Director, Duke Center for Palliative Care

Department / Division:
Medicine / General Internal Medicine

Address:
Duke Center for Palliative Care
Hock Plaza, Suite 1105
2424 Erwin Road
Durham, NC 27705

Office Telephone:
919-668-7215

Fax Telephone:
919-668-1300

• MD, University of Illinois College of Medicine, 1987

• Internal Medicine, University of California, San Francisco, 1987-1991

• Robert Wood Johnson Clinical Scholar, University of California, San Francisco, 1991-1993

Clinical Interests:
Pain and symptom control; improving physician-patient communication

Research Interests:
Dr. Tulsky's primary interests are palliative care and provider-patient communication.  He studies quality of life at the end of life, trajectories of patient experience and evaluates interventions to improve the care of patients with life-limiting illness.  Methodologically, he has used techniques of health services research and has focused particularly on content analysis of audio-recorded conversations.  He also uses qualitative and quantitative methods to develop assessment tools for palliative care.

Past projects include studies of audiorecorded discussions between physicians and patients about advance care planning, a prospective, controlled trial to teach medical house staff palliative care skills, and SCOPE, an NCI funded randomized controlled trial of a CD-ROM intervention to enhance oncologist communication skills.  He has also conducted two projects that explore how physicians negotiate patients' requests for medically unindicated tests, referrals and treatments in a resource constrained environment.  Finally, his team has developed a new measure of quality of life at the end of life (QUAL-E).  

Current major projects PATHWAYS, an NINR funded longitudinal study of the clinical and psychosocial trajectories of patients with advanced life-limiting illness, COPE, an NCI funded study to test a web-based intervention to help cancer patients get their emotional needs met when visiting with oncologists, and the NINR funded Center to Study Self-Management Interventions in Life-Limiting Illness.

Dr. Tulsky has gained national recognition for his work on end-of-life care.  He was a Project on Death in America Faculty Scholar, a Robert Wood Johnson Generalist Physician Faculty Scholar and received a VA Health Services Research Career Development Award.  He serves on the editorial board of the Journal of Palliative Medicine, is a Director of the Greenwall Foundation, and sits on numerous national panels and committees. In 2002, he was awarded the Presidential Early Career Award for Scientists and Engineers (PECASE) and in 2006 he received the American Academy on Hospice and Palliative Medicine Award for Research Excellence.

Representative Publications:
Skinner CS, Pollak KI, Farrell D, Olsen MK, Jeffreys AS, Tulsky JA. Use of and reactions to a tailored CD-ROM designed to enhance oncologist-patient communication: The SCOPE trial intervention. Patient Educ Couns. 2009 Mar 23. (2009) Abstract

Back AL, Arnold RM, Baile WF, Tulsky JA, Barley GE, Pea RD, Fryer-Edwards KA. Faculty development to change the paradigm of communication skills teaching in oncology. J Clin Oncol. 2009 Mar 1;27(7):1137-41. (2009) Abstract

Taylor DH, Steinhauser K, Tulsky JA, Rattliff J, Van Houtven CH. Characterizing Hospice Discharge Patterns in a Nationally Representative Sample of the Elderly, 1993-2000. Am J Hosp Palliat Care. 2008 Jan 15. (2008) Abstract

Steinhauser KE, Alexander SC, Byock IR, George LK, Olsen MK, Tulsky JA. Do preparation and life completion discussions improve functioning and quality of life in seriously ill patients? Pilot randomized control trial. J Palliat Med. 2008 Nov;11(9):1234-40. (2008) Abstract

Robinson TM, Alexander SC, Hays M, Jeffreys AS, Olsen MK, Rodriguez KL, Pollak KI, Abernethy AP, Arnold R, Tulsky JA. Patient-oncologist communication in advanced cancer: predictors of patient perception of prognosis. Support Care Cancer. 2008 Jan 15. (2008) Abstract

Kennifer SL, Alexander SC, Pollak KI, Jeffreys AS, Olsen MK, Rodriguez KL, Arnold RM, Tulsky JA. Negative emotions in cancer care: Do oncologists' responses depend on severity and type of emotion? Patient Educ Couns. 2008 Nov 26. (2008) Abstract

Johnson KS, Kuchibhatla M, Tulsky JA. What explains racial differences in the use of advance directives and attitudes toward hospice care? J Am Geriatr Soc. 2008 Oct;56(10):1953-8. (2008) Abstract

Johnson KS, Kuchibhatla M, Tanis D, Tulsky JA. Racial differences in hospice revocation to pursue aggressive care. Arch Intern Med. 2008 Jan 28;168(2):218-24. (2008) Abstract

Allen LA, Yager JE, Funk MJ, Levy WC, Tulsky JA, Bowers MT, Dodson GC, O'Connor CM, Felker GM. Discordance between patient-predicted and model-predicted life expectancy among ambulatory patients with heart failure. JAMA. 2008 Jun 4;299(21):2533-42. (2008) Abstract

Taylor DH Jr, Ostermann J, Van Houtven CH, Tulsky JA, Steinhauser K. What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program? Soc Sci Med. 2007 Oct;65(7):1466-78. (2007) Abstract

Pollak KI, Arnold RM, Jeffreys AS, Alexander SC, Olsen MK, Abernethy AP, Sugg Skinner C, Rodriguez KL, Tulsky JA. Oncologist communication about emotion during visits with patients with advanced cancer. J Clin Oncol. 2007 Dec 20;25(36):5748-52. (2007) Abstract

Munn JC, Zimmerman S, Hanson LC, Williams CS, Sloane PD, Clipp EC, Tulsky JA, Steinhauser KE. Measuring the quality of dying in long-term care. J Am Geriatr Soc. 2007 Sep;55(9):1371-9. (2007) Abstract

Keitz SA, Stechuchak KM, Grambow SC, Koropchak CM, Tulsky JA. Behind closed doors: management of patient expectations in primary care practices. Arch Intern Med. 2007 Mar 12;167(5):445-52. (2007) Abstract

Johnson KS, Kuchibhatla M, Tanis D, Tulsky JA. Racial differences in the growth of noncancer diagnoses among hospice enrollees. J Pain Symptom Manage. 2007 Sep;34(3):286-93. (2007) Abstract

Barclay JS, Blackhall LJ, Tulsky JA. Communication strategies and cultural issues in the delivery of bad news. J Palliat Med. 2007 Aug;10(4):958-77. (2007) Abstract

Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE, Gooley TA, Tulsky JA. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007 Mar 12;167(5):453-60. (2007) Abstract

Anderson WG, Alexander SC, Rodriguez KL, Jeffreys AS, Olsen MK, Pollak KI, Tulsky JA, Arnold RM. "What concerns me is..." Expression of emotion by advanced cancer patients during outpatient visits. Support Care Cancer. 2007 Oct 25. (2007) Abstract

Steinhauser KE, Voils CI, Clipp EC, Bosworth HB, Christakis NA, Tulsky JA. "Are you at peace?": one item to probe spiritual concerns at the end of life. Arch Intern Med. 2006 Jan 9;166(1):101-5. (2006) Abstract

Steinhauser KE, Clipp EC, Hays JC, Olsen M, Arnold R, Christakis NA, Lindquist JH, Tulsky JA. Identifying, recruiting, and retaining seriously-ill patients and their caregivers in longitudinal research. Palliat Med. 2006 Dec;20(8):745-54. (2006) Abstract

Smith AK, Ries AP, Zhang B, Tulsky JA, Prigerson HG, Block SD. Resident approaches to advance care planning on the day of hospital admission. Arch Intern Med. 2006 Aug 14-28;166(15):1597-602. (2006) Abstract

Koropchak CM, Pollak KI, Arnold RM, Alexander SC, Skinner CS, Olsen MK, Jeffreys AS, Rodriguez KL, Abernethy AP, Tulsky JA. Studying communication in oncologist-patient encounters: the SCOPE Trial. Palliat Med. 2006 Dec;20(8):813-9. (2006) Abstract

Johnson KS, Elbert-Avila K, Kuchibhatla M, Tulsky JA. Racial differences in next-of-kin participation in an ongoing survey of satisfaction with end-of-life care: a study of a study. J Palliat Med. 2006 Oct;9(5):1076-85. (2006) Abstract

Fryer-Edwards K, Arnold RM, Baile W, Tulsky JA, Petracca F, Back A. Reflective teaching practices: an approach to teaching communication skills in a small-group setting. Acad Med. 2006 Jul;81(7):638-44. (2006) Abstract

Evans WG, Tulsky JA, Back AL, Arnold RM. Communication at times of transitions: how to help patients cope with loss and re-define hope. Cancer J. 2006 Sep-Oct;12(5):417-24. (2006) Abstract

Evans WG, Cutson TM, Steinhauser KE, Tulsky JA. Is There No Place Like Home? Caregivers Recall Reasons for and Experience upon Transfer from Home Hospice to Inpatient Facilities. J Palliat Med. 2006 Feb;9(1):100-10. (2006) Abstract

Alexander SC, Keitz SA, Sloane R, Tulsky JA. A controlled trial of a short course to improve residents' communication with patients at the end of life. Acad Med. 2006 Nov;81(11):1008-12. (2006) Abstract

Tulsky JA. Beyond advance directives: importance of communication skills at the end of life. JAMA. 2005 Jul 20;294(3):359-65. (2005) Abstract

Johnson KS, Kuchibhatala M, Sloane RJ, Tanis D, Galanos AN, Tulsky JA. Ethnic differences in the place of death of elderly hospice enrollees. J Am Geriatr Soc. 2005 Dec;53(12):2209-15. (2005) Abstract

Johnson KS, Elbert-Avila KI, Tulsky JA. The influence of spiritual beliefs and practices on the treatment preferences of african americans: a review of the literature. J Am Geriatr Soc. 2005 Apr;53(4):711-9. (2005) Abstract

Back AL, Arnold RM, Tulsky JA, Baile WF, Fryer-Edwards KA. On saying goodbye: acknowledging the end of the patient-physician relationship with patients who are near death. Ann Intern Med. 2005 Apr 19;142(8):682-5. (2005) Abstract

Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer-Edwards K. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005 May-Jun;55(3):164-77. (2005) Abstract

Steinhauser KE, Clipp EC, Bosworth HB, McNeilly M, Christakis NA, Voils CI, Tulsky JA. Measuring quality of life at the end of life: validation of the QUAL-E. Palliat Support Care. 2004 Mar;2(1):3-14. (2004) Abstract

Peck BM, Ubel PA, Roter DL, Goold SD, Asch DA, Mstat AS, Grambow SC, Tulsky JA. Do unmet expectations for specific tests, referrals, and new medications reduce patients' satisfaction? J Gen Intern Med. 2004 Nov;19(11):1080-7. (2004) Abstract

Emanuel L, Alexander C, Arnold RM, Bernstein R, Dart R, Dellasantina C, Dykstra L, Tulsky J, . Integrating palliative care into disease management guidelines. J Palliat Med. 2004 Dec;7(6):774-83. (2004) Abstract

Lo B, Kates LW, Ruston D, Arnold RM, Cohen CB, Puchalski CM, Pantilat SZ, Rabow MW, Schreiber RS, Tulsky JA. Responding to requests regarding prayer and religious ceremonies by patients near the end of life and their families. J Palliat Med. 2003 Jun;6(3):409-15. (2003) Abstract

Back AL, Arnold RM, Tulsky JA, Baile WF, Fryer-Edwards KA. Teaching communication skills to medical oncology fellows. J Clin Oncol. 2003 Jun 15;21(12):2433-6. (2003) Abstract

Ury WA, Arnold RM, Tulsky JA. Palliative care curriculum development: a model for a content and process-based approach. J Palliat Med. 2002 Aug;5(4):539-48. (2002) Abstract

Tulsky JA. Hope and hubris. J Palliat Med. 2002 Jun;5(3):339-41. (2002) Abstract

Tulsky JA, Arnold RM.  Communication at End of Life.  In Berger AM, Portenoy RK, Weissman DE, eds.  Principles and Practice of Palliative Care and Supportive Oncology, 2nd Edition;Philadelphia:Lipincott Williams & Wilkins,2002:673-84. (2002)

Steinhauser KE, Clipp EC, Tulsky JA. Evolution in measuring the quality of dying. J Palliat Med. 2002 Jun;5(3):407-14. (2002) Abstract

Steinhauser KE, Bosworth HB, Clipp EC, McNeilly M, Christakis NA, Parker J, Tulsky JA. Initial assessment of a new instrument to measure quality of life at the end of life. J Palliat Med. 2002 Dec;5(6):829-41. (2002) Abstract

Lo B, Ruston D, Kates LW, Arnold RM, Cohen CB, Faber-Langendoen K, Pantilat SZ, Puchalski CM, Quill TR, Rabow MW, Schreiber S, Sulmasy DP, Tulsky JA, . Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA. 2002 Feb 13;287(6):749-54. (2002) Abstract

Kolarik RC, Arnold RM, Fischer GS, Tulsky JA. Objectives for advance care planning. J Palliat Med. 2002 Oct;5(5):697-704. (2002) Abstract

Clever SL, Tulsky JA. Dreaded Conversations. J Gen Intern Med. 2002 Nov;17(11):893-894. (2002) Abstract

Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, Grambow S, Parker J, Tulsky JA. Preparing for the end of life: preferences of patients, families, physicians, and other care providers. J Pain Symptom Manage. 2001 Sep;22(3):727-37. (2001) Abstract

Peck BM, Asch DA, Goold SD, Roter DL, Ubel PA, McIntyre LM, Abbott KH, Hoff JA, Koropchak CM, Tulsky JA. Measuring patient expectations: does the instrument affect satisfaction or expectations? Med Care. 2001 Jan;39(1):100-8. (2001) Abstract

Breen CM, Abernethy AP, Abbott KH, Tulsky JA. Conflict associated with decisions to limit life-sustaining treatment in intensive care units. J Gen Intern Med. 2001 May;16(5):283-9. (2001) Abstract

Abbott KH, Sago JG, Breen CM, Abernethy AP, Tulsky JA. Families looking back: one year after discussion of withdrawal or withholding of life-sustaining support. Crit Care Med. 2001 Jan;29(1):197-201. (2001) Abstract

Tulsky JA.  Book Review: Death Foretold: Prophecy and prognosis in medical care, N Christakis. N Engl J Med; 2000;342(7):522. (2000)

Tulsky JA. Ancient wisdom for modern medicine: the tradition of Judaism.  N C Med J.2000;61(3):141-4. (2000) Abstract

Tulsky JA, Ciampa R, Rosen EJ. Responding to legal requests for physician-assisted suicide. University of Pennsylvania Center for Bioethics Assisted Suicide Consensus Panel. Ann Intern Med. 2000 Mar 21;132(6):494-9. (2000) Abstract

Steinhauser KE, Maddox GL, Person JL, Tulsky JA. The evolution of volunteerism and professional staff within hospice care in North Carolina. Hosp J. 2000;15(1):35-51. (2000) Abstract

Steinhauser KE, Clipp EC, McNeilly M, Christakis NA, McIntyre LM, Tulsky JA. In search of a good death: observations of patients, families, and providers. Ann Intern Med. 2000 May 16;132(10):825-32. (2000) Abstract

Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000 Nov 15;284(19):2476-82. (2000) Abstract

Roter DL, Larson S, Fischer GS, Arnold RM, Tulsky JA. Experts practice what they preach: A descriptive study of best and normative practices in end-of-life discussions.  Arch Intern Med 2000;160(22):3477-85. (2000) Abstract

Fischer GS, Arnold RM, Tulsky JA. Talking to the older adult about advance directives. Clin Geriatr Med. 2000 May;16(2):239-54. (2000) Abstract

Lo B, Quill T, Tulsky J. Discussing palliative care with patients. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians-American Society of Internal Medicine. Ann Intern Med. 1999 May 4;130(9):744-9. (1999) Abstract

Danis M, Federman D, Fins JJ, Fox E, Kastenbaum B, Lanken PN, Long K, Lowenstein E, Lynn J, Rouse F, Tulsky J. Incorporating palliative care into critical care education: principles, challenges, and opportunities. Crit Care Med. 1999 Sep;27(9):2005-13. (1999) Abstract

Tulsky JA, Fischer GS, Rose MR, Arnold RM. Opening the black box: how do physicians communicate about advance directives? Ann Intern Med. 1998 Sep 15;129(6):441-9. (1998) Abstract

Fischer GS, Tulsky JA, Rose MR, Siminoff LA, Arnold RM. Patient knowledge and physician predictions of treatment preferences after discussion of advance directives. J Gen Intern Med. 1998 Jul;13(7):447-54. (1998) Abstract

Tulsky JA, Cassileth BR, Bennett CL. The effect of ethnicity on ICU use and DNR orders in hospitalized AIDS patients.  J Clin Ethics 1997;8(2):150-7. (1997) Abstract

Hanson LC, Tulsky JA, Danis M. Can clinical interventions change care at the end of life? Ann Intern Med. 1997 Mar 1;126(5):381-8. (1997) Abstract

Tulsky JA, Stocking CB. Obstacles and opportunities in the design of ethics consultation evaluation.  J Clin Ethics 1996;7(2):139-45. (1996) Abstract

Tulsky JA, Chesney MA, Lo B. See one, do one, teach one? House staff experience discussing do-not-resuscitate orders. Arch Intern Med. 1996 Jun 24;156(12):1285-9. (1996) Abstract

Tulsky JA, Alpers A, Lo B. A middle ground on physician-assisted suicide.  Camb Q Healthc Ethics 1996;5(1):33-43. (1996) Abstract

Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television. Miracles and misinformation. N Engl J Med. 1996 Jun 13;334(24):1578-82. (1996) Abstract

Tulsky JA, Chesney MA, Lo B. How do medical residents discuss resuscitation with patients? J Gen Intern Med. 1995 Aug;10(8):436-42. (1995) Abstract

Tulsky JA, Lo B. Ethics consultation: time to focus on patients. Am J Med. 1992 Apr;92(4):343-5. (1992) Abstract