Scholars@Duke
Jessica Ma

Jessica Ma

Assistant Professor of Medicine
Medicine, Geriatrics and Palliative Care
jessica.ma@duke.edu
DUMC Box 3688, Durham, NC 27710
Duke South Clinic/Busse Building, Blue Zone, Basement, Durham, NC 27710

Selected Publications

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

Impact of Prognostic Notifications on Inpatient Advance Care Planning: A Cluster Randomized Trial.

Journal Article J Pain Symptom Manage · December 2025 BACKGROUND: A poor prognosis is an important trigger for advance care planning (ACP) conversations, but clinicians often overestimate prognosis. OBJECTIVE: To determine whether ACP note documentation increases by notifying inpatient physicians that a patie ... Full text Link to item Cite

Physician Characteristics Associated With Advance Care Planning After a Machine Learning-Based Nudge.

Journal Article Am J Hosp Palliat Care · November 21, 2025 Prognostic machine learning models can help identify patients in need of advance care planning (ACP) conversations. However, additional work is needed to understand which factors guide physicians' comfort with and prioritization of ACP conversations, even ... Full text Link to item Cite

Using Natural Language Processing to Assess Goals-of-Care Conversations for Patients With Cancer.

Conference JCO Clin Cancer Inform · October 2025 PURPOSE: Goals-of-care (GOC) discussions during advanced serious illness and end-of-life (EOL) care are critical. Institutions are increasingly tracking the frequency and timing of GOC documentation, but large-scale content assessments have been limited. W ... Full text Link to item Cite

Engage: Protocol of a randomized controlled trial of a telehealth-delivered psychosocial intervention to decrease symptom interference in patients with advanced cancer.

Journal Article Contemp Clin Trials · September 2025 BACKGROUND: Pain, fatigue, and distress are highly prevalent co-occurring symptoms in patients with stage IV cancer. Emerging evidence suggests these patients may benefit from Acceptance and Commitment Therapy (ACT), a Cognitive-Behavioral Therapy (CBT) ap ... Full text Link to item Cite

Provider Perspectives on Implementation of Adult Community-Based Palliative Care: A Scoping Review.

Journal Article Med Care Res Rev · August 2025 While community-based palliative care (CBPC) programs have been expanding, there remain important obstacles to widespread use. Since provider perspectives on CBPC remain underexplored, we conducted a scoping review to summarize provider perspectives regard ... Full text Link to item Cite

Content and Comprehensiveness of Goals-of-Care Documentation in Pediatric Patients.

Journal Article J Pain Symptom Manage · August 2025 CONTEXT: Documented goals-of-care (GOC) conversations promote goal-concordant care; few studies have evaluated the comprehensiveness of this documentation within pediatrics. OBJECTIVE: To evaluate the content of pediatric GOC documentation within a health ... Full text Link to item Cite

Multi-Level Factors Impacting Implementation of Outpatient Palliative Care: Perceptions of VA Providers.

Journal Article J Appl Gerontol · May 27, 2025 To develop strategies to better meet palliative needs for older adults, it is critical to understand what factors influence the implementation and sustainability of palliative care (PC) in the outpatient setting. This study explored provider perceptions ab ... Full text Link to item Cite

Serious Illness Communication in a Randomized Trial of a Nurse and Social Worker Palliative Telecare Team.

Journal Article J Am Geriatr Soc · March 22, 2025 BACKGROUND: Early serious illness communication (SIC) has numerous benefits for patients with cardiopulmonary illnesses, yet engaging patients in this complex, iterative communication process is challenging due to constraints on clinician time, limited cli ... Full text Link to item Cite

Uncovering Psychosocial Contexts in Goals of Care Conversations: A Qualitative Study in a Multi-Centered Randomized Controlled Trial.

Journal Article Clin Gerontol · 2025 OBJECTIVES: Patients often struggle with psychological and social stressors that accompany life-limiting chronic illness. Because psychosocial concerns may be conveyed through emotional sentiments, this study aimed to identify emotional expressions to desc ... Full text Link to item Cite

Evaluating a Clinical Chaplain Pilot Intervention to Facilitate Advance Care Planning in a Primary Care Clinic

Journal Article Journal of General Internal Medicine · January 1, 2025 Background: While advance care planning (ACP) conversations align an individual’s healthcare options to their goals, primary care physicians (PCPs) often have limited time and training to conduct ACP in clinic. A clinical chaplain’s unique expertise may pr ... Full text Cite

A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program.

Journal Article Health Serv Res · December 2024 OBJECTIVE: To assess the effects of an evidence-based family caregiver training program (implementation of Helping Invested Families Improve Veteran Experiences Study [iHI-FIVES]) in the Veterans Affairs healthcare system on Veteran days not at home and fa ... Full text Link to item Cite

Machine Learning for Targeted Advance Care Planning in Cancer Patients: A Quality Improvement Study.

Journal Article J Pain Symptom Manage · December 2024 CONTEXT: Prognostication challenges contribute to delays in advance care planning (ACP) for patients with cancer near the end of life (EOL). OBJECTIVES: Examine a quality improvement mortality prediction algorithm intervention's impact on ACP documentation ... Full text Link to item Cite

Communication processes in an advance care planning initiative: A socio-ecological perspective for service evaluation.

Journal Article Palliat Med · December 2024 BACKGROUND: Advance care planning initiatives are becoming more widespread, increasing expectations for providers to engage in goals of care conversations. However, less is known about how providers communicate advance care planning within and throughout a ... Full text Link to item Cite

Veterans' use of inpatient and outpatient palliative care: The national landscape.

Journal Article J Am Geriatr Soc · November 2024 BACKGROUND: Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpat ... 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

Trajectories of Physical Resilience Among Older Veterans With Stage 4 CKD.

Journal Article Am J Kidney Dis · August 2024 RATIONALE & OBJECTIVE: Although functional impairment is common among older adults with chronic kidney disease (CKD), functional reserve before an acute health event and physical resilience after the event have not been characterized in this population. Th ... Full text Link to item Cite

Do goals of care documentation reflect the conversation?: Evaluating conversation-documentation accuracy.

Journal Article J Am Geriatr Soc · August 2024 BACKGROUND: Documenting goals of care in the electronic health record is meant to relay patient preferences to other clinicians. Evaluating the content and documentation of nurse and social worker led goals of care conversations can inform future goals of ... Full text Link to item Cite

Factors Associated With Hospital Admission in the Last Month: A Retrospective Single Center Analysis.

Journal Article J Pain Symptom Manage · June 2024 CONTEXT: Driven by concerns about care quality, patient experience, and national metrics, health systems are increasingly focusing on identifying risk factors for patients who are hospitalized in the last month of life. OBJECTIVE: To evaluate patient facto ... Full text 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

Quality Improvement Study Using a Machine Learning Mortality Risk Prediction Model Notification System on Advance Care Planning in High-Risk Patients.

Journal Article J Brown Hosp Med · 2024 BACKGROUND: Advance care planning (ACP) is an important aspect of patient care that is underutilized. Machine learning (ML) models can help identify patients appropriate for ACP. The objective was to evaluate the impact of using provider notifications base ... Full text Link to item Cite

Internal Medicine Resident Barriers to Advance Care Planning in the Primary Care Continuity Clinic.

Journal Article Am J Hosp Palliat Care · November 2023 Background: While primary care providers regularly engage in Advance Care Planning (ACP) conversations, it is not well known what challenges resident physicians face to achieving this core competency. Objectives: We aimed to assess resident perceptions of ... Full text Open Access Link to item Cite

Phenotypes of Symptom, Function, and Medication Burden in Older Adults with Nondialysis Advanced Kidney Disease.

Journal Article Kidney360 · October 1, 2023 KEY POINTS: There are three distinct classes of symptoms, functional impairment, and medication burden among older adults with advanced kidney disease. One class with Complex Needs with pain and psychological symptoms, functional difficulties, and polyphar ... Full text Link to item Cite

Videoconferencing of Movement-Based and Psychologically Informed Interventions for Chronic Pain: A Systematic Review and Horizon Scan.

Journal Article Telemed J E Health · September 2023 Introduction: With the coronavirus disease 2019 (COVID-19) pandemic, use of telehealth technology increased dramatically. Nonpharmacological approaches to pain management may be well suited for virtual care. Yet, it is not widely understood if this treatme ... Full text Link to item Cite

The Use of Templates for Documenting Advance Care Planning Conversations: A Descriptive Analysis.

Journal Article J Pain Symptom Manage · August 2023 CONTEXT: While professional societies and expert panels have recommended quality indicators related to advance care planning (ACP) documentation, including using structured documentation templates, it is unclear how clinicians document these conversations. ... Full text Link to item Cite

Using Design Thinking to Promote Goals of Care Conversations With Seriously Ill Patients.

Journal Article J Pain Symptom Manage · August 2023 BACKGROUND: Goals of care (GOC) conversations can improve serious illness outcomes such as pain and symptom management and patient satisfaction. PROBLEM: However, we recognized that very few Duke Health patients who died had a GOC conversation documented i ... Full text Link to item Cite

Provider Interaction With an Electronic Health Record Notification to Identify Eligible Patients for a Cluster Randomized Trial of Advance Care Planning in Primary Care: Secondary Analysis.

Journal Article J Med Internet Res · May 12, 2023 BACKGROUND: Advance care planning (ACP) improves patient-provider communication and aligns care to patient values, preferences, and goals. Within a multisite Meta-network Learning and Research Center ACP study, one health system deployed an electronic heal ... Full text Open Access Link to item Cite

Clinician Perspectives on Managing Chronic Pain After Curative-Intent Cancer Treatment.

Journal Article JCO Oncol Pract · April 2023 PURPOSE: Among cancer survivors who have completed curative-intent treatment, the high prevalence and adverse consequences of chronic pain are well documented. Yet, research on clinicians' experiences with and perspectives on managing chronic pain among ca ... Full text Link to item Cite

Top Ten Tips Palliative Care Clinicians Should Know About Caring for Chinese American Patients.

Journal Article J Palliat Med · March 2023 The Chinese American population is one of the fastest-growing communities in the United States, composed of ∼5.4 million people, and represents ∼5.5% of overseas Chinese populations. With an expected exponential population rise, Chinese American patients w ... 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

INAPPROPRIATE OPIOID PRESCRIBING AMONG VETERANS WITH KIDNEY DISEASE

Conference JOURNAL OF GENERAL INTERNAL MEDICINE · 2023 Cite

Goal-Concordant Care: End-of-Life Planning Conversations for All Seriously Ill Patients.

Journal Article Nejm Catalyst Innovations in Care Delivery · November 16, 2022 Substantial evidence indicates that goals-of-care (GOC) conversations in the setting of serious illness can improve a variety of health outcomes. However, only 3% of seriously ill Duke Health patients who died had goals of care documented in the electronic ... 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

Assessing Quality in Advance Care Planning Documentation: A Survey of Current Methods.

Journal Article Am J Hosp Palliat Care · August 2022 BACKGROUND: High-quality advance care planning (ACP) documentation facilitates the communication of patients' wishes as they progress in their disease course and travel between health care settings. No consensus exists regarding evaluation of documentation ... Full text Link to item Cite

Identifying Family and Unpaid Caregivers in Electronic Health Records: Descriptive Analysis.

Journal Article JMIR Form Res · July 18, 2022 BACKGROUND: Most efforts to identify caregivers for research use passive approaches such as self-nomination. We describe an approach in which electronic health records (EHRs) can help identify, recruit, and increase diverse representations of family and ot ... Full text Open Access Link to item Cite

Promoting timely goals of care conversations between gynecologic cancer patients at high-risk of death and their providers.

Journal Article Gynecol Oncol · February 2022 OBJECTIVE: We designed a multi-faceted intervention to increase the rate of outpatient goals of care (GOC) conversations in women with gynecologic cancers who are at high-risk of death. METHODS AND MATERIALS: A multidisciplinary team developed an education ... Full text Link to item Cite

The potential of mHealth for older adults on dialysis and their care partners: What's been done and where do we go from here?

Journal Article Front Nephrol · 2022 Self-care, or the dynamic, daily process of becoming actively involved in one's own care, is paramount to prevent and manage complications of end-stage kidney disease. However, many older dialysis patients face distinctive challenges to adequate engagement ... Full text Link to item Cite

Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach.

Journal Article Palliat Med · September 2021 BACKGROUND: The United States Veterans Health Administration National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative throughout the Veterans Health Administration health care system in 2017. This policy enco ... Full text Link to item Cite

Combining Multiple Decedent Data Sources for a Population-Based Picture of End-of-Life Healthcare Utilization.

Journal Article J Pain Symptom Manage · September 2021 CONTEXT: Although health systems need to track utilization and mortality, it can be difficult to obtain reliable information on patients who die outside of the health system. This leads to missing data and introduces the potential for bias. OBJECTIVES: To ... Full text Link to item Cite

Advance care planning billing practices and documentation quality for cancer patients requiring hospitalization.

Conference Journal of Clinical Oncology · May 20, 2021 e24000 Background: Advance Care Planning (ACP) is an important component of comprehensive cancer care, yet barriers exist to successful implementation. In 2016, Medicare introduced billing codes to provide reimbursement for ACP d ... Full text Cite

BILLING PRACTICES FOR ADVANCE CARE PLANNING AT AN ACADEMIC INSTITUTION

Conference JOURNAL OF GENERAL INTERNAL MEDICINE · 2021 Cite

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Journal Article Crit Care Med · April 2020 Full text Link to item Cite

Early Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial.

Journal Article Crit Care Med · December 2019 OBJECTIVES: To assess the impact of early triggered palliative care consultation on the outcomes of high-risk ICU patients. DESIGN: Single-center cluster randomized crossover trial. SETTING: Two medical ICUs at Barnes Jewish Hospital. PATIENTS: Patients (n ... Full text Link to item Cite

Birth cohort screening for chronic hepatitis during colonoscopy appointments.

Journal Article Am J Gastroenterol · June 2013 OBJECTIVES: More than 70% of infections with hepatitis C viruses (HCV) occur among people born between 1945 and 1965 (baby boomers). The US Centers for Disease Control estimate that 70% of people with chronic hepatitis are not aware that they are infected ... Full text Link to item Cite