Komal Patel Murali

Faculty

Komal Murali headshot

Komal Patel Murali

ACNP-BC PhD RN

1 212 998 5783

Komal Patel Murali's additional information

Komal Patel Murali, PhD, RN, ACNP-BC is an assistant professor at NYU Rory Meyers College of Nursing, interested in palliative and end-of-life care for seriously ill persons living with dementia. She is currently funded by a NIA IMPACT Collaboratory Career Development Award. In this study, Murali is exploring barriers to hospice care and developing a care management intervention to improve transitions to hospice for diverse persons living with dementia. Informed by prior nursing experiences in neuroscience and medical critical care, she is also passionate about the integration of palliative and end-of-life care in the ICU setting. Prior to joining NYU Meyers, Murali was a postdoctoral fellow in the Comparative and Cost-Effectiveness Research Training Program for Nurse Scientists (T32NR0114205, 2020-2022) at Columbia Nursing and a predoctoral scholar with the NYU Clinical and Translational Science Institute (UL1TR001445/TL1TR001447, 2018-2020).

PhD – New York University (2020)
MSN – University of Pennsylvania (2011)
BSN – University of Pennsylvania (2008)

Critical care
Palliative care

American Association of Critical Care Nurses
Hospice and Palliative Nurses Association
Gerontological Society of America
Eastern Nursing Research Society
Sigma Theta Tau International Nursing Honor Society
American Geriatrics Society

Faculty Honors Awards

NYU Alzheimer’s Disease Research Center Research Education Component Scholar (2023)
Research Scholar, Hospice and Palliative Nurses Association (2023)
Emerging Leaders Award, Hospice and Palliative Nurses Foundation (2022)
Distinguished PhD Student Award, NYU Meyers (2020)
Jonas Nurse Leader Scholar, Jonas Center for Nursing Excellence (2018)
Norman Volk Doctoral Scholarship, NYU Meyers (2018)
President’s Service Award, New York University (2018)
Mary D. Naylor Undergraduate Research Award, University of Pennsylvania (2008)
Sigma Theta Tau Inductee, University of Pennsylvania (2008)

Publications

An Evolutionary Concept Analysis of the "Fighter" in the Intensive Care Unit

Moreines, L. T., Brody, A. A., & Murali, K. P. (2024). Journal of Hospice and Palliative Nursing. 10.1097/NJH.0000000000001017
Abstract
Abstract
The purpose of this article was to analyze the concept of "the fighter in the intensive care unit (ICU)" per the scientific literature and the impact this mentality has on care administered in the ICU. A literature review and a concept analysis based on Rodger's evolutionary method were performed to identify surrogate terms, antecedents, attributes, and consequences pertaining to the "fighter" in the ICU. Thirteen articles with a focus on "the fighter" were included in this analysis. There is a strong desire to remain optimistic and maintain high spirits as a coping mechanism in the face of extreme prognostic uncertainty. Themes that emerged from the literature were the need to find inner strength and persist in the face of adversity. The concept of "the fighter in the ICU" can serve as either adaptive or maladaptive coping, depending on the larger clinical picture. Patient experiences in the ICU are fraught with physical and psychological distress. How the patient and family unit cope during this anxiety-provoking time is based on the individual. Maintaining optimism and identifying as a fighter can be healthy ways to adapt to the circumstances. This concept analysis highlights the importance of holistic care and instilling hope particularly as patients may be nearing the end of life.

Career development in pragmatic clinical trials to improve care for people living with dementia

Gabbard, J., Sadarangani, T. R., Datta, R., Fabius, C. D., Gettel, C. J., Douglas, N. F., Juckett, L. A., Kiselica, A. M., Murali, K. P., McCarthy, E. P., Torke, A. M., & Callahan, C. M. (2023). Journal of the American Geriatrics Society, 71(11), 3554-3565. 10.1111/jgs.18599
Abstract
Abstract
The growing number of people living with dementia (PLWD) requires a coordinated clinical response to deliver pragmatic, evidence-based interventions in frontline care settings. However, infrastructure to support such a response is lacking. Moreover, there are too few researchers conducting rigorous embedded pragmatic clinical trials (ePCTs) to make the vision of high quality, widely accessible dementia care a reality. National Institute on Aging (NIA) Imbedded Pragmatic Alzheimer's disease and Related Dementias Clinical Trials (IMPACT) Collaboratory seeks to improve the pipeline of early career researchers qualified to lead ePCTs by funding career development awards. Even with support from the Collaboratory, awardees face practical and methodological challenges to success, recently exacerbated by the COVID-19 pandemic. We first describe the training opportunities and support network for the IMPACT CDA recipients. This report then describes the unique career development challenges faced by early-career researchers involved in ePCTs for dementia care. Topics addressed include challenges in establishing a laboratory, academic promotion, mentoring and professional development, and work-life balance. Concrete suggestions to address these challenges are offered for early-career investigators, their mentors, and their supporting institutions. While some of these challenges are faced by researchers in other fields, this report seeks to provide a roadmap for expanding the work of the IMPACT Collaboratory and initiating future efforts to recruit, train, and retain talented early-career researchers involved in ePCTs for dementia care.

Clarifying Karma for Culturally Concordant Care

Patel, R. V., Murali, K. P., & Patel, V. R. (2023). JCO Global Oncology, 9, e2300259. 10.1200/GO.23.00259

Complex Care Needs at the End of Life for Seriously Ill Adults With Multiple Chronic Conditions

Murali, K. P., Merriman, J. D., Yu, G., Vorderstrasse, A., Kelley, A. S., & Brody, A. A. (2023). Journal of Hospice and Palliative Nursing, 25(3), 146-155. 10.1097/NJH.0000000000000946
Abstract
Abstract
Understanding the complex care needs of seriously ill adults with multiple chronic conditions with and without cancer is critical for the delivery of high-quality serious illness and palliative care at the end of life. The objective of this secondary data analysis of a multisite randomized clinical trial in palliative care was to elucidate the clinical profile and complex care needs of seriously ill adults with multiple chronic conditions and to highlight key differences among those with and without cancer at the end of life. Of the 213 (74.2%) older adults who met criteria for multiple chronic conditions (eg, 2 or more chronic conditions requiring regular care with limitations of daily living), 49% had a diagnosis of cancer. Hospice enrollment was operationalized as an indicator for severity of illness and allowed for the capture of complex care needs of those deemed to be nearing the end of life. Individuals with cancer had complex symptomatology with a higher prevalence of nausea, drowsiness, and poor appetite and end of life and lower hospice enrollment. Individuals with multiple chronic conditions without cancer had lower functional status, greater number of medications, and higher hospice enrollment. The care of seriously ill older adults with multiple chronic conditions requires tailored approaches to improve outcomes and quality of care across health care settings, particularly at the end of life.

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. (2023). Western Journal of Nursing Research, 45(1), 14-24. 10.1177/01939459211041174
Abstract
Abstract
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.

Nurses, Psychological Distress, and Burnout: Is There an App for That?

Murali, K. P., Brody, A. A., & Stimpfel, A. W. (2023). Annals of the American Thoracic Society, 20(10), 1404-1405. 10.1513/AnnalsATS.202307-629ED

Place of Death from Cancer in US States with vs Without Palliative Care Laws

Quan Vega, M. L., Chihuri, S. T., Lackraj, D., Murali, K. P., Li, G., & Hua, M. (2023). JAMA Network Open, 6(6). 10.1001/jamanetworkopen.2023.17247
Abstract
Abstract
Importance: In the US, improving end-of-life care has become increasingly urgent. Some states have enacted legislation intended to facilitate palliative care delivery for seriously ill patients, but it is unknown whether these laws have any measurable consequences for patient outcomes. Objective: To determine whether US state palliative care legislation is associated with place of death from cancer. Design, Setting, and Participants: This cohort study with a difference-in-differences analysis used information about state legislation combined with death certificate data for 50 US states (from January 1, 2005, to December 31, 2017) for all decedents who had any type of cancer listed as the underlying cause of death. Data analysis for this study occurred between September 1, 2021, and August 31, 2022. Exposures: Presence of a nonprescriptive (relating to palliative and end-of-life care without prescribing particular clinician actions) or prescriptive (requiring clinicians to offer patients information about care options) palliative care law in the state-year where death occurred. Main Outcomes and Measures: Multilevel relative risk regression with state modeled as a random effect was used to estimate the likelihood of dying at home or hospice for decedents dying in state-years with a palliative care law compared with decedents dying in state-years without such laws. Results: This study included 7547907 individuals with cancer as the underlying cause of death. Their mean (SD) age was 71 (14) years, and 3609146 were women (47.8%). In terms of race and ethnicity, the majority of decedents were White (85.6%) and non-Hispanic (94.1%). During the study period, 553 state-years (85.1%) had no palliative care law, 60 state-years (9.2%) had a nonprescriptive palliative care law, and 37 state-years (5.7%) had a prescriptive palliative care law. A total of 3780918 individuals (50.1%) died at home or in hospice. Most decedents (70.8%) died in state-years without a palliative care law, while 15.7% died in state-years with a nonprescriptive law and 13.5% died in state-years with a prescriptive law. Compared with state-years without a palliative care law, the likelihood of dying at home or in hospice was 12% higher for decedents in state-years with a nonprescriptive palliative care law (relative risk, 1.12 [95% CI 1.08-1.16]) and 18% higher for decedents in state-years with a prescriptive palliative care law (relative risk, 1.18 [95% CI, 1.11-1.26]). Conclusions and Relevance: In this cohort study of decedents from cancer, state palliative care laws were associated with an increased likelihood of dying at home or in hospice. Passage of state palliative care legislation may be an effective policy intervention to increase the number of seriously ill patients who experience their death in such locations.

Prioritizing Community-Based Care for People With Alzheimer’s Disease and Related Dementias in Ethnically Diverse Communities The Time is Now

Murali, K. P., & Sadarangani, T. R. (2023). Research in Gerontological Nursing, 16(5), 214-216. 10.3928/19404921-20230906-01

Clinicians' views on the use of triggers for specialist palliative care in the ICU: A qualitative secondary analysis

Murali, K. P., Fonseca, L. D., Blinderman, C. D., White, D. B., & Hua, M. (2022). Journal of Critical Care, 71. 10.1016/j.jcrc.2022.154054
Abstract
Abstract
Purpose: To understand clinicians' views regarding use of clinical criteria, or triggers, for specialist palliative care consultation in the ICU. Materials and methods: Secondary analysis of a qualitative study that explored factors associated with adoption of specialist palliative care in the ICU. Semi-structured interviews with 36 ICU and palliative care clinicians included questions related to triggers for specialist palliative care. We performed a thematic analysis to identify participants' views on use of triggers, including appropriateness of cases for specialists and issues surrounding trigger implementation. Results: We identified five major themes: 1) Appropriate triggers for specialist palliative care, 2) Issues leading to clinician ambivalence for triggers, 3) Prospective buy-in of stakeholders, 4) Workflow considerations in deploying a trigger system, and 5) Role of ICU clinicians in approving specialist palliative care consults. Appropriate triggers included end-of-life care, chronic critical illness, frequent ICU admissions, and patient/family support. Most clinicians had concerns about “trigger overload” and ICU clinicians wanted to be broadly involved in implementation efforts. Conclusions: ICU and palliative care clinicians identified important issues to consider when implementing triggers for specialist palliative care consultation. Future research is needed to longitudinally examine the most appropriate triggers and best practices for trigger implementation.

Interpersonal Conflict between Clinicians in the Delivery of Palliative and End-of-Life Care for Critically Ill Patients: A Secondary Qualitative Analysis

Tong, W., Murali, K. P., Fonseca, L. D., Blinderman, C. D., Shelton, R. C., & Hua, M. (2022). Journal of Palliative Medicine, 25(10), 1501-1509. 10.1089/jpm.2021.0631
Abstract
Abstract
Background: Conflict between clinicians is prevalent within intensive care units (ICUs) and may hinder optimal delivery of care. However, little is known about the sources of interpersonal conflict and how it manifests within the context of palliative and end-of-life care delivery in ICUs. Objective: To characterize interpersonal conflict in the delivery of palliative care within ICUs. Design: Secondary thematic analysis using a deductive-inductive approach. We analyzed existing qualitative data that conducted semistructured interviews to examine factors associated with variable adoption of specialty palliative care in ICUs. Settings/Subjects: In the parent study, 36 participants were recruited from two urban academic medical centers in the United States, including ICU attendings (n = 17), ICU nurses (n = 11), ICU social workers (n = 1), and palliative care providers (n = 7). Measurements: Coders applied an existing framework of interpersonal conflict to guide initial coding and analysis, combined with a flexible inductive approach allowing new codes to emerge. Results: We characterized three properties of interpersonal conflict: disagreement, interference, and negative emotion. In the context of delivering palliative and end-of-life care for critically ill patients, "disagreement" centered around whether patients were appropriate for palliative care, which care plans should be prioritized, and how care should be delivered. "Interference" involved preventing palliative care consultation or goals-of-care discussions and hindering patient care. "Negative emotion" included occurrences of silencing or scolding, rudeness, anger, regret, ethical conflict, and grief. Conclusions: Our findings provide an in-depth understanding of interpersonal conflict within palliative and end-of-life care for critically ill patients. Further study is needed to understand how to prevent and resolve such conflicts.