Ghazal, L. V., Merriman, J., Santacroce, S. J., & Dickson, V. V. (2021). Workplace Health and Safety, 69(11), 506-516. 10.1177/21650799211012675
Background: Young adult cancer survivors have significant work-related challenges, including interruptions to education and employment milestones, which may affect work-related goals (WRGs). The study purpose was to explore posttreatment perspectives of WRGs in a sample of young adult hematologic cancer survivors. Methods: This qualitative descriptive study used social media to recruit eligible cancer survivors (young adults working or in school at the time of cancer diagnosis). Data were collected through telephone semi-structured interviews and analyzed using directed content analysis, followed by thematic content analysis to identify themes. Findings: The sample (N = 40) were mostly female (63.5%), White (75%), and diagnosed with Hodgkin lymphoma (57.5%); most worked in professional (40%) or health care (23%) roles. The overarching theme, “Survivors’ Dilemma,” highlights a changed perspective on work-related fulfillment and financial obligations, capturing survivors’ decision-making process regarding work. Three subthemes illustrated questions that participants contemplated as they examined how their WRGs had changed: (a) Self-identity: Do I want to do this work? (b) Perceived health and work ability: Can I do this work? and (c) Financial toxicity: Can I afford to/not to do this work? Conclusions/Application to Practice: Participants experienced a state of dilemma around their WRGs, weighing areas around self-identity, perceived health and work ability, and financial toxicity. Findings suggest occupational health nurses should be aware of challenges surrounding WRGs, including how goals may change following a cancer diagnosis and treatment, and the potential stressors involved in the Survivors’ Dilemma. Occupational health nurses should assess for these issues and refer young survivors to employee and financial assistance programs, as necessary.

An Adapted Conceptual Model Integrating Palliative Care in Serious Illness and Multiple Chronic Conditions

Murali, K. P., Merriman, J. D., Yu, G., Vorderstrasse, A., Kelley, A., & Brody, A. A. (2020). American Journal of Hospice and Palliative Medicine, 37(12), 1086-1095. 10.1177/1049909120928353
Objective: Seriously ill adults with multiple chronic conditions (MCC) who receive palliative care may benefit from improved symptom burden, health care utilization and cost, caregiver stress, and quality of life. To guide research involving serious illness and MCC, palliative care can be integrated into a conceptual model to develop future research studies to improve care strategies and outcomes in this population. Methods: The adapted conceptual model was developed based on a thorough review of the literature, in which current evidence and conceptual models related to serious illness, MCC, and palliative care were appraised. Factors contributing to patients’ needs, services received, and service-related variables were identified. Relevant patient outcomes and evidence gaps are also highlighted. Results: Fifty-eight articles were synthesized to inform the development of an adapted conceptual model including serious illness, MCC, and palliative care. Concepts were organized into 4 main conceptual groups, including Factors Affecting Needs (sociodemographic and social determinants of health), Factors Affecting Services Received (health system; research, evidence base, dissemination, and health policy; community resources), Service-Related Variables (patient visits, service mix, quality of care, patient information, experience), and Outcomes (symptom burden, quality of life, function, advance care planning, goal-concordant care, utilization, cost, death, site of death, satisfaction). Discussion: The adapted conceptual model integrates palliative care with serious illness and multiple chronic conditions. The model is intended to guide the development of research studies involving seriously ill adults with MCC and aid researchers in addressing relevant evidence gaps.

Exploratory Study of Associations Between DNA Repair and Oxidative Stress Gene Polymorphisms and Cognitive Problems Reported by Postmenopausal Women With and Without Breast Cancer

Merriman, J. D., Sereika, S. M., Conley, Y. P., Koleck, T. A., Zhu, Y., Phillips, M. L., Bertocci, M. A., Brufsky, A. M., & Bender, C. M. (2019). Biological Research for Nursing, 21(1), 50-60. 10.1177/1099800418799964
Purpose: Women with breast cancer report varying frequencies of cognitive problems during adjuvant systemic therapy. This variability suggests latent subgroups. Therefore, we identified latent subgroups of self-reported cognitive problems among postmenopausal women with and without breast cancer. We explored associations between membership in these subgroups and (a) demographic, clinical, and symptom characteristics and (b) variations in candidate gene polymorphisms. Methods: We evaluated frequency of cognitive problems using the Patient Assessment of Own Functioning Inventory. Growth mixture modeling identified latent subgroups over 18 months of adjuvant systemic therapy and at matched time points for women without cancer (N = 331). We evaluated for differences among subgroups in demographic, clinical, and symptom characteristics and in 41 single nucleotide polymorphisms in 10 candidate genes involved in DNA repair and oxidative stress pathways (n = 199). We modeled associations between genotypes and subgroup membership using multinomial logistic regression. Results: We identified three latent subgroups: more frequent, persistent, and almost never. Receipt of chemotherapy plus anastrozole, depressive symptoms, and baseline neuropathic symptoms increased the odds of belonging to the more frequent subgroup. Anxiety and depressive symptoms increased the odds of belonging to the persistent subgroup. With covariates controlled for, carrying the ERCC5 rs873601 G minor allele increased the odds of reporting more frequent cognitive problems. Conclusions: Chemotherapy plus anastrozole, depressive symptoms, and presence of neuropathic symptoms may predict more frequent cognitive problems during systemic therapy that later resolve. Mood dysregulation before therapy may predict persistent cognitive problems during therapy. ERCC5 genotype may influence frequency of cognitive problems after controlling for these risk factors.

Symptom Science: Advocating for Inclusion of Functional Genetic Polymorphisms

Knisely, M. R., Maserati, M., Heinsberg, L. W., Shah, L. L., Li, H., Zhu, Y., Ma, Y., Graves, L. Y., Merriman, J. D., & Conley, Y. P. (2019). Biological Research for Nursing, 21(4), 349-354. 10.1177/1099800419846407
Incorporating biologically based data into symptom science research can contribute substantially to understanding commonly experienced symptoms across chronic conditions. The purpose of this literature review was to identify functional polymorphisms associated with common symptoms (i.e., pain, sleep disturbance, fatigue, affective and cognitive symptoms) with the goal of identifying a parsimonious list of functional genetic polymorphisms with evidence to advocate for their inclusion in symptom science research. PubMed was searched to identify genes and functional polymorphisms associated with symptoms across chronic conditions, revealing eight functional genetic polymorphisms in seven different genes that showed evidence of association with at least three or more symptoms and/or symptom clusters: BDNF rs6265, COMT rs4680, FKBP5 rs3800373, IL-6 rs1800795, NFKB2 rs1056890, SLC6A4 5-HTTLPR+rs25531, and TNFA rs1799964 and rs1800629. Of these genes, three represent protein biomarkers previously identified as common data elements for symptom science research (BDNF, IL-6, and TNFA), and the polymorphisms in these genes identified through the search are known to impact secretion or level of transcription of these protein biomarkers. Inclusion of genotype data for polymorphisms offers great potential to further advance scientific knowledge of the biological basis of individual symptoms and symptom clusters across studies. Additionally, these polymorphisms have the potential to be used as targets to optimize precision health through the identification of individuals at risk for poor symptom experiences as well as the development of symptom management interventions.

Trajectories of cognitive function and associated phenotypic and genotypic factors in breast cancer

Bender, C. M., Merriman, J. D., Sereika, S. M., Gentry, A. L., Casillo, F. E., Koleck, T. A., Rosenzweig, M. Q., Brufsky, A. M., McAuliffe, P., Zhu, Y., & Conley, Y. P. (2018). Oncology Nursing Forum, 45(3), 308-326. 10.1188/18.ONF.308-326
OBJECTIVES: This study identified women with unique trajectories of executive function, concentration, and visual working memory before and during adjuvant therapy for breast cancer, and examined phenotypic and genotypic predictors associated with subgroups. SAMPLE & SETTING: 399 postmenopausal women, of whom 288 were women with early-stage breast cancer and 111 were women without breast cancer, matched on age and years of education to the women with breast cancer, and all at an urban cancer center. METHODS & VARIABLES: A repeated-measures design was used; assessments occurred before adjuvant therapy and every six months post-therapy initiation. Group-based trajectory modeling determined subgroups. Multinomial logistic regression identified phenotypic and genotypic characteristics. RESULTS: Three executive function and concentration trajectory subgroups were identified: low, moderate, and high; two visual working memory subgroups were identified: low and high. IMPLICATIONS FOR NURSING: Advancing age, greater pretherapy fatigue, and poorer pretherapy cognitive function are associated with the low subgroups. DNA repair and oxidative stress mechanisms may be involved in the cognitive changes that women experience.