Browsing by Author "Periyakoil, Vyjeyanthi S."

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    Caught in a Loop with Advance Care Planning and Advance Directives: How to Move Forward?
    (Mary Ann Liebert, Inc., 2022-03) Periyakoil, Vyjeyanthi S.; von Gunten, Charles F.; Arnold, Robert; Hickman, Susan; Morrison, Sean; Sudore, Rebecca; Medicine, School of Medicine
    Completion of an advance care planning (ACP) process and/or an advance directive should result in patients receiving the care they desire at the end of life. However, three decades of research have shown that is just not the case. ACP has been a front runner in developing the science within palliative care. Some positive outcomes such as lowering levels of surrogate grief may be associated with ACP. Yet, it does not appear that further ACP research will ensure that seriously ill patients will get goal-concordant care. An unfortunate consequence of palliative care research and advocacy so far is the misguided notion of many hospital systems trying to solve their palliative care problems by only implementing an ACP initiative. At best, ACP is but one tool in the collective palliative care toolbox. New tools are needed. Given that we have finite resources, future research should focus more on tools to improve symptom management, better models of care, and systems that will ensure goal-concordant care that meet the needs of the population that the health care system is designed to meet.
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    Health equity engineering: Optimizing hope for a new generation of healthcare
    (Cambridge University Press, 2024-05-23) Enders, Felicity T.; Golembiewski, Elizabeth H.; Balls-Berry, Joyce E.; Brooks, Tayla R.; Carr, Allison R.; Cullen, John P.; DiazGranados, Deborah; Gaba, Ayorkor; Johnson, Leigh; Menser, Terri; Messinger, Shari; Milam, Adam J.; Orellana, Minerva A.; Perkins, Susan M.; Chisholm Pineda, Tiffany D.; Thurston, Sally W.; Periyakoil, Vyjeyanthi S.; Hanlon, Alexandra L.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Medical researchers are increasingly prioritizing the inclusion of underserved communities in clinical studies. However, mere inclusion is not enough. People from underserved communities frequently experience chronic stress that may lead to accelerated biological aging and early morbidity and mortality. It is our hope and intent that the medical community come together to engineer improved health outcomes for vulnerable populations. Here, we introduce Health Equity Engineering (HEE), a comprehensive scientific framework to guide research on the development of tools to identify individuals at risk of poor health outcomes due to chronic stress, the integration of these tools within existing healthcare system infrastructures, and a robust assessment of their effectiveness and sustainability. HEE is anchored in the premise that strategic intervention at the individual level, tailored to the needs of the most at-risk people, can pave the way for achieving equitable health standards at a broader population level. HEE provides a scientific framework guiding health equity research to equip the medical community with a robust set of tools to enhance health equity for current and future generations.