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Deepshikha Ashana

Assistant Professor of Medicine
Medicine, Pulmonary, Allergy, and Critical Care Medicine
Box 102352, Durham, NC 27710
115 Hanes House, 315 Trent Drive, Durham, NC 27710

Selected Publications


Racial Differences in Shared Decision-Making About Critical Illness.

Journal Article JAMA Intern Med · February 26, 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 Ann Am Thorac Soc · 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 Link to item Cite

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

Journal Article JAMA Netw Open · January 2, 2024 IMPORTANCE: Unmet and racially disparate palliative care needs are common in intensive care unit (ICU) settings. OBJECTIVE: To test the effect of a primary palliative care intervention vs usual care control both overall and by family member race. DESIGN, S ... Full text Link to item 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 Critical care (London, England) · July 2023 BackgroundTo 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 ... Full text 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

Interpersonal Perception: Family- and Physician-reported Conflict in the Intensive Care Unit.

Journal Article Annals of the American Thoracic Society · November 2022 Full text 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 J Gen Intern Med · May 2022 BACKGROUND: To 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 encoun ... Full text Link to item 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

Racial Differences in Shared Decision-Making About Critical Illness.

Journal Article JAMA Intern Med · February 26, 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 Ann Am Thorac Soc · 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 Link to item Cite

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

Journal Article JAMA Netw Open · January 2, 2024 IMPORTANCE: Unmet and racially disparate palliative care needs are common in intensive care unit (ICU) settings. OBJECTIVE: To test the effect of a primary palliative care intervention vs usual care control both overall and by family member race. DESIGN, S ... Full text Link to item 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 Critical care (London, England) · July 2023 BackgroundTo 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 ... Full text 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

Interpersonal Perception: Family- and Physician-reported Conflict in the Intensive Care Unit.

Journal Article Annals of the American Thoracic Society · November 2022 Full text 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 J Gen Intern Med · May 2022 BACKGROUND: To 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 encoun ... Full text Link to item 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