Scholars@Duke
Caroline Sloan

Caroline Sloan

Assistant Professor of Medicine
Medicine, General Internal Medicine

Selected Publications

Understanding the Causes of Nonadherence to Chronic Medications Among Patients With Cancer and Multimorbidity: A Qualitative Study.

Journal Article J Gen Intern Med · December 9, 2025 BACKGROUND: When patients with multimorbidity (≥ 2 chronic diseases) are diagnosed with cancer, their adherence to non-cancer medications declines. Nonadherence in this patient population has been linked to an increased risk of disease progression, hospita ... Full text Link to item Cite

Transforming provider-patient vaccine conversations: a randomised trial on presumptive communication training.

Journal Article BMJ Lead · December 9, 2025 BACKGROUND: Despite the widespread availability of many vaccines and health providers' favourable attitudes towards vaccines, suboptimal immunisation rates persist worldwide. This study investigates the impact of presumptive (opt-out) communication trainin ... Full text Link to item Cite

Financial Toxicity among Survivors of Extremity and Pelvic Sarcoma: A Retrospective Study.

Journal Article Ann Surg Oncol · November 13, 2025 BACKGROUND: Financial toxicity in oncology, defined as the economic burden and psychosocial distress of cancer care, has been associated with poor clinical outcomes. Despite high projected treatment costs, data on financial toxicity in patients with sarcom ... Full text Link to item Cite

A Patient-Informed Framework of Financial Strain Among Adults with Multimorbidity.

Journal Article J Gen Intern Med · November 3, 2025 BACKGROUND: Over one-quarter of adults have multimorbidity. Patients with multimorbidity are more likely to struggle to afford their care than patients without multimorbidity, but their experiences with financial strain have not been fully described. OBJEC ... Full text Link to item Cite

Associations between neighborhood socioeconomic status, readmission, and mortality for patients with cancer: A nationwide cohort study.

Journal Article Cancer Epidemiol · October 2025 BACKGROUND: Cancer presents a disproportionate burden, particularly among individuals from low socioeconomic status neighborhoods. Disparities in outcomes persist, influenced by limited access to healthcare services, cultural barriers, and neighborhood soc ... Full text Link to item Cite

Health Expenditures Decline After Bariatric Surgery for Patients With Type 2 Diabetes.

Journal Article Diabetes Care · September 1, 2025 OBJECTIVE: Bariatric surgery lowers the risk of developing microvascular and macrovascular complications of type 2 diabetes, but it is unclear whether it also lowers long-term health expenditures in this population. RESEARCH DESIGN AND METHODS: In a retros ... Full text Link to item Cite

Impact of Medical Conditions and Area Deprivation on Fundraising Success in Online Crowdfunding: Cross-Sectional Study.

Journal Article J Med Internet Res · July 29, 2025 BACKGROUND: Web-based crowdfunding is commonly used to defray medical expenses, but it is not fully known which factors determine fundraising success. Previous studies have usually focused on a single disease category at a time or a small number of mutuall ... Full text Link to item Cite

Association Between Polypharmacy and Physical Function in Middle-aged Adults: Findings from the CARDIA Function Study.

Journal Article J Gen Intern Med · July 7, 2025 BACKGROUND: Polypharmacy (≥ 5 medications) and potentially inappropriate medications (PIM; per Beers criteria) are common in midlife. Polypharmacy and PIM use are associated with poor physical function and adverse health outcomes in older age, but the asso ... Full text Link to item Cite

Receipt of Alcohol Screening, Brief Intervention, and Treatment Among US Adults With and Without a History of Cancer.

Journal Article JCO Oncol Pract · May 9, 2025 PURPOSE: Many cancer survivors consume alcohol above recommended limits, increasing their risk of recurrence, second cancers, and cancer-related mortality. Alcohol screening, brief intervention, and referral to treatment (SBIRT) is a guideline-recommended ... Full text Link to item Cite

Health Expenditures of Patients With Diabetes After Bariatric Surgery: Comparing Gastric Bypass and Sleeve Gastrectomy.

Journal Article Ann Intern Med · March 2025 BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differ in their effects on body weight and risk for reoperation. However, it is unclear whether long-term health expenditures differ by procedure type in patients with diabetes. OBJECT ... Full text Link to item Cite

Contributors and Solutions to High Out-of-Pocket Costs for Heart Failure Medications: A State-of-the-Art Review.

Journal Article J Am Coll Cardiol · February 4, 2025 As expensive therapeutics rise to the fore of heart failure management, out-of-pocket (OOP) medication costs have become increasingly relevant to patient care. Prescription medication costs influence medical decision-making and affect adherence. Yet, indiv ... Full text Link to item Cite

Integrating Out-of-Pocket Costs Into Shared Decision-Making for Heart Failure With Reduced Ejection Fraction: A Stepped-Wedge Trial (POCKET-COST-HF).

Journal Article Circ Cardiovasc Qual Outcomes · January 2025 BACKGROUND: Guideline-directed medical therapy for heart failure (HF) with reduced ejection fraction can entail high out-of-pocket (OOP) costs, prompting concerns about financial toxicity and access. OOP costs are generally unavailable during encounters. T ... Full text Link to item Cite

Examining Medical Interventions in Older Adults with Limited Life Expectancy—Opportunities and Challenges for De-implementation

Journal Article Sage Open Aging · January 1, 2025 Purpose: The benefits and harms of medical interventions shift as patients age, calling for re-evaluation of each intervention’s appropriateness and alignment with patients’ preferences. Continued use of medical interventions when harms outweigh benefits i ... Full text Cite

Medicare Enrollment and Spending Among Patients Initiating Dialysis After the Affordable Care Act.

Journal Article JAMA Health Forum · December 6, 2024 IMPORTANCE: Medicare finances health care for most US patients with end-stage kidney disease (ESKD), regardless of age. Medicare enrollment may have slowed for patients with incident ESKD who gained access to new private insurance options with the 2014 pas ... Full text Link to item Cite

Health Expenditures After Bariatric Surgery: A Retrospective Cohort Study.

Journal Article Ann Surg · December 1, 2024 OBJECTIVE: To compare expenditures between surgical and matched nonsurgical patients in a retrospective cohort study. BACKGROUND: Bariatric surgery leads to substantial improvements in weight and weight-related conditions, but prior literature on postsurgi ... Full text Link to item Cite

A comparison of time-varying propensity score vs sequential stratification approaches to longitudinal matching with a time-varying treatment.

Journal Article BMC Med Res Methodol · November 13, 2024 BACKGROUND: Methods for matching in longitudinal cohort studies, such as sequential stratification and time-varying propensity scores, facilitate causal inferences in the context of time-dependent treatments that are not randomized where patient eligibilit ... Full text Link to item Cite

Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries.

Journal Article J Am Geriatr Soc · August 2024 BACKGROUND: The use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program ... Full text Link to item Cite

Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure.

Journal Article JAMA Health Forum · May 3, 2024 IMPORTANCE: Comprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to encourag ... Full text Link to item Cite

Eliminating Health Disparities in Atrial Fibrillation, Heart Failure, and Dyslipidemia: A Path Toward Achieving Pharmacoequity.

Journal Article Curr Atheroscler Rep · December 2023 PURPOSE OF REVIEW: Pharmacoequity refers to the goal of ensuring that all patients have access to high-quality medications, regardless of their race, ethnicity, gender, or other characteristics. The goal of this article is to review current evidence on dis ... Full text Open Access Link to item Cite

Rates of Medicare Enrollment Among Dialysis Patients After Implementation of Medicare Payment Reform and the Affordable Care Act Marketplace.

Journal Article JAMA Netw Open · September 1, 2022 IMPORTANCE: Medicare finances health care for most US patients with end-stage kidney disease (ESKD), regardless of age. The 2011 Medicare prospective payment system (PPS) for dialysis reduced reimbursement for hemodialysis, and the 2014 Patient Protection ... Full text Link to item Cite

How can healthcare organizations improve cost-of-care conversations? A qualitative exploration of clinicians' perspectives.

Journal Article Patient Educ Couns · August 2022 OBJECTIVES: Clinicians increasingly believe they should discuss costs with their patients. We aimed to learn what strategies clinicians, clinic leaders, and health systems can use to facilitate vital cost-of-care conversations. METHODS: We conducted focus ... Full text Link to item Cite

Accuracy of Physician Estimates of Out-of-Pocket Costs for Medication Filling.

Journal Article JAMA Netw Open · November 1, 2021 IMPORTANCE: One-third of US residents have trouble paying their medical bills. They often turn to their physicians for help navigating health costs and insurance coverage. OBJECTIVE: To determine whether physicians can accurately estimate out-of-pocket exp ... Full text Link to item Cite

Trends in Dialysis Industry Consolidation After Medicare Payment Reform, 2006-2016.

Journal Article JAMA Health Forum · November 2021 IMPORTANCE: The dialysis industry is highly concentrated, with large dialysis organizations now providing dialysis for more than 85% of patients with kidney failure in the United States. In 2011, Medicare introduced a new Prospective Payment System (PPS) f ... Full text Open Access Link to item Cite

Trends in Regional Supply of Peritoneal Dialysis in an Era of Health Reform, 2006 to 2013.

Journal Article Med Care Res Rev · June 2021 Peritoneal dialysis (PD), a home-based treatment for kidney failure, is associated with similar mortality, higher quality of life, and lower costs compared with hemodialysis. Yet <10% of patients receive PD. Access to this alternative treatment, vis-à-vis ... Full text Link to item Cite

Comparing Mortality of Peritoneal and Hemodialysis Patients in an Era of Medicare Payment Reform.

Journal Article Med Care · February 1, 2021 BACKGROUND: Prior studies have shown peritoneal dialysis (PD) patients to have lower or equivalent mortality to patients who receive in-center hemodialysis (HD). Medicare's 2011 bundled dialysis prospective payment system encouraged expansion of home-based ... Full text Link to item Cite

Resident Physician Experiences With and Responses to Biased Patients.

Journal Article JAMA Netw Open · November 2, 2020 IMPORTANCE: Biased patient behavior negatively impacts resident well-being. Data on the prevalence and frequency of these encounters are lacking and are needed to guide the creation of institutional trainings and policies to support trainees. OBJECTIVE: To ... Full text Link to item Cite

Fragmentation of care as a barrier to optimal ESKD management.

Journal Article Semin Dial · November 2020 Caring for patients with end-stage kidney disease (ESKD) in the United States is challenging, due in part to the complex epidemiology of the disease's progression as well as the ways in which care is delivered. As CKD progresses toward ESKD, the number of ... Full text Link to item Cite

Short-Term VA Health Care Expenditures Following a Health Risk Assessment and Coaching Trial.

Journal Article J Gen Intern Med · May 2020 BACKGROUND: Short-term health care costs following completion of health risk assessments and coaching programs in the VA have not been assessed. OBJECTIVE: To compare VA health care expenditures among veterans who participated in a behavioral intervention ... Full text Link to item Cite

Trends in Peritoneal Dialysis Use in the United States after Medicare Payment Reform.

Journal Article Clin J Am Soc Nephrol · December 6, 2019 BACKGROUND AND OBJECTIVES: Peritoneal dialysis (PD) for ESKD is associated with similar mortality, higher quality of life, and lower costs compared with hemodialysis (HD), but has historically been underused. We assessed the effect of the 2011 Medicare pro ... Full text Link to item Cite

Ask Early and Ask Often: How Discussing Costs Could Save Your Patient's Life.

Journal Article N C Med J · 2018 Out-of-pocket spending continues to increase, particularly in cancer care. High out-of-pocket expenditures are associated with increased psychosocial distress, lower adherence, and higher mortality. In order to improve cancer-related outcomes, we must come ... Full text Link to item Cite

Urine assay for tenofovir to monitor adherence in real time to tenofovir disoproxil fumarate/emtricitabine as pre-exposure prophylaxis.

Journal Article HIV Med · July 2017 OBJECTIVES: Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) is approved for pre-exposure prophylaxis (PrEP) against HIV infection. Adherence is critical for the success of PrEP, but current adherence measurements are inadequate for real-time adherenc ... Full text Link to item Cite

A Modified Integrated Genetic Model for Risk Prediction in Younger Patients with Acute Myeloid Leukemia.

Journal Article PLoS One · 2016 BACKGROUND: Although cytogenetics-based prognostication systems are well described in acute myeloid leukemia (AML), overall survival (OS) remains highly variable within risk groups. An integrated genetic prognostic (IGP) model using cytogenetics plus mutat ... Full text Link to item Cite

Appropriateness of expectorated sputum cultures in the hospital setting.

Journal Article Diagn Microbiol Infect Dis · September 2015 We assessed whether expectorated sputum samples are ordered according to national guidelines and the impact of culture results on patient management. Overall, guidelines for ordering sputum samples were followed for 23% (18/78) of patients. Results affecte ... Full text Link to item Cite

Multifocal mantle cell lymphoma in situ in the setting of a composite lymphoma.

Journal Article Am J Clin Pathol · February 2015 OBJECTIVES: Mantle cell lymphoma in situ (MCLIS) consists of immunophenotypically defined but histologically inapparent neoplastic cells restricted to narrow mantle zones, without expansion or invasion beyond the mantle zone. We report a unique case of MCL ... Full text Link to item Cite

Assessment of follow-up completeness and notification preferences for imaging findings of possible cancer: what happens after radiologists submit their reports?

Journal Article Acad Radiol · December 2014 RATIONALE AND OBJECTIVES: To understand the reasons leading to potentially inappropriate management of imaging findings concerning for malignancy and identify optimal methods for communicating these findings to providers. MATERIALS AND METHODS: We identifi ... Full text Link to item Cite

Newer drugs and earlier treatment: impact on lifetime cost of care for HIV-infected adults.

Journal Article AIDS · January 2, 2012 OBJECTIVE: To determine the component costs of care to optimize treatment with limited resources. DESIGN: We used the Cost-Effectiveness of Preventing AIDS Complications Model of HIV disease and treatment to project life expectancy and both undiscounted an ... Full text Link to item Cite

Coverage of intermittent prevention treatment with sulphadoxine-pyrimethamine among pregnant women and congenital malaria in Côte d'Ivoire.

Journal Article Malar J · April 29, 2011 BACKGROUND: The World Health Organization (WHO) recommends using insecticide-treated mosquito nets (ITNs) and intermittent preventive treatment with sulphadoxine-pyrimethamine (IPT-SP) to prevent malaria in sub-Saharan Africa. Data on IPT-SP coverage and f ... Full text Link to item Cite

Association between medication possession ratio, virologic failure and drug resistance in HIV-1-infected adults on antiretroviral therapy in Côte d'Ivoire.

Journal Article J Acquir Immune Defic Syndr · April 2011 BACKGROUND: Adherence is a strong determinant of viral suppression with antiretroviral therapy (ART) but measuring it is challenging. Medication delivery can be measured accurately in settings with computerized prescription databases. We studied the associ ... Full text Link to item Cite

Drug efficacy by direct and adjusted indirect comparison to placebo: An illustration by Mycobacterium avium complex prophylaxis in HIV.

Journal Article AIDS Res Ther · March 10, 2011 BACKGROUND: Our goal was to illustrate a method for making indirect treatment comparisons in the absence of head-to-head trials, by portraying the derivation of published efficacies for prophylaxis regimens of HIV-related opportunistic infections. RESULTS: ... Full text Link to item Cite

Routine HIV screening in France: clinical impact and cost-effectiveness.

Journal Article PLoS One · October 1, 2010 BACKGROUND: In France, roughly 40,000 HIV-infected persons are unaware of their HIV infection. Although previous studies have evaluated the cost-effectiveness of routine HIV screening in the United States, differences in both the epidemiology of infection ... Full text Link to item Cite

Economic evaluation of ART in resource-limited countries.

Journal Article Curr Opin HIV AIDS · May 2010 PURPOSE OF REVIEW: In the face of increasing economic constraints, it is critically important to evaluate how best to utilize available resources. In this article, we review the growing number of cost-effectiveness analyses of HIV treatment with antiretrov ... Full text Link to item Cite

Early antiretroviral therapy for patients with acute aids-related opportunistic infections: a cost-effectiveness analysis of ACTG A5164.

Journal Article HIV Clin Trials · 2010 PURPOSE: ACTG A5164 demonstrated that early antiretroviral therapy (ART) in HIV-infected patients with acute opportunistic infections (OIs) reduced death and AIDS progression compared to ART initiation 1 month later. We project the life expectancies, costs ... Full text Link to item Cite

CD4+ T-cell-guided structured treatment interruptions of antiretroviral therapy in HIV disease: projecting beyond clinical trials.

Journal Article Antivir Ther · 2010 BACKGROUND: International trials have shown that CD4+ T-cell-guided structured treatment interruptions (STI) of antiretroviral therapy (ART) lead to worse outcomes than continuous treatment. We simulated continuous ART and STI strategies with higher CD4+ T ... Full text Link to item Cite

Targeted vs. systematic early antiviral treatment against A(H1N1)v influenza with neuraminidase inhibitors in patients with influenza-like symptoms: clinical and economic impact.

Journal Article PLoS Curr · October 26, 2009 Capitalizing on available data, we used a decision model to estimate the clinical and economic outcomes associated with early initiation of treatment with neuraminidase inhibitors in all patients with influenza-like illnesses ( ILI ) (systematic strategy) ... Full text Link to item Cite

HIV preexposure prophylaxis in the United States: impact on lifetime infection risk, clinical outcomes, and cost-effectiveness.

Journal Article Clin Infect Dis · March 15, 2009 BACKGROUND: The combination of tenofovir and emtricitabine shows promise as HIV preexposure prophylaxis (PrEP). We sought to forecast clinical, epidemiologic, and economic outcomes of PrEP, taking into account uncertainties regarding efficacy, the risks of ... Full text Link to item Cite