Scholars@Duke
Katherine Ramos

Katherine Ramos

Associate Professor in Psychiatry and Behavioral Sciences
Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences
DUMC Box 102506, Durham, NC 27710
2400 Pratt Street, Room 7057, Durham, NC 27705

Scholarly Works - Journal articles

Depression, non-medical pain prescriptions, and suicidal behavior in cancer survivors.

Journal article J Cancer Surviv · August 2026 PURPOSE: A cancer diagnosis results in significant distress and adverse psychosocial sequelae, including suicide, the 10th leading cause of death in the USA. Primary risks for death by suicide include depression and opioid abuse, which are prevalent among ... Full text Link to item Cite

Emotion Regulation Treatment to Enhance Active Aging in Older Adults with Affective Distress: A Pilot Study.

Journal article J Contemp Psychother · April 13, 2026 This pilot study evaluated the feasibility and acceptability of a five-session version of the transdiagnostic Unified Protocol adapted for older adults with emotional distress and impaired functional activity. In Phase 1, the therapist-delivered treatment ... Full text Link to item Cite

A virtual program to teach pain coping skills to dyads of caregivers and Veterans with dementia or mild cognitive impairment: Preliminary quantitative and qualitative findings.

Journal article Palliat Support Care · April 8, 2026 OBJECTIVES: To evaluate the feasibility and preliminary efficacy of a clinical program designed to teach informal caregivers of older Veterans with pain and mild-to-moderate dementia or mild cognitive impairment (MCI), pain management, pain coping and pain ... Full text Open Access Link to item Cite

Top Ten Tips Palliative Care Clinicians Should Know About Wound Care.

Journal article J Palliat Med · March 30, 2026 Wounds are a common and burdensome problem for patients with serious illness receiving palliative care and hospice services. Declining mobility, functional impairment, malnutrition, progression of underlying disease, and age-related skin changes all increa ... Full text Link to item Cite

Characterizing Intervention Components and Complexity of Nonpharmacologic Healthcare Interventions to Manage Distress Behaviors in Older Adults.

Journal article J Appl Gerontol · January 2026 Distress behaviors are common in residential care settings and contribute to staff burnout and poor quality of life for older adults. While nonpharmacologic interventions reduce distress behaviors, implementation in routine care remains challenging. Our st ... Full text Link to item Cite

Prevalence and Impact of Traumatic Life Events among Black and White Family Members of Intensive Care Unit Patients.

Journal article Ann Am Thorac Soc · November 2025 Rationale: Lifetime trauma is common and may affect interactions with the healthcare system. Objectives: To measure the prevalence of lifetime trauma and its association with family-clinician interpersonal outcomes in the intensive care unit (ICU). Methods ... Full text Open Access Link to item Cite

Adaptation and Implementation of Self-System Therapy for Older Adults with Advanced Lung Cancer: Pilot Trial Results.

Journal article Cancers (Basel) · August 28, 2025 Background/Objectives: Advanced lung cancer is a highly distressing disease that negatively impacts older adults. Supportive care interventions designed for this population are scarce and often inaccessible due to competing demands and transportation acces ... Full text Open Access Link to item Cite

Adaptation and Implementation of Self-System Therapy for Older Adults with Advanced Lung Cancer: Pilot Trial Results

Journal article Cancers · August 28, 2025 Background/Objectives: Advanced lung cancer is a highly distressing disease that negatively impacts older adults. Supportive care interventions designed for this population are scarce and often inaccessible due to competing demands and transportati ... Full text Open Access Cite

Assessing the Content of Goals of Care Documentation for Hospitalized Patients With Alzheimer's Disease and Related Dementias.

Journal article J Am Geriatr Soc · August 2025 BACKGROUND: Goals of care (GOC) conversations are an evidence-based practice that help clarify and align patient values and preferences for medical care with treatment options. Little is known about how clinicians document the content of GOC conversations ... Full text Link to item Cite

Empower GBM: A pilot study of a patient-caregiver supportive intervention for patients with glioblastoma.

Journal article Palliat Support Care · July 18, 2025 OBJECTIVES: The aim of this article is to develop and pilot test a new supportive care intervention, Empower GBM, designed for patients with glioblastoma and their family caregivers to reduce psychological distress and improve quality of life. METHODS: Qua ... Full text Open Access Link to item Cite

Non-curative care options for patients with advanced-stage head and neck cancer: Current state of the science and future opportunities.

Journal article Palliat Support Care · February 17, 2025 OBJECTIVES: Head and neck cancer (HNC) often requires complex management and care. While the primary goal of treatment is curative, some advanced cases require consideration of non-curative pathways to optimize patients' quality of life (QOL) and survival. ... Full text Link to item Cite

Identity, Resilience and their Psychological Impact Among Older Adults with Cancer

Journal article Vertices: Duke's Undergraduate Research Journal · February 2025 Older adults (65+) make up 60% of cancer diagnoses and 70% of deaths related to cancer (Marosi & Köller, 2016). Although this age group experiences significant distress, behavioral studies investigating distress tend to be overrepresented by yo ... Full text Cite

Understanding and Addressing Mental Health Disparities and Stigma in Serious Illness and Palliative Care.

Journal article Illn Crises Loss · January 2025 Patients receiving palliative care experience stigma associated with their illness, personal identity, and healthcare utilization. These stigmas can occur at any stage of the disease process. Varying stigmas combine to cause palliative care patients to fee ... Full text Link to item Cite

Parenting Concerns, Psychological Distress, and Relationship Adjustment Among Patients With Cancer and Their Partners: A Longitudinal Study.

Journal article Psychooncology · January 2025 OBJECTIVE: Studies have found that cancer patients with dependent children exhibit high symptoms of anxiety, depression, and worry. Patients' parenting concerns can negatively impact their own and their family's adjustment to the cancer experience. However ... Full text Link to item Cite

Understanding veterans' experiences with lung cancer and psychological distress: A multimethod approach.

Journal article Psychol Serv · November 2024 Psychological distress while coping with cancer is a highly prevalent and yet underrecognized and burdensome adverse effect of cancer diagnosis and treatment. Left unaddressed, psychological distress can further exacerbate poor mental health, negatively in ... Full text Open Access Link to item Cite

Head and neck cancer mortality in the United States: Regional differences in hospice use and place of death.

Journal article BJC Rep · October 8, 2024 BACKGROUND: With more than 15,000 annual deaths from head and neck cancer (HNC), an important aspect of end-of-life care for these patients is place of death. Recent evidence suggests an increasing preference for home/hospice at end of life; however, it is ... Full text Open Access Link to item Cite

Couples communication and cancer: Sequences and trajectories of behavioral affective processes in relation to intimacy.

Journal article J Fam Psychol · March 2024 Cancer poses a set of physical and emotional challenges to the patient, spouse, and their relationship. One challenge for couples is discussing cancer-related concerns in a manner that facilitates intimacy. Current couple-based interventions have been show ... Full text Link to item Cite

Efficacy of BETTER transitional care intervention for diverse patients with traumatic brain injury and their families: Study protocol of a randomized controlled trial.

Journal article PLoS One · 2024 OBJECTIVE: The purpose of this study is to examine the efficacy of BETTER (Brain Injury, Education, Training, and Therapy to Enhance Recovery) vs. usual transitional care management among diverse adults with traumatic brain injury (TBI) discharged home fro ... Full text Open Access Link to item Cite

Health Care Team Interventions to Reduce Distress Behaviors in Older Adults: A Systematic Review.

Journal article Clin Gerontol · 2024 OBJECTIVES: This review examines health care team-focused interventions on managing persistent or recurrent distress behaviors among older adults in long-term residential or inpatient health care settings. METHODS: We searched interventions addressing heal ... Full text Link to item Cite

Concurrent and Prospective Associations Between Communicated Emotional Arousal and Adjustment Among Couples Coping With Cancer.

Journal article Ann Behav Med · August 21, 2023 BACKGROUND: The experience of cancer can create considerable emotional distress for patients and their committed partners. How couples communicate about cancer-related concerns can have important implications for adjustment. However, past research has prim ... Full text Link to item Cite

Knowledge, goals, and misperceptions about palliative care in adults with chronic disease or cancer.

Journal article Palliat Support Care · August 10, 2023 OBJECTIVES: Limited evidence investigates how knowledge, misconceptions, and beliefs about palliative care vary across patients with cancerous versus non-cancerous chronic disease. We examined the knowledge of and misconceptions about palliative care among ... Full text Link to item Cite

Top Ten Tips Palliative Care Clinicians Should Know About Behavioral Pain Management for Persistent Pain.

Journal article J Palliat Med · July 2023 Seriously ill patients often experience persistent pain. As a part of a comprehensive repertoire of pain interventions, palliative care clinicians can help by using behavioral pain management. Behavioral pain management refers to evidence-based psychosocia ... Full text Link to item Cite

Meaning-centered pain coping skills training for patients with metastatic cancer: Results of a randomized controlled pilot trial.

Journal article Psychooncology · July 2023 OBJECTIVE: For patients with advanced cancer, pain is a common and debilitating symptom that can negatively impact physical, emotional, and spiritual well-being. This trial examined the feasibility and initial effects of Meaning-Centered Pain Coping Skills ... Full text Link to item Cite

Patient experiences of a care transition intervention for Veterans to reduce emergency department visits.

Journal article Acad Emerg Med · April 2023 OBJECTIVES: Care transition interventions (CTIs) are used to improve outcomes after an emergency department (ED) visit. A recent randomized controlled trial of a Veterans Health Administration (VHA) CTI titled Discharge Information and Support for Patients ... Full text Link to item Cite

Attachment in Couples Coping with Cancer: Associations with Observed Communication and Long-Term Health.

Journal article Int J Environ Res Public Health · March 24, 2023 Cancer poses a threat to well-being that may activate the attachment system and influence interpersonal dynamics, such as communication. Research indicates that avoidant and anxious attachment, as well as communication, are independently associated with po ... Full text Link to item Cite

Barriers and facilitators to the implementation and adoption of improvement coaching: A qualitative evidence synthesis.

Journal article J Clin Nurs · January 2023 BACKGROUND: Healthcare organisations and teams perform improvement activities to facilitate high-quality healthcare. The use of an improvement coach who provides support and guidance to the healthcare team may facilitate improvement activities; however, no ... Full text Link to item Cite

Partnering to cope with pain: A pilot study of a caregiver-assisted pain coping skills intervention for patients with cognitive impairment and dementia.

Journal article Palliat Support Care · December 2022 OBJECTIVE: To develop a new caregiver-assisted pain coping skills training protocol specifically tailored for community-dwelling persons with cognitive impairment and pain, and assess its feasibility and acceptability. METHOD: In Phase I, we conducted inte ... Full text Link to item Cite

Evaluating a couple communication skills training (CCST) intervention for advanced cancer: study protocol for a randomized controlled trial.

Journal article Trials · August 26, 2022 BACKGROUND: For patients and their intimate partners, advanced cancer poses significant challenges that can negatively impact both individuals and their relationship. Prior studies have found evidence that couple-based communication skills interventions ca ... Full text Link to item Cite

Psychological distress among medically complex veterans with a recent emergency department visit.

Journal article Psychol Serv · May 2022 Medical complexity and psychological distress are associated with frequent emergency department (ED) use. Despite this known association, our understanding is limited about which patients are at risk for persistent psychological distress and what patterns ... Full text Link to item Cite

Mental Health Impacts of the COVID-19 Pandemic

Journal article Generations (San Francisco) · April 27, 2022 Throughout the course of the pandemic, the mental health of many has suffered due to social isolation, disruptions to daily living, and limitations in participating in previously enjoyed activities. This article provides an overview about the mental health ... Link to item Cite

Effectiveness of Quality Improvement Coaching on Process Outcomes in Health Care Settings: A Systematic Review.

Journal article J Gen Intern Med · March 2022 BACKGROUND: A culture of improvement is an important feature of high-quality health care systems. However, health care teams often need support to translate quality improvement (QI) activities into practice. One method of support is consultation from a QI ... Full text Link to item Cite

Meaning-Centered Pain Coping Skills Training: A Pilot Feasibility Trial of a Psychosocial Pain Management Intervention for Patients with Advanced Cancer.

Journal article J Palliat Med · January 2022 Background: Pain from advanced cancer can greatly reduce patients' physical, emotional, and spiritual well-being. Objective: To examine the feasibility and acceptability of a behavioral pain management intervention, Meaning-Centered Pain Coping Skills Trai ... Full text Link to item Cite

Mental healthcare and palliative care: barriers.

Journal article BMJ Support Palliat Care · June 2021 CONTEXT: Psychological symptoms are common among palliative care patients with advanced illness, and their effect on quality of life can be as significant as physical illness. The demand to address these issues in palliative care is evident, yet barriers e ... Full text Link to item Cite

Couple Communication in Cancer: Protocol for a Multi-Method Examination.

Journal article Front Psychol · 2021 Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples' ability to communicate effectively plays a major role in the psychological a ... Full text Link to item Cite

Current measures of distress may not account for what's most important in existential care interventions: Results of the outlook trial.

Journal article Palliat Support Care · December 2020 OBJECTIVE: Compare the efficacy of two interventions addressing emotional and existential well-being in early life-limiting illness. METHOD: Primary trial analysis (n = 135) included patients with advanced cancer, congestive heart failure, or end-stage ren ... Full text Link to item Cite

Attachment Style, Partner Communication, and Physical Well-Being among Couples Coping with Cancer.

Journal article Pers Relatsh · September 2020 Attachment styles may influence interpersonal strategies used to cope with stress. We examined links between attachment style, communicative behaviors, and physical well-being among 166 couples coping with cancer. Results of actor-partner interdependence m ... Full text Link to item Cite

Enhancing meaning in the face of advanced cancer and pain: Qualitative evaluation of a meaning-centered psychosocial pain management intervention.

Journal article Palliat Support Care · June 2020 OBJECTIVES: The objectives of this study were to obtain patient evaluations of the content, structure, and delivery modality of Meaning-Centered Pain Coping Skills Training (MCPC), a novel psychosocial intervention for patients with advanced cancer and pai ... Full text Link to item Cite

Anxiety Disorders in Late Life.

Journal article Clin Geriatr Med · May 2020 Anxiety disorders in later life are some of the most significant mental health problems affecting older adults. Prevalence estimates of anxiety disorders in late life vary considerably based on multiple methodological issues. Current diagnostic criteria ma ... Full text Link to item Cite

Connecting Caregivers to Support: Lessons Learned From the VA Caregiver Support Program.

Journal article J Appl Gerontol · April 2020 Development and evaluation of supportive caregiver interventions has become a national priority. This study's aim was to evaluate how caregivers participating in the Department of Veterans Affairs (VA) Caregiver Support Program (CSP) use and value supporti ... Full text Link to item Cite

Psychometric properties of worry and anxiety measures in a sample of african american and caucasian older adults.

Journal article Aging Ment Health · February 2020 Objective: The aim of our study was to examine the psychometric properties of commonly used anxiety and worry assessment measures in a community-based, low-income sample of African American and Caucasian older adults.Method: African American and Caucasian ... Full text Link to item Cite

Discharge Information and Support for Patients Discharged from the Emergency Department: Results from a Randomized Controlled Trial.

Journal article J Gen Intern Med · January 2020 BACKGROUND: Little research has been done on primary care-based models to improve health care use after an emergency department (ED) visit. OBJECTIVE: To examine the effectiveness of a primary care-based, nurse telephone support intervention for Veterans t ... Full text Link to item Cite

Self-System Therapy for Older Adults With Lung Cancer

Journal article Case Medical Research · August 15, 2019 Full text Cite

Emergency Department Interventions for Older Adults: A Systematic Review.

Journal article J Am Geriatr Soc · July 2019 OBJECTIVES: To evaluate the effect of emergency department (ED) interventions on clinical, utilization, and care experience outcomes for older adults. DESIGN: A conceptual model informed, protocol-based systematic review. SETTING: Emergency Department (ED) ... Full text Link to item Cite

Assessing Key Stakeholders' Knowledge, Needs, and Preferences for Head and Neck Cancer Survivorship Care Plans.

Journal article J Cancer Educ · June 2019 Cancer survivorship care plans (SCPs) are endorsed to support quality care for cancer survivors, but uptake is slow. We assessed knowledge, needs, and preferences for SCP content and delivery from a wide variety of stakeholders. We focused SCP content for ... Full text Open Access Link to item Cite

Integrated outpatient palliative care for patients with advanced cancer: A systematic review and meta-analysis.

Journal article Palliat Med · February 2019 BACKGROUND:: Despite increasing emphasis on integration of palliative care with disease-directed care for advanced cancer, the nature of this integration and its effects on patient and caregiver outcomes are not well-understood. AIM:: We evaluated the effe ... Full text Link to item Cite

Life Program: Pilot Testing a Palliative Psychology Group Intervention.

Journal article J Palliat Med · November 2018 BACKGROUND: Psychosocial interventions for palliative care populations, individuals with life-limiting illness, improve distress; however, less is known about these interventions among military Veterans. OBJECTIVES: This quality improvement project evaluat ... Full text Open Access Link to item Cite

Career Planning Confidence Among Facebook Users: Contributions of Adult Attachment Security and Authenticity

Journal article Journal of Career Assessment · November 1, 2018 As a highly popular social networking site (SNS) for exchanging information about their personal activities, values, goals, and accomplishments with their online “friends,” Facebook (FB)© enables social comparisons and identity negotiations that ... Full text Cite

Development and initial validation of a measure of attachment security in late adulthood.

Journal article Psychol Assess · September 2018 Attachment theory-guided studies of older adults have generally relied on self-report measures that were validated on young adult samples and that focus on fears of rejection by romantic partners and on experiences of chronic discomfort with romantic intim ... Full text Link to item Cite

Psychotherapy Targeting Depression and Anxiety for Use in Palliative Care: A Meta-Analysis.

Journal article J Palliat Med · July 2018 BACKGROUND: Research on the effectiveness of evidence-based practices in the treatment of depression and anxiety with palliative care populations is primarily limited to individuals having specific conditions such as cancer. OBJECTIVE: This meta-analysis e ... Full text Link to item Cite

Anxiety Disorders in Late Life.

Journal article Psychiatr Clin North Am · March 2018 Anxiety disorders in later life are some of the most significant mental health problems affecting older adults. Prevalence estimates of anxiety disorders in late life vary considerably based on multiple methodological issues. Current diagnostic criteria ma ... Full text Link to item Cite

Effects of religious versus conventional cognitive-behavioral therapy (CBT) on suicidal thoughts in major depression and chronic medical illness

Journal article Psychology of Religion and Spirituality · February 1, 2018 We compared the effectiveness of religiously integrated cognitive-behavioral therapy (RCBT) versus conventional CBT (CCBT) on decreasing suicidal thoughts in persons with major depressive disorder (MDD) and chronic medical illness (CMI). Persons ages 18-85 ... Full text Cite

Attachment security and career adaptability as predictors of subjective well-being among career transitioners

Journal article Journal of Vocational Behavior · February 1, 2018 One's career adaptability can provide valuable information regarding the quality of their life satisfaction and life meaning during important career transitions. To date, however, few studies have examined the dispositional antecedents of career adaptabili ... Full text Cite

Improving Medication Adherence in Coronary Heart Disease.

Journal article Curr Cardiol Rep · September 22, 2017 PURPOSE OF REVIEW: The purpose of this review was to synthesize research findings from recently published randomized controlled trials (RCTs) targeting any phase of medication adherence, from initiation to discontinuation, among patients with coronary hear ... Full text Open Access Link to item Cite

An Exploration of Gender and Career Stage Differences on a Multidimensional Measure of Work Meaningfulness

Journal article Journal of Career Assessment · August 1, 2017 In recent years, the constructs of work meaning and work meaningfulness have been differentiated, and multidimensional measures of the latter have been developed. In the present study, we administered one such measure—the Comprehensive Meaningful Work Scal ... Full text Cite

Vida Calma: CBT for Anxiety with a Spanish-Speaking Hispanic Adult.

Journal article Clin Gerontol · 2017 BACKGROUND: Hispanic adults aged 55 years and older are the fastest growing ethnic minority group in the United States facing significant mental health disparities. Barriers in accessing care have been attributed to low income, poor education, language bar ... Full text Link to item Cite

Psychosocial Health of Older Adults with Cancer: Clinical Interventions Promoting Meaning and Value-Driven Behavior

Journal article Current Geriatrics Reports · September 1, 2016 The last decade has evidenced a strong push by the interdisciplinary medical community to improve mental health service delivery with older adults. As this momentum grows, additional questions are raised regarding the utility of psychosocial interventions ... Full text Cite

Reliability and Validity of the Vietnamese Depression Interview (VDI).

Journal article J Immigr Minor Health · August 2016 Current instruments used to aid in the diagnosis of psychological disorders have limited effectiveness with clients from Asian backgrounds. The Vietnamese Depression Interview (VDI) is a diagnostic instrument created to assess the presence of current and l ... Full text Link to item Cite

Predicting well-being in managers: Test of a positive psychology model

Journal article Journal of Positive Psychology · July 3, 2016 Contemporary scholars in vocational, applied, and organizational psychology have emphasized that working must be understood as a relational act with important implications for worker well-being. Drawing upon emergent research extending the constructs of ad ... Full text Cite

Building a primary care/research partnership: lessons learned from a telehealth intervention for diabetes and depression.

Journal article Fam Pract · April 2015 INTRODUCTION: Evidence-based interventions are often poorly translated into primary care settings due to inadequate integration into organizational cultures and clinical workflows. Study designs that blend evaluation of effectiveness and implementation may ... Full text Link to item Cite

Predicting the Presence and Search for Life Meaning: Test of an Attachment Theory-Driven Model

Journal article Journal of Happiness Studies · February 1, 2015 To date, little is known about how perceptions of life meaning are formed, although recent evidence suggests that “basic attitudes about the meaning of existence are commonly rooted in evolved biological factors and conjointly influenced through people’s e ... Full text Cite

Incorporating Nonmainstream Spirituality into CBT for Anxiety: A Case Study

Journal article Spirituality in Clinical Practice · December 1, 2014 Generalized anxiety disorder is common in adults, and cognitive-behavior therapy has demonstrated positive outcomes. Recent approaches have considered the potential benefit of incorporating religion and spirituality into cognitive-behavioral therapy for ge ... Full text Cite

Parental antipathy and neglect: Relations with Big Five personality traits, cross-context trait variability and authenticity

Journal article Personality and Individual Differences · January 1, 2014 A sample of adults (N= 553) aged 18-56 completed self-report measures of recalled parental antipathy/neglect in childhood, Big Five personality traits (rated across three contexts: with parents, friends and work colleagues), and authenticity. Parents, frie ... Full text Cite

Authenticity, Social Context, and Well-Being in the United States, England, and Russia: A Three Country Comparative Analysis

Journal article Journal of Cross Cultural Psychology · July 1, 2013 The study investigated interrelationships among trait authenticity, context-specific authenticity, and well-being in three samples drawn from England, the United States, and Russia. Six hundred and twenty-eight adults participated: 196 from the United Stat ... Full text Cite