Physicians

Director, Duke Center for Palliative Care

Departments / Divisions

• Medicine / General Internal Medicine
• School of Nursing

Address
2424 Erwin Road, Suite 1105
Durham, NC 27705

Office Telephone
919-668-7215

Fax Telephone
919-668-1300

Training

• MD, University of Illinois College of Medicine, 1987

Residency

• Internal Medicine, UCSF Medical Center (California), 1987-1991

Fellowship

• 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.

Industry Relationships and Collaborations (What's this?)

This physician (or a member of their immediate family) has a working relationship (i.e. consulting, research, and/or educational services) with the companies listed below. These relations have been reported to the health system leadership and, when appropriate, management plans are in place to address potential conflicts.

• Merck & Co. USA (not assoc'd with Merck KGaA)

Representative Publications
Alexander SC, Pollak KI, Morgan PA, Strand J, Abernethy AP, Jeffreys AS, Arnold RM, Olsen M, Rodriguez KL, Garrigues SK, Manusov JR, Tulsky JA. How do non-physician clinicians respond to advanced cancer patients' negative expressions of emotions? Support Care Cancer. 2011 Jan;19(1):155-9. (2011) Abstract

Bailey DE Jr, Steinhauser K, Hendrix C, Tulsky JA. Pairing Self-Management with Palliative Care: Intervening in Life-Limiting Illness. J Nurs Healthc Chronic Illn. 2011 Mar;3(1):1-3. (2011) Abstract

Hays JC, Wood L, Steinhauser K, Olson MK, Lindquist JH, Tulsky JA. Clergy-laity support and patients' mood during serious illness: a cross-sectional epidemiologic study. Palliat Support Care. 2011 Sep;9(3):273-80. (2011) Abstract

Johnson KS, Kuchibhatla M, Tulsky JA. Racial differences in location before hospice enrollment and association with hospice length of stay. J Am Geriatr Soc. 2011 Apr;59(4):732-7. (2011) Abstract

Johnson KS, Tulsky JA, Hays JC, Arnold RM, Olsen MK, Lindquist JH, Steinhauser KE. Which domains of spirituality are associated with anxiety and depression in patients with advanced illness? J Gen Intern Med. 2011 Jul;26(7):751-8. (2011) Abstract

Leblanc TW, Tulsky JA, Simel DL. Autopsy and Grief: A Case of Transformative Postmortem Examination. J Palliat Med. 2011 Aug 4. (2011) Abstract

Loberiza FR, Swore-Fletcher BA, Block SD, Back AL, Goldman RE, Tulsky JA, Lee SJ. Coping styles, health status and advance care planning in patients with hematologic malignancies. Leuk Lymphoma. 2011 Aug 18. (2011) Abstract

Steinhauser KE, Arnold RM, Olsen MK, Lindquist J, Hays J, Wood LL, Burton AM, Tulsky JA. Comparing three life-limiting diseases: does diagnosis matter or is sick, sick? J Pain Symptom Manage. 2011 Sep;42(3):331-41. (2011) Abstract

Tulsky JA, Arnold RM, Alexander SC, Olsen MK, Jeffreys AS, Rodriguez KL, Skinner CS, Farrell D, Abernethy AP, Pollak KI. Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial. Ann Intern Med. 2011 Nov 1;155(9):593-601. (2011) Abstract

Abernethy AP, McDonald CF, Frith PA, Clark K, Herndon JE 2nd, Marcello J, Young IH, Bull J, Wilcock A, Booth S, Wheeler JL, Tulsky JA, Crockett AJ, Currow DC. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010 Sep 4;376(9743):784-93. (2010) Abstract

Back AL, Arnold RM, Baile WF, Edwards KA, Tulsky JA. When praise is worth considering in a difficult conversation. Lancet. 2010 Sep 11;376(9744):866-7. (2010) Abstract

Back AL, Arnold RM, Tulsky JA, Baile WF, Edwards K. "Could I add something?": Teaching communication by intervening in real time during a clinical encounter. Acad Med. 2010 Jun;85(6):1048-51. (2010) Abstract

Pollak KI, Alexander SC, Coffman CJ, Tulsky JA, Lyna P, Dolor RJ, James IE, Brouwer RJ, Manusov JR, Østbye T. Physician communication techniques and weight loss in adults: Project CHAT. Am J Prev Med. 2010 Oct;39(4):321-8. (2010) Abstract

Rodriguez KL, Bayliss NK, Alexander SC, Jeffreys AS, Olsen MK, Pollak KI, Garrigues SK, Tulsky JA, Arnold RM. Effect of patient and patient-oncologist relationship characteristics on communication about health-related quality of life. Psychooncology. 2010 Aug 25. (2010) Abstract

Tulsky JA. Decision-making in serious illness: a matter of life, death and words. Patient Educ Couns. 2010 Jul;80(1):1-2. (2010) Abstract

Unroe M, Kahn JM, Carson SS, Govert JA, Martinu T, Sathy SJ, Clay AS, Chia J, Gray A, Tulsky JA, Cox CE. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010 Aug 3;153(3):167-75. (2010) 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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