Komal Patel Murali

Faculty

Komal Murali headshot

Komal Patel Murali

ACNP-BC PhD RN

1 212 998 5783

433 FIRST AVENUE
NEW YORK, NY 10010
United States

Komal Patel Murali's additional information

Komal Patel Murali, PhD, RN, ACNP-BC is an assistant professor at NYU Rory Meyers College of Nursing dedicated to advancing equitable palliative and hospice care for seriously ill persons living with dementia and multiple chronic conditions. She has received funding from the NIA IMPACT Collaboratory Career Development Award and a NIA K23 Career Development Award (K23AG083125) through which she is exploring barriers to hospice care and developing and testing a co-designed culturally sensitive care management intervention to guide transitions to hospice for persons living with dementia and their family caregivers in home healthcare. Another area of her research includes culturally sensitive caregiving support for South Asian older adults with chronic conditions and their families in faith-based settings, which is currently supported by pilot funding from the Rutgers-NYU Center for Asian Health Promotion and Equity (P50MD017356). 

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

Nessa Coyle Leadership Lecture and Award, Hospice and Palliative Nurses Association (2024)
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)
HRSA Nurse Corps Loan Repayment Program (2012)
Mary D. Naylor Undergraduate Research Award, University of Pennsylvania (2008)
Pennsylvania Higher Education Foundation Scholarship (2008)
Promise of Nursing Regional Scholarship Award, Foundation of the National Student Nurses Association (2008)
Sigma Theta Tau Inductee, University of Pennsylvania (2008)
Scholar, Center for Health Disparities Research, Penn Nursing (2007)

Publications

Intersection of social determinants of health with ventricular assist device therapy: An integrative review

Chehade, M., Murali, K. P., Dickson, V. V., & McCarthy, M. M. (2024). Heart and Lung: Journal of Acute and Critical Care, 66, 56-70. 10.1016/j.hrtlng.2024.04.002
Abstract
Abstract
BACKGROUND: Social determinants of health (SDOH) may influence the clinical management of patients with heart failure. Further research is warranted on the relationship between SDOH and Ventricular Assist Device (VAD) therapy for heart failure.OBJECTIVES: The purpose of this integrative review was to synthesize the state of knowledge on the intersection of SDOH with VAD therapy.METHODS: Guided by Whittemore and Knafl's methodology, this literature search captured three concepts of interest including VAD therapy, SDOH, and their domains of intersection with patient selection, decision-making, treatment outcome, and resource allocation. CINAHL, Embase, PsycINFO, PubMed, and Web of Science were searched in March 2023. Articles were included if they were peer-reviewed publications in English, published between 2006 and 2023, conducted in the United States, and examined VAD therapy in the context of adult patients (age ≥ 18 years).RESULTS: 22 quantitative studies meeting the inclusion criteria informed the conceptualization of SDOH using the Healthy People 2030 framework. Four themes captured how the identified SDOH intersected with different processes relating to VAD therapy: patient decision-making, healthcare access and resource allocation, patient selection, and treatment outcomes. Most studies addressed the intersection of SDOH with healthcare access and treatment outcomes.CONCLUSION: This review highlights substantial gaps in understanding how SDOH intersect with patient and patient selection for VAD. More research using mixed methods designs is warranted. On an institutional level, addressing bias and discrimination may have mitigated health disparities with treatment outcomes, but further research is needed for implementing system-wide change. Standardized assessment of SDOH is recommended throughout clinical practice from patient selection to outpatient VAD care.

Palliative Nursing in Home Health Care Across the Lifespan

Murali, K. P., Ma, C., Harrison, K. L., Hunt, L. J., Rosa, W. E., & Boyden, J. Y. (2024). The American Journal of Nursing. 10.1097/01.naj.0001095240.11717.87
Abstract
Abstract
ABSTRACT: Primary palliative nursing in home health care (HHC) can be delivered to medically complex patients across the lifespan. Primary palliative nursing provides patient- and family-centered care for serious illness by alleviating the stress and symptoms of illness; coordinating care; and supporting the social, cultural, and psychological aspects of care. In this article, two case scenarios of patients in different phases of life serve as examples of primary palliative nursing in HHC. Key elements and challenges of delivering primary palliative nursing care in HHC are also highlighted.

The perspectives of older adults related to transcatheter aortic valve replacement: An integrative review

Moreines, L. T., David, D., Murali, K. P., Dickson, V. V., & Brody, A. (2024). Heart and Lung, 68, 23-36. 10.1016/j.hrtlng.2024.05.013
Abstract
Abstract
Background: Aortic Stenosis (AS) is a common syndrome in older adults wherein the narrowing of the aortic valve impedes blood flow, resulting in advanced heart failure.1 AS is associated with a high mortality rate (50 % at 6 months if left untreated), substantial symptom burden, and reduced quality of life.1-3 Transcatheter aortic valve replacement (TAVR) was approved in 2012 as a less invasive alternative to surgical valve repair, offering a treatment for older frail patients. Although objective outcomes have been widely reported,4 the perspectives of older adults undergoing the TAVR process have never been synthesized. Objectives: To contextualize the perspectives and experiences of older adults undergoing TAVR. Methods: An integrative review was conducted using Whittemore and Knafl's five-stage methodology.5 Four electronic databases were searched in April 2023. Articles were included if a qualitative methodology was used to assess the perceptions of older adults (>65 years old) undergoing or recovering from TAVR. Results: Out of 4619 articles screened, 12 articles met the criteria, representing 353 individuals from 10 countries. Relevant themes included the need for an individualized care plan, caregiver and family support, communication and education, persistent psychosocial and physical symptoms, and the unique recovery journey. Conclusion: Older adults with AS undergoing TAVR generally perceive their procedure positively. Improved interdisciplinary and holistic management, open communication, symptom assessment, support, and education is needed.

Using mHealth to Improve Communication in Adult Day Services Around the Needs of People With Dementia: Mixed Methods Assessment of Acceptability and Feasibility

Zheng, A., Bergh, M., Murali, K. P., & Sadarangani, T. (2024). JMIR Formative Research, 8, 1-13. 10.2196/49492
Abstract
Abstract
Background: Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users’ health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers. Objective: This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting. Methods: A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption. Results: A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process. Conclusions: The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting.

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.

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