Scholars@Duke
Deepshikha Ashana

Deepshikha Ashana

Assistant Professor of Medicine
Medicine, Pulmonary, Allergy, and Critical Care Medicine
deepshikha.ashana@duke.edu
Box 102352, Durham, NC 27710
115 Hanes House, 315 Trent Drive, Durham, NC 27710

Selected Publications

A Descriptive Qualitative Study of Religion and Spirituality's Role in Critical Illness Decision-Making Among Black and White Family Caregivers.

Journal Article CHEST Crit Care · March 2025 BACKGROUND: Spiritual beliefs and spiritual support from clinicians can affect medical decision-making and coping during times of serious illness. RESEARCH QUESTION: How do religion and spirituality affect the critical illness experience of Black and White ... Full text Link to item Cite

Mobile App-Facilitated Collaborative Palliative Care Intervention for Critically Ill Older Adults: A Randomized Clinical Trial.

Journal Article JAMA Intern Med · February 1, 2025 IMPORTANCE: Few person-centered, scalable models of collaborative intensive care unit (ICU) clinician-palliative care specialist care exist. OBJECTIVE: To evaluate the effect of a collaborative palliative care intervention compared to usual care among fami ... Full text Link to item Cite

Response.

Journal Article Chest · February 2025 Full text Link to item Cite

Role of Social Determinants of Health in COVID-19 Recovery: A Qualitative Study.

Journal Article JAMA Netw Open · January 2, 2025 IMPORTANCE: Health systems are increasingly required to conduct health-related social needs screening. However, how social resources negatively and positively affect recovery from acute illnesses, such as COVID-19, is incompletely understood. OBJECTIVE: To ... Full text Link to item Cite

Talking About Suffering in the Intensive Care Unit.

Journal Article AJOB Empir Bioeth · 2025 BACKGROUND: Some have hypothesized that talk about suffering can be used by clinicians to motivate difficult decisions, especially to argue for reducing treatment at the end of life. We examined how talk about suffering is related to decision-making for cr ... Full text Link to item Cite

"Against Medical Advice" Discharges After Respiratory-Related Hospitalizations: Strategies for Respectful Care.

Journal Article Chest · November 2024 Against medical advice (AMA) discharges are practically and emotionally challenging for both patients and clinicians. Moreover, they are common after admissions for respiratory conditions such as COPD and asthma, and they are associated with poor outcomes. ... Full text Cite

Variation in Mentions of Race and Ethnicity in Notes in Intensive Care Units Across a Health Care System.

Journal Article Am J Crit Care · November 1, 2024 BACKGROUND: Social constructs like race can affect how patients are perceived and impact care. This study investigated whether mentions of race in notes for critically ill patients differed according to patients' race. METHODS: This retrospective cohort st ... Full text Link to item Cite

The Association of Pregnancy With Outcomes Among Critically Ill Reproductive-Aged Women: A Propensity Score-Matched Retrospective Cohort Analysis.

Journal Article Chest · October 2024 BACKGROUND: The maternal mortality rate in the United States is unacceptably high. However, the relative contribution of pregnancy to these outcomes is unknown. Studies comparing outcomes among pregnant vs nonpregnant critically ill patients show mixed res ... Full text Link to item Cite

Racial, Ethnic, and Socioeconomic Differences in Critical Care Near the End of Life: A Narrative Review.

Journal Article Crit Care Clin · October 2024 Patients from groups that are racially/ethnically minoritized or of low socioeconomic status receive more intensive care near the end of life, endorse preferences for more life-sustaining treatments, experience lower quality communication from clinicians, ... Full text Link to item Cite

Shared Decision-Making Communication and Prognostic Misunderstanding in the ICU.

Journal Article JAMA Netw Open · October 1, 2024 IMPORTANCE: Surrogate misunderstanding of patient survival prognosis in the intensive care unit (ICU) is associated with poor patient and surrogate outcomes. Shared decision-making (SDM) may reduce misunderstanding. OBJECTIVE: To evaluate the association b ... Full text Link to item Cite

Improving Equity in Shared Decision-Making-Reply.

Journal Article JAMA Intern Med · September 1, 2024 Full text Link to item Cite

Transition of Intensive Care Unit Patients and Their Families to Home After Acute Hospital Care.

Journal Article AACN Adv Crit Care · June 15, 2024 Patients in the intensive care unit (ICU) increasingly are expected to eventually return home after acute hospital care. Yet transitional care for ICU patients and their families is often delayed until the patient is about to be transferred to another loca ... Full text Link to item Cite

Measuring Implicit Bias in ICU Notes Using Word-Embedding Neural Network Models.

Journal Article Chest · June 2024 BACKGROUND: Language in nonmedical data sets is known to transmit human-like biases when used in natural language processing (NLP) algorithms that can reinforce disparities. It is unclear if NLP algorithms of medical notes could lead to similar transmissio ... Full text Link to item Cite

Racial Differences in Shared Decision-Making About Critical Illness.

Journal Article JAMA Intern Med · April 1, 2024 IMPORTANCE: Shared decision-making is the preferred method for evaluating complex tradeoffs in the care of patients with critical illness. However, it remains unknown whether critical care clinicians engage diverse patients and caregivers equitably in shar ... Full text Link to item Cite

Defining the Time-limited Trial for Patients with Critical Illness: An Official American Thoracic Society Workshop Report.

Journal Article Annals of the American Thoracic Society · February 2024 In critical care, the specific, structured approach to patient care known as a "time-limited trial" has been promoted in the literature to help patients, surrogate decision makers, and clinicians navigate consequential decisions about life-sustaining thera ... Full text Cite

Mobile Application-Based Communication Facilitation Platform for Family Members of Critically Ill Patients: A Randomized Clinical Trial.

Journal Article JAMA network open · January 2024 ImportanceUnmet and racially disparate palliative care needs are common in intensive care unit (ICU) settings.ObjectiveTo test the effect of a primary palliative care intervention vs usual care control both overall and by family member ra ... Full text Cite

Neighborhood Socioeconomic Disadvantage, Healthcare Access, and Outcomes of Hospitalizations for Common Pulmonary Conditions: A National Study of Medicare Beneficiaries.

Journal Article Ann Am Thorac Soc · October 2023 Rationale: Understanding how systemic forces and environmental exposures impact patient outcomes is critical to advancing health equity and improving population health for patients with pulmonary disease. This relationship has not yet been assessed at the ... Full text Link to item Cite

Negativity and Positivity in the ICU: Exploratory Development of Automated Sentiment Capture in the Electronic Health Record.

Journal Article Crit Care Explor · October 2023 OBJECTIVES: To develop proof-of-concept algorithms using alternative approaches to capture provider sentiment in ICU notes. DESIGN: Retrospective observational cohort study. SETTING: The Multiparameter Intelligent Monitoring of Intensive Care III (MIMIC-II ... Full text Link to item Cite

Neighborhood socioeconomic deprivation, healthcare access, and 30-day mortality and readmission after sepsis or critical illness: findings from a nationwide study.

Journal Article Crit Care · July 15, 2023 BACKGROUND: To determine if neighborhood socioeconomic deprivation independently predicts 30-day mortality and readmission for patients with sepsis or critical illness after adjusting for individual poverty, demographics, comorbidity burden, access to heal ... Full text Link to item Cite

Trajectories of Palliative Care Needs in the ICU and Long-Term Psychological Distress Symptoms.

Journal Article Crit Care Med · January 1, 2023 OBJECTIVES: While palliative care needs are assumed to improve during ICU care, few empiric data exist on need trajectories or their impact on long-term outcomes. We aimed to describe trajectories of palliative care needs during ICU care and to determine i ... Full text Link to item Cite

Palliative care phenotypes among critically ill patients and family members: intensive care unit prospective cohort study.

Journal Article BMJ Support Palliat Care · September 27, 2022 OBJECTIVE: Because the heterogeneity of patients in intensive care units (ICUs) and family members represents a challenge to palliative care delivery, we aimed to determine if distinct phenotypes of palliative care needs exist. METHODS: Prospective cohort ... Full text Link to item Cite

Educational Resources and Self-Management Support to Engage Patients in Advance Care Planning: An Interpretation of Current Practice in the US.

Journal Article Am J Hosp Palliat Care · August 2022 BACKGROUND: Educational resources and decision aids help patients, their care partners and health care providers prepare for and confidently engage in Advance Care Planning (ACP). Incorporating ACP resources as part of a self-management approach may lead t ... Full text Link to item Cite

Improving Outcomes Measurement in Palliative Care: The Lasting Impact of Randy Curtis and his Collaborators.

Journal Article J Pain Symptom Manage · June 2022 Palliative care research is deeply challenging for many reasons, not the least of which is the conceptual and operational difficulty of measuring outcomes within a seriously ill population such as critically ill patients and their family members. This manu ... Full text Link to item Cite

Is This ACP? A Focus Group Study of Patient Experiences of Advance Care Planning.

Journal Article Journal of general internal medicine · May 2022 BackgroundTo date, most research on patients' experiences with advance care planning (ACP) focuses on motivations to engage in discussions and how patients prepare. Gaps remain in understanding how non-critically ill Medicare patients perceive ACP ... Full text Cite

"Don't Talk to Them About Goals of Care": Understanding Disparities in Advance Care Planning.

Journal Article J Gerontol A Biol Sci Med Sci · February 3, 2022 BACKGROUND: Structurally marginalized groups experience disproportionately low rates of advance care planning (ACP). To improve equitable patient-centered end-of-life care, we examine barriers and facilitators to ACP among clinicians as they are central pa ... Full text Link to item Cite

Assessment of Clinical Palliative Care Trigger Status vs Actual Needs Among Critically Ill Patients and Their Family Members.

Journal Article JAMA Netw Open · January 4, 2022 IMPORTANCE: Palliative care consultations in intensive care units (ICUs) are increasingly prompted by clinical characteristics associated with mortality or resource utilization. However, it is not known whether these triggers reflect actual palliative care ... Full text Link to item Cite

The Impact of Resident Holdover Admissions on Length of Hospital Stay and Risk of Transfer to an Intensive Care Unit.

Journal Article J Patient Saf · December 1, 2021 OBJECTIVE: Implementation of residency duty hour standards has led to adoption of different staffing models, such as the "holdover" model, whereby nighttime teams admit patients and transfer their care to daytime teams who provide ongoing care. In contrast ... Full text Link to item Cite

Equitably Allocating Resources during Crises: Racial Differences in Mortality Prediction Models.

Journal Article Am J Respir Crit Care Med · July 15, 2021 Rationale: Crisis standards of care (CSCs) guide critical care resource allocation during crises. Most recommend ranking patients on the basis of their expected in-hospital mortality using the Sequential Organ Failure Assessment (SOFA) score, but it is unk ... Full text Link to item Cite

Accuracy of the Sequential Organ Failure Assessment Score for In-Hospital Mortality by Race and Relevance to Crisis Standards of Care.

Journal Article JAMA Netw Open · June 1, 2021 IMPORTANCE: Crisis Standards of Care (CSC) are guidelines for rationing health care resources during public health emergencies. The CSC adopted by US states ration intensive care unit (ICU) admission using the Sequential Organ Failure Assessment (SOFA) sco ... Full text Link to item Cite

Improving racial disparities in unmet palliative care needs among intensive care unit family members with a needs-targeted app intervention: The ICUconnect randomized clinical trial.

Journal Article Contemp Clin Trials · April 2021 INTRODUCTION: The technologies used to treat the millions who receive care in intensive care unit (ICUs) each year have steadily advanced. However, the quality of ICU-based communication has remained suboptimal, particularly concerning for Black patients a ... Full text Link to item Cite

Operationalizing needs-focused palliative care for older adults in intensive care units: Design of and rationale for the PCplanner randomized clinical trial.

Journal Article Contemp Clin Trials · November 2020 INTRODUCTION: The number of older adults who receive life support in an intensive care unit (ICU), now 2 million per year, is increasing while survival remains unchanged. Because the quality of ICU-based palliative care is highly variable, we developed a m ... Full text Link to item Cite

Association of Billed Advance Care Planning with End-of-Life Care Intensity for 2017 Medicare Decedents.

Journal Article J Am Geriatr Soc · September 2020 BACKGROUND/OBJECTIVE: The Centers for Medicare & Medicaid Services (CMS) reimburses clinicians for advance care planning (ACP) discussions with Medicare patients. The objective of the study was to examine the association of CMS-billed ACP visits with end-o ... Full text Link to item Cite

Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life.

Journal Article JAMA Netw Open · November 1, 2019 IMPORTANCE: Although advance care planning is known to increase patient and caregiver satisfaction, its association with health care utilization is not well understood. OBJECTIVE: To examine the association between billed advance care planning encounters a ... Full text Link to item Cite

Determining the Association Between End-of-Life Care Resources and Patient Outcomes in Pennsylvania ICUs.

Journal Article Crit Care Med · November 2019 OBJECTIVES: As ICUs are increasingly a site of end-of-life care, many have adopted end-of-life care resources. We sought to determine the association of such resources with outcomes of ICU patients. DESIGN: Retrospective cohort study. SETTING: Pennsylvania ... Full text Link to item Cite