Palliative Care Communication Research Initiative (PCCRI):

The purposes of this multi-site observational cohort study are to understand how patients, families and palliative care clinicians discuss prognoses in the setting of advanced cancer and to identify the approaches that are most strongly associated with patient-centered outcomes in the setting of advanced cancer.

PI: Bob Gramling MD, DSc

Funder: American Cancer Society. Grant #: RSG-13-239-01-PCSM

Project Team: (UVM) Bob Gramling (PI), Jeffrey Priest (University of Rochester) Sally Norton, Susan Ladwig, Liz Gajary-Coots, Ronald Epstein, Kevin Fiscella, Susan Stanek, Nathalie Dougoud, Heather Pyke (Purdue University) Stewart Alexander, Luke Ingersoll (University of California, San Francisco) Wendy Anderson, Jenica Cimino (University of Arizona) David Gramling (University of Pennsylvania) Elise Tarbi


  • Ingersoll LT, Alexander SC, Anderson WG, Ladwig S, Norton SA, Gramling R. The contagion of optimism: The relationship between patient optimism and palliative care clinician overestimation of survival among hospitalized patients with advanced cancer.  PsychoOncology. 2019. April. [epub ahead of print]
  • Gramling R, Gajary-Coots E, Cimino J, Fiscella K, Epstein R, Ladwig S, Anderson W, Alexander SA, Han PK, Gramling D, Norton SA. Palliative Care Clinician Overestimation of Survival in Advanced Cancer: Disparities and Association with End-of-Life Care. Journal of Pain and Symptom Management. 2019. Feb;57(2)233-240. Listen to the GeriPal Podcast
  • Gramling R, Ingersoll L, Priest J, Berns S, Cheung K, Anderson W, Norton SA, Alexander SC. End-of-life treatment preferences, prognosis conversations, and hospice enrollment in palliative care: a direct observation cohort study among people with advanced cancer. Journal of Palliative Medicine. 2019. Feb;22(2):152-156
  • Ingersoll LT, Alexander SC, Priest J, Ladwig S, Anderson WA, Fiscella K, Epstein R, Norton SA, Gramling R. Racial/Ethnic Differences in PrognosisTalk during Inpatient Palliative Care Consultations among People with Advanced Cancer. Patient, Education & Counseling. 2019. [epub ahead of print]
  • Gramling D and Gramling R. Palliative Care Conversations: Clinical and Applied Linguistics Perspectives. (de Gruyter Press). January 2019
  • Manukyan V, Durieux B, Gramling C, Clarfeld L, Rizzo D, Eppstein M, Gramling R. Automated Detection of Conversational Pauses from Audio Recordings of Serious Illness Conversations in Natural Hospital Settings. Journal of Palliative Medicine. Dec 2018. 21 (12), p 1724-1728 
  • Durieux B, Gramling C, Manukyan V, Clarfeld L, Ryan A, Ross L, Niland M, Rizzo D, Eppstein M, Alexander SC, Gramling R. Tandem Machine Learning-Human Coding Method for Identification of Connectional Silence in Serious Illness Conversations. Journal of Palliative Medicine. Dec 2018. 21 (12), p 1755-1760
  • Ingersoll L, Alexander S, Anderson WG, Ladwig S, Norton SA, Gramling R. Benchmarking the Inpatient Palliative Care Heard & Understood Quality Indicator among Patients with Advanced Cancer. Journal of Pain & Symptom Management. 2018. Aug;56(2):239-244
  • Gramling R, Stanek S, Han PK, Duberstein P, Quill TE, Temel J, Alexander S, Anderson WG, Ladwig S, Norton SA. Distress due to Prognostic Uncertainty in Palliative Care: Frequency, Distribution and Outcomes Among Hospitalized Patients with Advanced Cancer. Journal of Palliative Medicine. 2018. Mar;21(3):315-321.
  • Gramling R, Stanek S, Ladwig S, Gajary-Coots L, Cimino J, Anderson W, Norton SA and the AAHPM Research Committee Writing Group. Feeling heard and understood: a patient-reported quality measure for the inpatient palliative care setting. Journal of Pain & Symptom Management. 2016. Feb;51(2):150-4.
  • Gramling R, Gajary-Coots E, Stanek S, Dougoud N, Pyke H, Thomas M, Cimino J, Sanders M, Alexander SC, Epstein R, Fiscella K, Gramling D, Ladwig S, Anderson W, Pantilat S, Norton SA. Design and Enrollment in the Palliative Care Communication Research Initiative: a Direct-Observation Cohort Study. BMC Palliative Care. 2015. Aug 19;14:40.


Student Theses and Dissertations:

  • "Patient & Family Expressions of Uncertainty in Palliative Care Conversations"
    Susan Stanek, RN (Doctoral Dissertation, University of Rochester School of Nursing)
  • "Family Contributions to Palliative Care Conversations"
    Nathalie Dougoud, RN, APRN (Doctoral Dissertation, University of Rochester School of Nursing)
  • "Expressions of Existential Experience in Palliative Care Conversations"
    Elise Tarbi, RN, APRN (Doctoral Dissertation, University of Pennsylvania School of Nursing)
  • "Exploration of StoryArcs in Palliative Care Conversations using Natural Language Processing"
    Lindsay Ross (Honor's Thesis, University of Vermont Department of Computer Science)
  • Dougoud N, Stanek S, Norton S, Gramling R. Use of Secondary Data for Doctoral Dissertations. Nursing Research. 66(2) E30-E31 (abstract)
  • "Machine Learning for Characterizing Acoustic Features of Serious Illness Conversations" Larry Clarfeld, MS (Doctoral Dissertation, University of Vermont School of Engineering).