Scholars@Duke
Nathan Adam Boucher

Nathan Adam Boucher

Associate Research Professor in the Sanford School of Public Policy
Sanford School of Public Policy
nathan.boucher@duke.edu
Box 90312, Durham, NC 27708
206 Rubenstein Hall, Box 90312, Durham, NC 27708

Selected Publications

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

Journal Article J Appl Gerontol · April 28, 2025 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

Effectiveness of Synchronous Postdischarge Contacts on Health Care Use and Patient Satisfaction : A Systematic Review and Meta-analysis.

Journal Article Ann Intern Med · February 2025 BACKGROUND: Postdischarge contacts (PDCs) after hospitalization are common practice, but their effectiveness in reducing use of acute care after discharge remains unclear. PURPOSE: To assess the effects of PDC on 30-day emergency department (ED) visits, 30 ... Full text Open Access Link to item Cite

Exploring the Sources and Experiences of Joy in Caregiving: Insights From Formal Caregivers in Long-Term Care

Journal Article Journal of the American Medical Directors Association · December 30, 2024 Objectives To explore and understand the sources and experiences of joy in caregiving among formal caregivers in Canadian long-term care (LTC). Design A qualitative study with interpretative descriptive design. Setting and Participants The participants con ... Full text Open Access Link to item 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

Family caregiver lived experience matters in home- and community-based services.

Journal Article Journal of the American Geriatrics Society · November 2024 Full text Cite

Using Collective Impact to Examine Direct Service Worker Training and Credentialing in North Carolina: Recommendations for Change.

Journal Article Journal of applied gerontology : the official journal of the Southern Gerontological Society · October 2024 Older adults and people living with disabilities receive home- and community-based services (HCBS) from approximately 113,000 often under-resourced and inadequately supported direct service workers (e.g., personal care aides, direct support professionals, ... Full text Cite

Older Caregivers: Who They Are and How to Support Them.

Journal Article Journal of aging & social policy · July 2024 Caregivers play a crucial role in providing health and social supports to their family and friends. Older adults who take on caregiving roles are themselves uniquely vulnerable to negative health and financial effects due to their age and underlying health ... Full text Cite

Barriers to and Facilitators of Pediatric Vaccination Reporting in Four US States, 2023.

Journal Article American journal of public health · June 2024 In a 2023 sequential explanatory mixed-methods study in four US states, we identified barriers and facilitators experienced by Vaccines for Children (VFC) program providers in reporting vaccination data to state immunization information systems (IISs). We ... Full text Cite

"I've been doing this for years": the COVID-19 pandemic and family caregiver isolation and loneliness.

Journal Article Front Aging · 2024 BACKGROUND: Family caregivers are family members or friends of care recipients who assist with activities of daily living, medication management, transportation, and help with finances among other activities. As a result of their caregiving, family caregiv ... 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

Clinician's perspectives on gene therapy for Alzheimer's disease: A qualitative study.

Journal Article PLoS One · 2024 INTRODUCTION: We aimed to understand clinician views regarding gene therapy as a future treatment for Alzheimer's disease (AD) and potential barriers and facilitators to its use. METHODS: We interviewed ten clinicians who treat patients with AD. Clinicians ... Full text Open Access Link to item Cite

Inpatient clinicians' approach to diagnosis of urinary tract infections in older adults using the COM-B model: a qualitative assessment.

Journal Article Antimicrob Steward Healthc Epidemiol · 2024 Our interviews of inpatient clinicians (physicians, physician assistants) modeled after the Capability, Opportunity, and Motivation Model of Behavior model revealed opportunity and motivation as important drivers for overdiagnosis and overprescribing for a ... Full text Link to item Cite

Frontline Clinician Appraisement of Research Engagement: "I feel out of touch with research".

Journal Article J Gen Intern Med · September 2023 BACKGROUND: Health services research can benefit from frontline clinician input across all stages of research, yet their key perspectives are often not meaningfully engaged. OBJECTIVE: How can we improve clinician engagement in research? DESIGN: Convenienc ... Full text Open Access Link to item Cite

Mandated Caregiver Training in the Veterans Health Administration: Caregiver Inquiry Informs National Dissemination.

Journal Article Gerontologist · March 21, 2023 BACKGROUND AND OBJECTIVES: A minority of family caregivers receive training, with implications for their own and their recipient's outcomes. Federal policy has supported the implementation and expansion of caregiver training and support. The Department of ... Full text Open Access Link to item Cite

Training Health Care Practitioners to Include Family Caregivers With Web-Based Learning Modules.

Journal Article Perm J · March 15, 2023 Background Caregivers play a key role in supporting patient health; however, they have largely been excluded from participating in health care teams. This paper describes development and evaluation of web-based training for health care professionals about ... Full text Link to item Cite

Developing the Future End-of-Life Health Care Workforce: Lessons Learned From a Survey of Advanced Health Professions Students.

Journal Article The American journal of hospice & palliative care · June 2022 ObjectiveTo examine health professions trainees' end-of-life (EOL) care knowledge, attitudes, and intentions.MethodsIRB-approved online survey of 346 students/5 universities in final training years-public health, pharmacy, physician, phys ... Full text Cite

Parents of Children With Newly Diagnosed Disorders of Sex Development Identify Major Concerns: A Qualitative Study.

Journal Article Urology · June 2022 OBJECTIVES: To develop a conceptual framework to understand and define the impact of DSD diagnosis and management from the perspective of parents of recently diagnosed children. METHODS: Semi-structured interviews were conducted with parents of children di ... Full text Link to item Cite

Needs of care partners of older Veterans with serious illness.

Journal Article J Am Geriatr Soc · June 2022 BACKGROUND: The quality of life of care partners and care recipients may be improved by programs that address unmet needs. The aim of this qualitative study was to identify care partners' social and practical needs as they care for Veterans (65 yo+) with s ... Full text Link to item Cite

"That Little Bit of Time": Transition-to-Hospice Perspectives From Hospice Staff and Bereaved Family.

Journal Article Innovation in aging · January 2022 Background and objectivesMany patients lack understanding of hospice services and their preparation for the transition to hospice at home may be insufficient. This study explored how hospice admissions staff and caregivers of hospice patients perc ... Full text Open Access Cite

Caregiving in U.S. Gulf States During Natural Disasters and COVID-19.

Journal Article Gerontol Geriatr Med · 2022 OBJECTIVES: To ascertain common experiences and needs of a diverse group of caregivers challenged by hurricanes/floods and COVID-19. METHODS: In-depth interviews with unpaid caregivers in U.S. Southeast/Gulf Coast states who had experienced caregiving duri ... Full text Link to item Cite

"He Needed Just About Everything": Caring for Aging Adults Postincarceration.

Journal Article Journal of applied gerontology : the official journal of the Southern Gerontological Society · December 2021 MethodsWe conducted a thematic analysis on semi-structured interviews with 11 caregivers.ResultsCaregivers discussed how prior incarceration coupled with aging present barriers to housing, employment, and safety-net benefits-making caregi ... Full text Cite

Developing a person-centered, population based measure of "home time": Perspectives of older patients and unpaid caregivers.

Journal Article Healthc (Amst) · December 2021 Measuring "home time," number of days not in facility-based care, with medical claims is a promising approach to assess person-centered outcomes on a population level. Generally, spending more time at home matches long-term care preferences and improves qu ... Full text Link to item Cite

Family Caregiver and Provider Perspectives on Inclusive Care: Aligning Needs and Expectations.

Journal Article Med Care · November 1, 2021 BACKGROUND: Home-based and community-based health care for individuals with complex medical conditions is often provided by family caregivers. Yet caregivers often are not meaningfully included in interactions with clinical health care teams. Inclusive car ... Full text Link to item Cite

Inclusion of Caregivers in Veterans' Care: A Critical Literature Review.

Journal Article Med Care Res Rev · October 2021 More direct inclusion of informal caregivers (i.e., family, friends) in patients' care will make care more patient- and family-centered and has the potential to improve overall quality of care for patients. We need to understand what potentially comprises ... Full text Link to item Cite

Hospice Access and Scope of Services for Undocumented Immigrants: A Clinician Survey.

Journal Article J Palliat Med · August 2021 Objectives: To characterize clinician experiences of hospice access and scope of services for undocumented immigrants. Background: The 10.5 million undocumented immigrants in the United States are not covered by Medicare's hospice benefit and are at high r ... Full text Link to item Cite

COVID-19: The Time for Collaboration Between Long-Term Services and Supports, Health Care Systems, and Public Health Is Now.

Journal Article Milbank Q · June 2021 UNLABELLED: Policy Points To address systemic problems amplified by COVID-19, we need to restructure US long-term services and supports (LTSS) as they relate to both the health care systems and public health systems. We present both near-term and long-term ... Full text Open Access Link to item Cite

Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design.

Journal Article BMC Health Serv Res · May 6, 2021 BACKGROUND: Caring for a growing aging population using existing long-term care resources while simultaneously supporting and educating family caregivers, is a public health challenge. We describe the application of the Replicating Effective Programs (REP) ... Full text Open Access Link to item Cite

Insurance Barriers, Gendering, and Access: Interviews with Central North Carolinian Women About Their Health Care Experiences.

Journal Article The Permanente journal · May 2021 BackgroundWomen face unique logistical and financial barriers to health care access. They also have higher health care expenditures and higher rates of morbidity. Women's experiences while utilizing health care are historically less well researche ... Full text Cite

Older Adults Post-Incarceration: Restructuring Long-term Services and Supports in the Time of COVID-19.

Journal Article J Am Med Dir Assoc · March 2021 OBJECTIVES: To describe long-term care services and supports (LTSS) in the United States, note their limitations in serving older adults post-incarceration, and offer potential solutions, with special consideration for the Coronavirus Disease 2019 pandemic ... Full text Open Access Link to item Cite

Cultivating Cultural Competence: How Are Hospice Staff Being Educated to Engage Racially and Ethnically Diverse Patients?

Journal Article Am J Hosp Palliat Care · February 2021 BACKGROUND: Compared to Whites, racial/ethnic minorities are less likely to enroll in hospice and if they enroll, more likely to experience poor quality care. Building cultural competence (CC) among hospice staff is a strategy that may reduce disparities. ... Full text Link to item Cite

No Hugs Allowed: Isolation and Inequity in North Carolina Long-term Services and Supports During COVID-19.

Journal Article North Carolina medical journal · January 2021 Four in 10 COVID-19 cases and deaths in North Carolina have occurred in long-term care facilities. The virus has contributed to increased health complications and financial stressors for recipients of long-term care services and supports and their caregive ... Full text Cite

State Policy Responses to COVID-19 in Nursing Homes

Journal Article Journal of Long-Term Care · January 1, 2021 Context: COVID-19 has a high case fatality rate in high-risk populations and can cause severe morbidity and high healthcare resource use. Nursing home residents are a high-risk population; they live in congregate settings, often with shared rooms, and requ ... Full text Cite

Investigating barriers to vaccination among durham county’s vulnerable populations

Journal Article North Carolina Medical Journal · January 1, 2021 Background As antivaccination movements increase in the United States, underlying structural barriers to vaccination are often ignored. This study examines barriers to vaccination in an adult population to uncover factors leading to vaccination rates in un ... Full text Cite

Issue Brief: A Report from the NCIOM Task Force on Serious Illness Care

Journal Article North Carolina Medical Journal · July 2020 Full text Cite

Hope, Religiosity, and Mental Health in U.S. Veterans and Active Duty Military with PTSD Symptoms.

Journal Article Mil Med · February 12, 2020 INTRODUCTION: Many studies have linked hope with better mental health and lower risk of suicide. This is especially true in those who have experienced severe physical or emotional trauma. Religious involvement is associated with greater hope. We examine he ... Full text Link to item Cite

Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention.

Journal Article J Nurs Scholarsh · January 2020 PURPOSE: We describe an approach to rapidly adapt and implement an education and skills improvement intervention to address the needs of family caregivers of functionally impaired veterans-Helping Invested Families Improve Veterans' Experience Study (HI-FI ... Full text Link to item Cite

The Moderating Effect of Religious Involvement on the Relationship Between PTSD Symptoms and Physical Pain in U.S. Veterans and Active Duty Military

Journal Article Military Behavioral Health · July 3, 2019 The relationship between posttraumatic stress disorder (PTSD) symptom severity and pain is well known in veterans and active duty military (V/ADM). This study examines the buffering effect of religiosity on that relationship. A multisite study was conducte ... Full text Cite

Including Family Caregivers In Seriously Ill Veterans' Care: A Mixed-Methods Study.

Journal Article Health Aff (Millwood) · June 2019 Family caregivers often serve as unpaid members of the home and community-based care workforce for people with serious illness; as key partners in the home-clinic continuum, they should be included in health care teams. The Campaign for Inclusive Care is a ... Full text Link to item Cite

Patient, Caregiver, and Taxpayer Knowledge of Palliative Care and Views on a Model of Community-Based Palliative Care.

Journal Article Journal of pain and symptom management · December 2018 ContextPalliative care (PC) model delivered by two large hospices and PC providers.ObjectivesTo understand study participants' knowledge of PC and acceptability of a new community-based PC model.MethodsSemistructured interview wi ... Full text Cite

Feasibility and Acceptability of a Best Supportive Care Checklist among Clinicians.

Journal Article Journal of palliative medicine · August 2018 ContextBest supportive care (BSC) is often not standardized across sites, consistent with best evidence, or sufficiently described. We developed a consensus-based checklist to document BSC delivery, including symptom management, decision making, a ... Full text Cite

Older, Seriously Ill Veterans' Views on the Role of Religion and Spirituality in Health-Care Delivery.

Journal Article Am J Hosp Palliat Care · July 2018 OBJECTIVES: To describe older Veteran's perspectives on the current delivery of religious or spiritual (R/S) care. METHODS: Semi-structured interviews with older veterans with advanced stage cancer, heart failure, or pulmonary disease to elicit views on wh ... Full text Link to item Cite

Will Changes to Medicare Payment Rates Alter Hospice's Cost-Saving Ability?

Journal Article J Palliat Med · May 2018 BACKGROUND: On January 1, 2016, Medicare implemented a new "two-tiered" model for hospice services, with per diem rates increased for days 1 through 60, decreased for days 61 and greater, and service intensity add-on payments made retrospectively for the l ... Full text Link to item Cite

Acute Leukemia Patients' Needs: Qualitative Findings and Opportunities for Early Palliative Care.

Journal Article Journal of pain and symptom management · February 2018 ContextPatients with acute leukemias likely have needs that palliative care can respond to, yet little is known about specific challenges they face, particularly during active treatment. We examined acute myeloid leukemia (AML) patients' expressed ... Full text Cite

Meeting Basic Needs: Social Supports and Services Provided by Hospice.

Journal Article J Palliat Med · June 2017 OBJECTIVE: Describe social goods and services for which hospices assist patients and families and the resources hospices use to do so. BACKGROUND: Basic social supports and services not routinely covered by insurers may be needed by terminally ill patients ... Full text Link to item Cite

Hospice Access for Undocumented Immigrants.

Journal Article JAMA Intern Med · April 1, 2017 Full text Link to item Cite

Faith, Family, Filiality, and Fate.

Journal Article Journal of applied gerontology : the official journal of the Southern Gerontological Society · March 2017 ObjectiveWhat is the characterization of family involvement in health decisions, filial piety, religiosity/spirituality, and fatalism as they relate to attitudes/intentions toward end-of-life (EOL) planning/decision making among elderly Dominicans ... Full text Cite

Rationale for Spiritually Oriented Cognitive Processing Therapy for Moral Injury in Active Duty Military and Veterans With Posttraumatic Stress Disorder.

Journal Article J Nerv Ment Dis · February 2017 Wartime experiences have long been known to cause ethical conflict, guilt, self-condemnation, difficulty forgiving, loss of trust, lack of meaning and purpose, and spiritual struggles. "Moral injury" (MI) (also sometimes called "inner conflict") is the ter ... Full text Link to item Cite

Supporting Muslim Patients During Advanced Illness.

Journal Article Perm J · 2017 Religion is an important part of many patients' cultural perspectives and value systems that influence them during advanced illness and toward the end of life when they directly face mortality. Worldwide violence perpetrated by people identifying as Muslim ... Full text Link to item Cite

The benefits of expanded physician assistant practice in hospice and palliative medicine.

Journal Article JAAPA : official journal of the American Academy of Physician Assistants · September 2016 Patients with advanced or terminal illness, especially racial and ethnic minorities, would benefit from greater access to hospice and palliative care. Expanding the PA role in these areas would help fill gaps in both access and patients' understanding of w ... Full text Cite

Direct Engagement With Communities and Interprofessional Learning to Factor Culture Into End-of-Life Health Care Delivery.

Journal Article American journal of public health · June 2016 Aging patients with advanced or terminal illnesses or at the end of their lives become highly vulnerable when their cultural needs-in terms of ethnic habits, religious beliefs, and language-are unmet. Cultural diversity should be taken into account during ... Full text Cite

Agents for change: nonphysician medical providers and health care quality.

Journal Article The Permanente journal · January 2015 Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NP ... Full text Cite

End-of-life Issues on the National Stage: A Content Analysis

Journal Article The International Journal of Aging and Society · 2015 Full text Cite

Health care and end-of-life decisions: community engagement with adults in East Harlem.

Journal Article Journal of community health · December 2014 This was a model of community engagement for a Hispanic population in East Harlem, New York City to assess health care decision-making processes, with a focus on end-of-life decisions, among older men and women. The design involved two senior center-based ... Full text Cite

Made-to-Measure Palliative Care: An Ethical Imperative for Growing Cultural Plurality in the United States

Journal Article Ethics in Biology, Engineering and Medicine: An International Journal · 2014 Full text Cite

Maintaining quality of care 24/7 in a nontrauma surgical intensive care unit.

Journal Article The journal of trauma and acute care surgery · July 2012 BackgroundMost surgical critical care literature reflects practices at trauma centers and tertiary hospitals. Surgical critical care needs and practices may be quite different at nontrauma center teaching hospitals. As acute care surgery develops ... Full text Cite