COIN Investigators & Staff
COIN Investigators
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David B. Bekelman, MD, MPH
- Title: Core Investigator
Professor, University of Colorado School of Medicine - Contact: David.Bekelman@va.gov
- Location: Denver
- University of Colorado webpage
Research Interests
Dr. Bekelman conducts research to improve the quality of life for people with chronic heart failure and chronic lung disease and their families. His research expertise is in measuring and improving quality of life and testing novel health care delivery interventions using clinical trials. He has tested telephone, team (nurse and social worker), and peer (layperson) interventions to integrate early palliative care and psychosocial care into the outpatient setting.
He is inspired by the commitment Veterans have given our country. His aim is to make life a little better for Veterans living with serious illnesses.
His hope is the VA will adopt programs that ease the burden of serious illness for Veterans and their families. Lastly, it is his aim to train the next generation of patient-oriented researchers.
Grants & Funding
Mid-Career Mentoring Award in Palliative Care, Aging, and Cognitive Impairment
This project is significant to public health because it will:
(1) train mentees to increase the cadre of successful patient-oriented researchers who will improve care and outcomes for older adults with serious medical illness and cognitive impairment (i.e., problems with thinking and memory), and
(2) generate new knowledge on how to implement early palliative care in primary care to help this patient population and their informal (family) caregivers.
Funder: National Institute on Aging
NIH website
Improving Implementation of Outpatient Goals of Care Conversations for Veterans with Serious Illness
VA developed the Life-Sustaining Treatment Decisions Initiative (LSTDI) to elicit, document, and honor the values, goals, and preferences of Veterans with serious illnesses. The LSTDI is important to Veterans because it ensures they can express their preferences for life-sustaining treatments (e.g., cardiopulmonary resuscitation, breathing machine, artificial nutrition) and have them honored.
However, across VA nationally, only 39% of LSTDI conversations occur in the outpatient setting; the majority occur in the inpatient setting, often close to death. At this late stage, Veterans are often unable to make their preferences known because they are so ill.
Decisions fall to surrogates who may not know what the Veteran would have wanted.
This study will examine ways to increase LSTDI conversations among Veterans and their health care providers earlier in illness in the outpatient setting.
Funder: Veterans Affairs
NIH website
Improving Patient and Caregiver Outcomes in Pulmonary Fibrosis: a Novel, Dyadic Assessment of Caregiver Burden
Funder: Pulmonary Fibrosis Foundation (PFF)
VA Dimensions complete information
Recent Publications
2024
Valenti K, Doyon K, Morgan B, Quinn G, Bekelman D. My Partner Is My Family: Engaging and Advocating for Lesbian, Gay, Bisexual, Transgender, Queer+ Patients in Goals of Care Conversations. J Hosp Palliat Nurs. 2024 Apr 29. doi: 10.1097/NJH.0000000000001030. Epub ahead of print.
PMID: 38683581
Ma JE, Schlichte L, Haverfield M, Gambino J, Lange A, Blanchard K, Morgan B, Bekelman DB. Do goals of care documentation reflect the conversation?: Evaluating conversation-documentation accuracy. J Am Geriatr Soc. 2024 Apr 9. doi: 10.1111/jgs.18913. Epub ahead of print.
PMID: 38593240
Glickman A, Mikulich-Gilbertson S, Abshire Saylor M, DeGroot L, Bekelman DB. Relationship Status and Quality Are Associated With Perceived Benefits of Caregiving for People With Heart Failure. J Cardiovasc Nurs. 2024 Mar 21. doi: 10.1097/JCN.0000000000001093. Epub ahead of print.
PMID: 38509047
Smirnova N, Lange AV, Glickman A, Desanto K, McDermott CL, Sullivan DR, Bekelman DB, Kavalieratos D. Criteria for Enrollment of Patients with COPD in Palliative Care Trials: A Systematic Review. J Pain Symptom Manage. 2024 Jan 25:S0885-3924(24)00046-0. doi: 10.1016/j.jpainsymman.2024.01.028. Epub ahead of print.
PMID: 38280439
Bekelman DB, Feser W, Morgan B, Welsh CH, Parsons EC, Paden G, Baron A, Hattler B, McBryde C, Cheng A, Lange AV, Au DH. Nurse and Social Worker Palliative Telecare Team and Quality of Life in Patients With COPD, Heart Failure, or Interstitial Lung Disease: The ADAPT Randomized Clinical Trial. JAMA. 2024 Jan 16;331(3):212-223. doi: 10.1001/jama.2023.24035.
PMID: 38227034
2023
Paek M, Rinderle T, Resnick R, Bekelman DB. Palliative Care Issues in Aortic Stenosis #467. J Palliat Med. 2023 Nov;26(11):1578-1580. doi: 10.1089/jpm.2023.0388.
PMID: 37955887
Learn more about this publication on Dimensions
Ha DM, Nunnery MA, Klocko RP, Haverhals LM, Bekelman DB, New ML, Randhawa SK, Stevens-Lapsley JE, Studts JL, Prochazka AV, Keith RL. Lung cancer survivors' views on telerehabilitation following curative intent therapy: a formative qualitative study. BMJ Open. 2023 Jun 23;13(6):e073251. doi: 10.1136/bmjopen-2023-073251.
PMID: 37355268
Learn more about this publication on Dimensions
2022
Deng LR, Doyon KJ, Masters KS, Steinhauser KE, Langner PR, Siler S, Bekelman DB. How Does Spiritual Well-Being Change Over Time Among US Patients with Heart Failure and What Predicts Change? J Relig Health. 2022 Dec 7. doi: 10.1007/s10943-022-01712-4. Epub ahead of print.
PMID: 36478542
Learn more about this publication on Dimensions
Lange AV, Mehta AB, Bekelman D. How important is spirometry for identifying patients with COPD appropriate for palliative care? J Pain Symptom Manage. 2022 Nov 21:S0885-3924(22)00976-9. doi: 10.1016/j.jpainsymman.2022.11.016. Epub ahead of print.
PMID: 36423798
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Kavalieratos D, Harinstein ME, Rose B, Lowers J, Hoydich ZP, Bekelman DB, Allen LA, Rollman BL, Ernecoff NC, Moreines LT, Bakitas MA, Arnold RM. Primary palliative care for heart failure provided within ambulatory cardiology: A randomized pilot trial. Heart Lung. 2022 Jul 18;56:125-132. doi: 10.1016/j.hrtlng.2022.07.002. Epub ahead of print.
PMID: 35863099
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Portz JD, Powers JD, Baldwin M, Gleason K, Casillas A, Bekelman DB, Boxer R, Bayliss E, Palen TE. How can patient portals support caregivers of older adults near the end-of-life? A mixed-methods study. J Am Geriatr Soc. 2022 Apr 29. doi: 10.1111/jgs.17818. Epub ahead of print.
PMID: 35488465
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Deng LR, Matlock DD, Bekelman DB. Preferred Role in Healthcare Decision-Making Over Time among Patients with Heart Failure: My Decision, Or My Doctor's Decision? J Card Fail. 2022 Apr 22:S1071-9164(22)00493-6. doi: 10.1016/j.cardfail.2022.03.357. Epub ahead of print.
PMID: 35470060
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Ha DM, Deng LR, Lange AV, Swigris JJ, Bekelman DB. Reliability, Validity, and Responsiveness of the DEG, a Three-Item Dyspnea Measure. J Gen Intern Med. 2022 Jan 3. doi: 10.1007/s11606-021-07307-1. Epub ahead of print.
PMID: 34981344
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2021
Haverfield MC, Garcia A, Giannitrapani KF, Walling A, Rigdon J, Bekelman DB, Lo N, Lehmann LS, Jacobs J, Festa N, Lorenz KA. Goals of Care Documentation: Insights from A Pilot Implementation Study. J Pain Symptom Manage. 2021 Dec 21:S0885-3924(21)00701-6. doi: 10.1016/j.jpainsymman.2021.12.023. Epub ahead of print.
PMID: 34952172
Ha DM, Prochazka AV, Bekelman DB, Stevens-Lapsley JE, Studts JL, Keith RL. Modifiable factors associated with health-related quality of life among lung cancer survivors following curative intent therapy. Lung Cancer. 2021 Dec 2;163:42-50. doi: 10.1016/j.lungcan.2021.11.012. Epub ahead of print.
PMID: 34896804
Portz JD, Graney BA, Bekelman DB. "Made Me Realize That Life Is Worth Living": A Qualitative Study of Patient Perceptions of a Primary Palliative Care Intervention. J Palliat Med. 2021 Jul 14. doi: 10.1089/jpm.2021.0015. Epub ahead of print.
PMID: 34264752
Deng LR, Masters KS, Schmiege SJ, Hess E, Bekelman DB. Factor Structure of Functional Assessment of Chronic Illness Therapy: Spiritual Well-Being Scale in Patients with Heart Failure Depends on Method Used. J Palliat Med. 2021 Jun;24(6):807-808. doi: 10.1089/jpm.2021.0064. PMCID: PMC8147496.
PMID: 34061665
Ahluwalia SC, Bandini JI, Coulourides Kogan A, Bekelman DB, Olsen B, Phillips J, Sudore RL. Impact of group visits for older patients with heart failure on advance care planning outcomes: Preliminary data. J Am Geriatr Soc. 2021 Jun 2. doi: 10.1111/jgs.17283. Epub ahead of print.
PMID: 34077563
Ma JE, Haverfield M, Lorenz KA, Bekelman DB, Brown-Johnson C, Lo N, Foglia MB, Lowery JS, Walling AM, Giannitrapani KF. Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach. Palliat Med. 2021 Jun 3:2692163211020473. doi: 10.1177/02692163211020473. Epub ahead of print.
PMID: 34080488
Portz JD, Powers JD, Casillas A, Baldwin M, Bekelman DB, Palen TE, Bull S, Kutner JS, Bayliss E. Characteristics of Patients and Proxy Caregivers Using Patient Portals in the Setting of Serious Illness and End of Life. J Palliat Med. 2021 May 28. doi: 10.1089/jpm.2020.0667. Epub ahead of print.
PMID: 34061675
Deng LR, Masters KS, Schmiege SJ, Hess E, Bekelman DB. Two Factor Structures Possible for the FACIT-Sp in Patients with Heart Failure. J Pain Symptom Manage. 2021 May 18:S0885-3924(21)00341-9. doi: 10.1016/j.jpainsymman.2021.05.009. Epub ahead of print.
PMID: 34019976
Portz JD, Powers JD, Baldwin M, Bekelman DB, Casillas A, Kutner JS, Bayliss E. Patient Portal Use Near the End-of-Life. J Gen Intern Med. 2021 Jan 27. doi: 10.1007/s11606-020-06333-9. Epub ahead of print.
PMID: 33506403
Ha DM, Prochazka AV, Bekelman DB, Stevens-Lapsley JE, Chan ED, Keith RL. Association of Leisure-Time Physical Activity With Health-Related Quality of Life Among US Lung Cancer Survivors. JNCI Cancer Spectr. 2021 Jan 23;5(1):pkaa118. doi: 10.1093/jncics/pkaa118. PMCID: PMC7853156.
PMID: 35075444
Bandini JI, Kogan AC, Olsen B, Phillips J, Sudore RL, Bekelman DB, Ahluwalia SC. Feasibility of Group Visits for Advance Care Planning Among Patients with Heart Failure and Their Caregivers. J Am Board Fam Med. 2021 Jan-Feb;34(1):171-180. doi: 10.3122/jabfm.2021.01.200184.
PMID: 33452095
2020
Sheffler JL, Schmiege SJ, Sussman J, Bekelman DB. A longitudinal analysis of the relationships between depression, fatigue, and pain in patients with heart failure. Aging Ment Health. 2020 Dec 7:1-7. doi: 10.1080/13607863.2020.1855626. Epub ahead of print.
PMID: 33287562
Portz JD, Ford KL, Doyon K, Bekelman DB, Boxer RS, Kutner JS, Czaja S, Bull S. Using Grounded Theory to Inform the Human-Centered Design of Digital Health in Geriatric Palliative Care. J Pain Symptom Manage. 2020 Dec;60(6):1181-1192.e1. doi: 10.1016/j.jpainsymman.2020.06.027. Epub 2020 Jun 29.
PMID: 32615298
Schenker Y, Ellington L, Bell L, Kross EK, Rosenberg AR, Kutner JS, Bickel KE, Ritchie C, Kavalieratos D, Bekelman DB, Mooney KB, Fischer SM. The National Postdoctoral Palliative Care Research Training Collaborative: History, Activities, Challenges, and Future Goals. J Palliat Med. 2020 Sep 21. doi: 10.1089/jpm.2020.0411. Epub ahead of print. PMID: 32955969
Portz JD, Ford KL, Elsbernd K, Knoepke CE, Flint K, Bekelman DB, Boxer RS, Bull S. ""I Like the Idea of It…But Probably Wouldn't Use It"" - Health Care Provider Perspectives on Heart Failure mHealth: Qualitative Study. JMIR Cardio. 2020 Sep 4;4(1):e18101. doi: 10.2196/18101. PMID: 32885785
Griffith MF, Chen HP, Bekelman DB, Feemster LC, Spece LJ, Donovan LM, Au DH, Carey EP. Comorbid Anxiety and Depression, Though Underdiagnosed, Are Not Associated with High Rates of Low-Value Care in Patients with COPD. Ann Am Thorac Soc. 2020 Dec 11. doi: 10.1513/AnnalsATS.201912-877OC. Epub ahead of print. PMID: 33306930
Brown-Johnson C, Haverfield MC, Giannitrapani KF, Lo N, Lowery JS, Foglia MB, Walling AM, Bekelman DB, Shreve ST, Lehmann LS, Lorenz KA. Implementing Goals-of-Care Conversations: Lessons From High- and Low-Performing Sites From a VA National Initiative. J Pain Symptom Manage. 2020 Aug 8:S0885-3924(20)30652-7. doi: 10.1016/j.jpainsymman.2020.07.040. Online ahead of print.PMID: PMID: 32781166
Cooney TM, Proulx CM, Bekelman DB. Changes in Social Support and Relational Mutuality as Moderators in the Association Between Heart Failure Patient Functioning and Caregiver Burden. J Cardiovasc Nurs. 2020 Jul 29. doi: 10.1097/JCN.0000000000000726. Online ahead of print. PMID: 32740225
Hadler RA, Curtis BR, Ikejiani DZ, Bekelman DB, Harinstein M, Bakitas MA, Hess R, Arnold RM, Kavalieratos D. ""I'd Have to Basically Be on My Deathbed"": Heart Failure Patients' Perceptions of and Preferences for Palliative Care. J Palliat Med. 2020 Jul;23(7):915-921. doi: 10.1089/jpm.2019.0451. Epub 2020 Jan 9. PMID: 31916910
Portz JD, Lum HD, Bull S, Boxer RS, Bekelman DB, Ford KL, Gleason K, Casillas A, Bayliss EA. Perceptions of Patient Portal Use for Advance Directive Documentation among Older Adults with Multiple Chronic Conditions. J Soc Work End Life Palliat Care. 2020 Jul-Sep;16(3):238-249. doi: 10.1080/15524256.2020.1771806. Epub 2020 Jun 1. PMID: 32482160
Bekelman DB, Fink RM, Sannes T, Kline DM, Borrayo EA, Turvey C, Fischer SM. Puente para cuidar (bridge to caring): A palliative care patient navigator and counseling intervention to improve distress in Latino/as with advanced cancer. Psychooncology. 2020 Apr;29(4):688-695. doi: 10.1002/pon.5313. Epub 2019 Dec 27. PMID: 31834646
In the News
- Funding: Improving Implementation of Outpatient Goals of Care Conversations for Veterans with Serious Illness, David Bekelman, MD, MPH
- 15 January 2021 - Dr. David Bekelman, MD, MPH, has received funding along with Dr. Annie Walling, MD, PhD, of VA Greater Los Angeles and Karleen Giannitrapani, PhD of VA Palo Alto to study how to improve implementation of the VA Life Sustaining Treatment Decisions Initiative (LSTDI).
The VA LSTDI is an initiative to elicit, document, and honor the values, goals, and preferences of Veterans with serious illness. The LSTDI is important to Veterans because it ensures they can express their preferences for life sustaining treatments (e.g., cardiopulmonary resuscitation, breathing machine, artificial nutrition) and have them honored. However, across VA nationally, only 39% of LSTDI conversations occur in the outpatient setting; the majority occur in the inpatient setting often close to death. At this late stage, Veterans are often not able to make their preferences known because they are so ill. Decisions fall to surrogates who may be uncertain about what the Veteran would have wanted.
This study will examine ways to increase LSTDI conversations among Veterans and their health care providers earlier in illness in the outpatient setting. The primary aim of this project is to use a clinician-level Sequential Multiple Assignment Randomized Trial (SMART) in three VA health systems to determine the effectiveness of clinician and patient implementation strategies to improve the occurrence of documented goals of care conversations in Veterans with serious medical illness.
