1. Improving outcomes for patients with serious illness

A central tenant to palliative care is to provide interdisciplinary care that is integrated with usual care provided to patients with serious illness regardless of the setting in which the care is being provided. Our projects in this domain have included the following:

Symptom Management Service Database Research


Psilocybin Therapy in Palliative Care

This multi-center, parallel group, randomized controlled trial will evaluate the efficacy and safety of psilocybin therapy compared to an active control in treating demoralization in adults near the end of life. The aim of this multicenter study is to evaluate the efficacy of psilocybin therapy, compared to active control, for treating demoralization in adult patients at the end-of-life.

PIs: Charles Grob, The Linguist Institute | Site investigators: Michael Rabow, MD, Brian Anderson, MD

Primary Addiction Medicine Skills Training for Hospice and Palliative Medicine Fellows

HPM clinicians are increasingly managing pain complicated by substance use, misuse, and use disorder, but little is known about the current national variation in training opportunities, requirements, and challenges in training on primary addiction medicine skills for HPM specialists. We conducted a national survey of Program Directors for all ACGME certified physician, nurse practitioner, social work, and pharmacy HPM fellowships to describe the current state of training as well as to identify areas of greatest value and urgency for curricular development. 

PI: Janet Ho, MD MPH

ENCOMPASS: Education to Navigate Communication and Optimal Management of Pain, Addiction, Substance use, and Serious illness

The aim is to improve HPM clinician comfort and confidence in talking with patients about substance use, misuse, and use disorder in a non-stigmatizing and empathetic manner through practice with simulated patients. We also aim to improve clinician knowledge and skills in managing concurrent non-prescribed substance use and painful serious, decision making around high-risk medications through a benefit/ risk approach, and use of buprenorphine in serious illness. Altogether, this course aims to reduce disparities and stigma in the treatment of pain and addiction, as well as reduce clinician distress around challenging clinical care.

PI: Janet Ho, MD MPH

Support-PC (Substance Use, Pain, and imProving Opiod Risk Together in Palliative Care)

Pilot of an interdisciplinary team to provide additional clinical support in co-managing patients in outpatient palliative care with concurrent substance use, misuse, or use disorder

Investigators: Janet Ho, MD MPHJeannie Zanetti, NP, Teddy Scheel, LCSW MPH, Jules Vieaux, MD

ACE Inhibitors - Bone Marrow Transplant

Multisite, randomized trial of usual care vs combined inpatient and outpatient palliative care for older patients undergoing bone marrow transplant for hematologic malignancy.

Site PI: Mike Rabow, MD

Pediatric Palliative Care Quality Network data analysis

An ongoing collaboration between researchers in the UCSF Division of Palliative Care, the new Division of Pediatric Pain, Palliative, and Integrative Medicine, and external collaborators. The team is currently working on two analytic projects: 1) a descriptive exploration of inpatient pediatric palliative care referral processes and outcomes for children with serious illness, and 2) examination of symptom distress in children after referral to a palliative care team. Additional analyses of the pediatric dataset are planned. Link to first conference abstract: 2022 abstract

PI: Andrea Postier, PhD, MPH (Mentor: David O’Riordan, PhD)

2. Evaluating models of palliative care & quality improvement


Understanding and evaluating new approaches toward the care of patients with a serious illness that are referred for palliative care provides helps identify strengths and opportunities for improvement.  This, in turn, promotes a change in care practices and a framework for dissemination.

Palliative Care Poster

Assessing functional measures used in palliative care

Using data from UCSF, we are updating the prognostic estimates associated with various Palliative Performance Scale (PPS) scores in inpatient and outpatient palliative care settings. We are also exploring whether a given PPS score is associated with a different prognosis in different disease groups, and whether PPS performs equally well when determined via video visit.

Investigators: Alex Smith MD, Kara Bischoff MD

Improving care delivery models

Understanding care delivery models enable us to identify the best practice of patient care throughout the disease trajectory. We are currently studying care delivery models for providing outpatient palliative care to patients with serious illnesses other than cancer, including amyotrophic lateral sclerosis (ALS), interstitial lung disease (ILD), cystic fibrosis (CF), cirrhosis, pulmonary hypertension, dementia, and Parkinson’s disease.

Investigators: Kara Bischoff, MD, Natalie Young, MD, Kwame Adjepong, MD, Eve Cohen, NP

Screening for caregiver needs

Family caregivers play an integral part in patient care.  While many caregivers willingly undertake this role, an extensive body of literature documents the negative physical, emotional, and financial consequences of providing care to their loved ones. The aim of this project is to develop routine clinical assessments of caregiver needs and interventions for emotional and logistical support for sustainable caregiving. This is part of a multi-site quality improvement projects with other palliative care clinics across California.

PI: Carly Zapata, MD, MPH

SMS Psycho-oncology group visit study

Patients with advanced cancer face significant physical and emotional distress, complex medical decisions, and the threat of their own mortality. Psycho-oncology has been demonstrated to improve QOL, distress, and the management of physical symptoms using mind-body interventions. The aim of this study is to evaluate the benefits and impact of a palliative care/Psycho-oncology delivery model and develop a feasible method of integrating group medical visits into routine care at the UCSF Cancer Center.

PI: Stephanie Cheng, MD, Neha Goyal, PhD

Group Visits for Patients Living with Dementia

The overall aim of this project is to improve care of patients living with dementia and their care partners through development of palliative care group visits to promote connection and support for patients and care partners, provide early introduction and connection to specialty palliative care, introduce advance care planning, and discuss how to live with dementia.

PI: Natalie Young, MD

Palliative Care Group Medical Visit Training Program

Create a training program to educate and empower palliative care clinicians to conduct group medical visits (GMVs) as a way to increase patient access to palliative care.

PI: Stephanie Cheng, MD

REACH PC: Comparative Effectiveness of Early Integrated Telehealth versus In-Person Palliative Care for Patients with Advanced Lung Cancer

The goal of the REACH PC project is to evaluate the comparative effectiveness of early integrated palliative care delivered via telehealth versus in-person for improving QOL, depression, satisfaction with care, and end-of-life (EOL) care outcomes among patients with advanced non-small-cell lung cancer (NSCLC) and their caregivers.

PI: Jennifer S. Temel, MD – Harvard Medical School, Boston, Massachusetts, Joseph A. Greer, MD – Massachusetts General Hospital, Michael Rabow, MD – Site PI

In-Person Palliative Care for Patients with Advanced Lung Cancer


3. Ensuring equitable access to PC

Our vision is that all patients with serious illness and their family caregivers will be routinely assessed for palliative care needs and provided tailored care that is aligned with their values and goals.

Population disparities in palliative care

We are assessing the demographics of patients who are referred to our palliative care services, who establish care in palliative care, and who return for follow-up to ensure that our services are serving people of all demographic groups equitably.

PI: Kara Bischoff, MD

PROactive Palliative Care (Pro–PC)

The vision at the DPM is to fundamentally change the approach to care for people with serious illness from one in which patients are “lucky” to receive PC to one in which their PC needs are reliably and proactively identified and addressed. PRO-PC aims to build this reliable system of care by developing and institutionalizing a screening protocol to identify the PC needs systematically and proactively of seriously ill inpatients and their family caregivers.

PI: Laura Schoenherr, MD

Care +

Care+ is an outpatient project that aims to develop a system of proactive screening for palliative care needs in a population of seriously ill patients, and routing patients and family caregivers to tiered palliative care services specifically tailored to meet their care needs.

Principal Investigator: Kara Bischoff, MD, Steve Pantilat, MD, Mike Rabow, MD, Bridget Sumser, MSW, Judy Long, Carly Zapata, MD, MPH

Assessing socio-demographic disparities in Telehealth

People of color and those with limited English proficiency and low socioeconomic status have a lower quality of care and lower utilization of palliative care.  Compounding these challenges, the COVID-19 pandemic has revealed significant disparities in access to virtual (specifically video) visits in primary care among these disadvantaged populations. This situation is highly concerning as it suggests the increasing use of virtual visits may result in widening the already existing disparities to palliative care access.  The goal of this proposal is to evaluate the process and clinical outcomes of in-person vs virtual visits and assess the patient characteristics associated with outpatient palliative care access.

Principal Investigator: Sarah Nouri, MD, MPH