Komal Patel Murali


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Komal Patel Murali


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Komal Patel Murali's additional information

Komal Patel Murali, PhD, RN, ACNP-BC is an assistant professor at NYU Meyers interested in palliative and end-of-life care for seriously ill persons living with dementia with a special focus on identifying ways to improve the delivery of culturally sensitive care in the home healthcare setting. She is currently supported by a NIA IMPACT Collaboratory Career Development Award for which she is exploring barriers to hospice to inform the design of a transitional care coordination intervention to improve transitions for diverse persons living with dementia. Driven by previous 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).

Active Project: Barriers to Hospice Care Transitions for Diverse Persons Living with Dementia, 2022-2024, NIA IMPACT Collaboratory Career Development Award

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

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

Faculty Honors Awards

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


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
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.

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
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
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.

Measuring Palliative Care-Related Knowledge, Attitudes, and Confidence in Home Health Care Clinicians, Patients, and Caregivers: A Systematic Review

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What End-of-Life Communication in ICUs Around the World Teaches Us About Shared Decision-Making

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What End-of-Life Communication in ICUs Around the World Teaches Us About Shared Decision-Making?

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Association of Infection-Related Hospitalization with Cognitive Impairment among Nursing Home Residents

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Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia

Lackraj, D., Kavalieratos, D., Murali, K. P., Lu, Y., & Hua, M. (2021). Journal of the American Geriatrics Society, 69(5), 1199-1207. 10.1111/jgs.17032
Background: In patients with serious illness, use of specialist palliative care may result in improved quality of life, patient and caregiver satisfaction and advance care planning, as well as lower health care utilization. However, evidence of efficacy is limited for patients with dementia, particularly in the setting of an acute hospitalization. Objective: To determine whether implementation of hospital-based specialist palliative care was associated with differences in treatment intensity outcomes for hospitalized patients with dementia. Design: Retrospective cohort study. Setting: Fifty-one hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded. Participants: Hospitalized patients with dementia. Measurements: The primary outcome of this study was discharge to hospice from an acute hospitalization. Secondary outcomes included hospital length of stay, use of mechanical ventilation and dialysis, and days in intensive care. Difference-in-difference analyses were performed using multilevel regression to assess the association between implementing a palliative care program and outcomes, while adjusting for patient and hospital characteristics and time trends. Results: During the study period, 82,118 patients with dementia (mean (SD) age, 83.04 (10.04), 51,170 (62.21%) female) underwent an acute hospitalization, of which 41,227 (50.27%) received care in hospitals that implemented a palliative care program. In comparison to patients who received care in hospitals without palliative care, patients with dementia who received care in hospitals after the implementation of palliative care were more 35% likely to be discharged to hospice (adjusted odds ratio (aOR) = 1.35 (1.19–1.51), P <.001). No meaningful differences in secondary outcomes were observed. Conclusion: Implementation of a specialist palliative care program was associated with an increase in discharge to hospice following acute hospitalization in patients with dementia.

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.

The Role of Regional and State Initiatives in Nursing Home Advance Care Planning Policies

Fu, C. J., Agarwal, M., Estrada, L. V., Murali, K. P., Quigley, D. D., Dick, A. W., & Stone, P. W. (2021). American Journal of Hospice and Palliative Medicine, 38(9), 1135-1141. 10.1177/1049909120970117
Objective: Antibiotic use at the end of life (EoL) may introduce physiological as well as psychological stress and be incongruent with patients’ goals of care. Advance care planning (ACP) related to antibiotic use at the EoL helps improve goal-concordant care. Many nursing home (NH) residents are seriously ill. Therefore, we aimed to examine whether state and regional ACP initiatives play a role in the presence of “do not administer antibiotics” orders for NH residents at the EoL. Methods: We surveyed a random, representative national sample of 810 U.S. NHs (weighted n = 13,983). The NH survey included items on “do not administer antibiotics” orders in place and participation in infection prevention collaboratives. The survey was linked to state Physician Orders for Life-Sustaining Treatment (POLST) adoption status and resident, facility, and county characteristics data. We conducted multivariable regression models with state fixed effects, stratified by state POLST designation. Results: NHs in mature POLST states reported higher rates of “do not administer antibiotics” orders compared to developing POLST states (10.1% vs. 4.6%, respectively, p = 0.004). In mature POLST states, participation in regional collaboratives and smaller NH facilities (<100 beds) were associated with having “do not administer antibiotics” orders for seriously ill residents (β = 0.11, p = 0.006 and β = 0.12, p = 0.003, respectively). Discussion: NHs in states with mature POLST adoption that participated in infection control collaboratives were more likely to have “do not administer antibiotics” orders. State ACP initiatives combined with regional antibiotic stewardship initiatives may improve inappropriate antibiotic use at the EoL for NH residents.