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, University of California–San Francisco Medical Center, 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 include: Pathways, the identification of clinical, psychosocial and spiritual trajectories of patients at the end of life; COPE, an NCI funded study to test a web-based intervention to help cancer patients get their emotional needs met when visiting with oncologists; the NINR funded Center to Study Self-Management Interventions in Life-Limiting Illness; and PAL-HF, an NINR funded randomized controlled trial of palliative care in heart failure.

Dr. Tulsky has gained national recognition for his work on end-of-life care and he has over 140 peer reviewed publications as well as a book on Mastering Communication With Seriously Ill Patients (Cambridge). 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), in 2006 he received the American Academy on Hospice and Palliative Medicine Award for Research Excellence, and in 2013 he was elected a Member of the Association of American Physicians.

Industry Relationships and Collaborations (What's this?)

This faculty member has no reported relationships with industry.

Representative Publications
Barclay, JS; Kuchibhatla, M; Tulsky, JA; Johnson, KS. Association of hospice patients' income and care level with place of death. Jama Internal Medicine. 2013;173:450-456. (2013) Abstract

Goldstein, AO; Barnhouse, KK; Viera, AJ; Tulsky, JA; Richman, BD. Assessing Competency for Concealed-Weapons Permits - The Physician's Role. New England Journal of Medicine. 2013; (2013) Abstract

Burton, AM; Sautter, JM; Tulsky, JA; Lindquist, JH; Hays, JC; Olsen, MK; Zimmerman, SI; Steinhauser, KE. Burden and well-being among a diverse sample of cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers. Journal of Pain and Symptom Management. 2012;44:410-420. (2012) Abstract

Johnson, KS; Elbert-Avila, K; Kuchibhatla, M; Tulsky, JA. Characteristics and outcomes of hospice enrollees with dementia discharged alive. Journal of the American Geriatrics Society. 2012;60:1638-1644. (2012) Abstract

Morris, DA; Johnson, KS; Ammarell, N; Arnold, RM; Tulsky, JA; Steinhauser, KE. What is your understanding of your illness? A communication tool to explore patients' perspectives of living with advanced illness. Journal of General Internal Medicine. 2012;27:1460-1466. (2012) Abstract

Bailey, DE; Steinhauser, K; Hendrix, C; Tulsky, JA. Pairing Self-Management with Palliative Care: Intervening in Life-Limiting Illness. Journal of Nursing and Healthcare of Chronic Illness: an international interdisciplinary journal. 2011;3:1-3. (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. Palliative and Supportive Care. 2011;9:273-280. (2011) Abstract

Johnson, KS; Kuchibhatla, M; Tulsky, JA. Racial differences in location before hospice enrollment and association with hospice length of stay. Journal of the American Geriatrics Society. 2011;59:732-737. (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?. Journal of General Internal Medicine. 2011;26:751-758. (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?. Journal of Pain and Symptom Management. 2011;42:331-341. (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. Annals of Internal Medicine. 2011;155:593-601. (2011) Abstract

Abernethy, AP; McDonald, CF; Frith, PA; Clark, K; Herndon, JE; 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;376:784-793. (2010) Abstract

Back, AL; Arnold, RM; Baile, WF; Edwards, KA; Tulsky, JA. When praise is worth considering in a difficult conversation. Lancet. 2010;376:866-867. (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. Academic Medicine. 2010;85:1048-1051. (2010) Abstract

Casarett, D; Pickard, A; Fishman, JM; Alexander, SC; Arnold, RM; Pollak, KI; Tulsky, JA. Can metaphors and analogies improve communication with seriously ill patients?. Journal of Palliative Medicine. 2010;13:255-260. (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. American Journal of Preventive Medicine. 2010;39:321-328. (2010) Abstract

Pollak, KI; Arnold, R; Alexander, SC; Jeffreys, AS; Olsen, MK; Abernethy, AP; Rodriguez, KL; Tulsky, JA. Do patient attributes predict oncologist empathic responses and patient perceptions of empathy?. Supportive Care in Cancer. 2010;18:1405-1411. (2010) Abstract

Rodriguez, KL; Bayliss, N; Alexander, SC; Jeffreys, AS; Olsen, MK; Pollak, KI; Kennifer, SL; Tulsky, JA; Arnold, RM. How oncologists and their patients with advanced cancer communicate about health-related quality of life. Psycho-Oncology: journal of the psychological, social and behavioral dimensions of cancer. 2010;19:490-499. (2010) Abstract

Tulsky, JA. Decision-making in serious illness: a matter of life, death and words. Patient Education and Counseling. 2010;80:1-2. (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. Annals of Internal Medicine. 2010;153:167-175. (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. Journal of Clinical Oncology. 2009;27:1137-1141. (2009) Abstract

Cox, CE; Martinu, T; Sathy, SJ; Clay, AS; Chia, J; Gray, AL; Olsen, MK; Govert, JA; Carson, SS; Tulsky, JA. Expectations and outcomes of prolonged mechanical ventilation. Critical Care Medicine. 2009;37:2888-2894. (2009) 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 Education and Counseling. 2009;76:51-56. (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 Education and Counseling. 2009;77:90-96. (2009) Abstract

Steinhauser, KE; Alexander, SC; Byock, IR; George, LK; Tulsky, JA. Seriously ill patients' discussions of preparation and life completion: an intervention to assist with transition at the end of life. Palliative and Supportive Care. 2009;7:393-404. (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: Journal of the American Medical Association. 2008;299:2533-2542. (2008) Abstract

Johnson, KS; Kuchibhatla, M; Tanis, D; Tulsky, JA. Racial differences in hospice revocation to pursue aggressive care. Archives of Internal Medicine. 2008;168:218-224. (2008) Abstract

Johnson, KS; Kuchibhatla, M; Tulsky, JA. What explains racial differences in the use of advance directives and attitudes toward hospice care?. Journal of the American Geriatrics Society. 2008;56:1953-1958. (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. Supportive Care in Cancer. 2008;16:1049-1057. (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. Archives of Internal Medicine. 2007;167:453-460. (2007) Abstract

Keitz, SA; Stechuchak, KM; Grambow, SC; Koropchak, CM; Tulsky, JA. Behind closed doors: management of patient expectations in primary care practices. Archives of Internal Medicine. 2007;167:445-452. (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. Journal of Clinical Oncology. 2007;25:5748-5752. (2007) Abstract

Taylor, DH; 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?. Social Science and Medicine. 2007;65:1466-1478. (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. Academic Medicine. 2006;81:1008-1012. (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. Annals of Internal Medicine. 2005;142:682-685. (2005) Abstract

Tulsky, JA. Beyond advance directives: importance of communication skills at the end of life. JAMA: Journal of the American Medical Association. 2005;294:359-365. (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; Working Group on Religious and Spiritual Issues at the End of Life. Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA: Journal of the American Medical Association. 2002;287:749-754. (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. Critical Care Medicine. 2001;29:197-201. (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: Journal of the American Medical Association. 2000;284:2476-2482. (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. Annals of Internal Medicine. 2000;132:825-832. (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. Annals of Internal Medicine. 1999;130:744-749. (1999) Abstract

Tulsky, JA; Fischer, GS; Rose, MR; Arnold, RM. Opening the black box: how do physicians communicate about advance directives?. Annals of Internal Medicine. 1998;129:441-449. (1998) Abstract

Diem, SJ; Lantos, JD; Tulsky, JA. Cardiopulmonary resuscitation on television. Miracles and misinformation. New England Journal of Medicine. 1996;334:1578-1582. (1996) Abstract

Tulsky, JA; Chesney, MA; Lo, B. How do medical residents discuss resuscitation with patients?. Journal of General Internal Medicine. 1995;10:436-442. (1995) Abstract