Kathryn Pollak

Overview:

Dr. Pollak is a social psychologist who designs and tests behavioral interventions to promote smoking cessation, reduce health disparities, and improve clinician-patient communication. She also is one of the heads of the Palliative Care Research Cooperative that supports multi-site palliative care trials. Finally, Dr. Pollak serves as a Communication Coach where she teaches clinicians effective communication techniques.

Area of expertise: Health Behavior

Positions:

Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Professor in the Department of Family Medicine and Community Health

Family Medicine and Community Health
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 1996

University of Houston

Grants:

Optimizing a standalone text messaging-based weight loss intervention

Administered By
Duke Global Health Institute
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

SMS scheduled gradual reduction text messages to help pregnant smokers quit

Administered By
Duke Cancer Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Addressing Tobacco Use Disparities through an Innovative Mobile Phone Intervention: The textto4gosmokelesstobacco

Administered By
School of Nursing
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

En Pareja: A Latino couples intervention to help expectant fathers quit smoking

Administered By
Duke Cancer Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Smoking Resumption-Prevention in Postpartum Women

Administered By
Duke Cancer Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Publications:

Systemic Therapy Decision Making in Advanced Cancer: A Qualitative Analysis of Patient-Oncologist Encounters.

PURPOSE: We sought to characterize patient-oncologist communication and decision making about continuing or limiting systemic therapy in encounters after an initial consultation, with a particular focus on whether and how oncologists foster shared decision making (SDM). METHODS: We performed content analysis of outpatient oncology encounters at two US National Cancer Institute-designated cancer centers audio recorded between November 2010 and September 2014. A multidisciplinary team used a hybrid approach of inductive and deductive coding and theme development. We used a combination of random and purposive sampling. We restricted quantitative frequency counts to the coded random sample but included all sampled encounters in qualitative thematic analysis. RESULTS: Among 31 randomly sampled dyads with three encounters each, systemic therapy decision making was discussed in 90% (84 of 93) encounters. Thirty-four (37%) broached limiting therapy, which 27 (79%) framed as temporary, nine (26%) as completion of a standard regimen, and five (15%) as permanent discontinuation. Thematic analysis of these 93 encounters, plus five encounters purposively sampled for permanent discontinuation, found that (1) patients and oncologists framed continuing therapy as the default, (2) deficiencies in the SDM process (facilitating choice awareness, discussing options, and incorporating patient preferences) contributed to this default, and (3) oncologists use persuasion rather than deliberation when broaching discontinuation. CONCLUSION: In this study of outpatient encounters between patients with advanced cancer and their oncologists, when discussing systemic therapy, there exists a default to continue systemic therapy, and deficiencies in SDM contribute to this default.
Authors
Wasp, GT; Knutzen, KE; Murray, GF; Brody-Bizar, OC; Liu, MA; Pollak, KI; Tulsky, JA; Schenker, Y; Barnato, AE
MLA Citation
Wasp, Garrett T., et al. “Systemic Therapy Decision Making in Advanced Cancer: A Qualitative Analysis of Patient-Oncologist Encounters.Jco Oncol Pract, vol. 18, no. 8, Aug. 2022, pp. e1357–66. Pubmed, doi:10.1200/OP.21.00377.
URI
https://scholars.duke.edu/individual/pub1502809
PMID
34855459
Source
pubmed
Published In
Jco Oncol Pract
Volume
18
Published Date
Start Page
e1357
End Page
e1366
DOI
10.1200/OP.21.00377

Role of Social Workers in Family Conferences for Critically Ill Infants.

Background: Communication challenges in the neonatal intensive care unit include fragmented communication, challenges managing expectations amidst uncertainty, and navigating complex medical information. Social workers are well suited to mitigate these challenges. Objective: In this study, we aimed to characterize the extent and nature of social worker participation in family conferences for critically ill infants. Design: We used a longitudinal observational mixed-methods design, enrolling infants with a neurological condition, their parent(s), and their clinicians. All audio-recorded conferences were transcribed and de-identified. Emergent themes and subthemes were identified using conventional content analysis. Results: We enrolled 40 infants and 61 parents. Sixty-eight conferences were held and audio recorded for 24 infants. Social workers were present for 51 of these conferences (n = 51/68, 75%) across 18 cases (n = 18/24, 75%). We identified four themes, conceptualized as distinct roles played by social workers in family conferences: (1) Translator: social workers served as a communicative bridge between parents and the medical team; (2) Coordinator: social workers simplified logistics and connected parents to community resources, including home health agencies and financial assistance; (3) Expectation manager: social workers provided anticipatory guidance and helped parents conceptualize the remainder of the hospital stay, discharge, and life at home; and (4) Advocate: social workers validated parental values and concerns and provided immediate emotional support. Conclusions: Social workers participated in three-quarters of family conferences for critically ill infants. When they participated, they facilitated communication, coordinated care, managed expectations, and advocated for families. These findings underscore the important, varied, and concurrent roles social workers play in the care of critically ill infants. Future communication and family support interventions should leverage these distinct roles.
Authors
Farley, S; Bansal, S; Barks, MC; Pollak, KI; Kaye, EC; Quarles, A; Briglia, K; Johnson, E; Lakis, K; Lemmon, ME
MLA Citation
Farley, Sam, et al. “Role of Social Workers in Family Conferences for Critically Ill Infants.J Palliat Med, vol. 25, no. 8, Aug. 2022, pp. 1236–42. Pubmed, doi:10.1089/jpm.2021.0574.
URI
https://scholars.duke.edu/individual/pub1513299
PMID
35285675
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
25
Published Date
Start Page
1236
End Page
1242
DOI
10.1089/jpm.2021.0574

How can healthcare organizations improve cost-of-care conversations? A qualitative exploration of clinicians' perspectives.

OBJECTIVES: Clinicians increasingly believe they should discuss costs with their patients. We aimed to learn what strategies clinicians, clinic leaders, and health systems can use to facilitate vital cost-of-care conversations. METHODS: We conducted focus groups and semi-structured interviews with outpatient clinicians at two US academic medical centers. Clinicians recalled previous cost conversations and described strategies that they, their clinic, or their health system could use to facilitate cost conversations. Independent coders recorded, transcribed, and coded focus groups and interviews. RESULTS: Twenty-six clinicians participated between December 2019 and July 2020: general internists (23%), neurologists (27%), oncologists (15%), and rheumatologists (35%). Clinicians proposed the following strategies: teach clinicians to initiate cost conversations; systematically collect financial distress information; partner with patients to identify costs; provide accurate insurance coverage and/or out-of-pocket cost information via the electronic health record; develop local lists of lowest-cost pharmacies, laboratories, and subspecialists; hire financial counselors; and reduce indirect costs (e.g., parking). CONCLUSIONS: Despite considerable barriers to discussing, identifying, and reducing patient costs, clinicians described a variety of strategies for improving cost communication in the clinic. PRACTICE IMPLICATIONS: Health systems and clinic leadership can and should implement these strategies to improve the financial health of the patients they serve.
Authors
Sloan, CE; Gutterman, S; Davis, JK; Campagna, A; Pollak, KI; Barks, MC; Santanam, T; Sharma, M; Grande, DT; Zafar, SY; Ubel, PA
MLA Citation
Sloan, Caroline E., et al. “How can healthcare organizations improve cost-of-care conversations? A qualitative exploration of clinicians' perspectives.Patient Educ Couns, vol. 105, no. 8, Aug. 2022, pp. 2708–14. Pubmed, doi:10.1016/j.pec.2022.04.005.
URI
https://scholars.duke.edu/individual/pub1517774
PMID
35440376
Source
pubmed
Published In
Patient Educ Couns
Volume
105
Published Date
Start Page
2708
End Page
2714
DOI
10.1016/j.pec.2022.04.005

Decisional Satisfaction, Regret, and Conflict Among Parents of Infants with Neurologic Conditions.

OBJECTIVE: To characterize decisional satisfaction, regret, and conflict among parents of critically ill infants with neurologic conditions. STUDY DESIGN: In this prospective cohort study, we enrolled parents of infants with neurologic conditions in the intensive care unit (ICU). Hospital discharge surveys included the validated Family Satisfaction with the ICU (FS-ICU) decision making subscale, Decision Regret Scale (DRS), and Decisional Conflict Scale (DCS). We defined high satisfaction with decision making as an FS-ICU score ≥75, high decisional regret/conflict as DRS/DCS score >25, and within-couple disagreement as a difference of at least 25 points between scores. RESULTS: We enrolled 61 parents of 40 infants (n = 40 mothers, n = 21 fathers); 35 mothers and 15 fathers completed surveys. Most mothers reported high satisfaction with decision making (27 of 35; 77%) and low decision regret (28 of 35; 80%); 40% (14 of 35) reported high decisional conflict. Mothers and fathers reported higher decisional conflict in the domains of uncertainty and values clarity compared with the domain of effective decision making (Bonferroni-corrected P < .05). There were no differences in decision outcomes between paired mothers and fathers; however, within any given couple, there were numerous instances of disagreement (7 of 15 for decision regret and 5 of 15 for decisional conflict). CONCLUSIONS: Many parents experience decisional conflict even if they ultimately have high satisfaction and low regret, underscoring the need for decision aids targeting uncertainty and values clarity. Couples frequently experience different levels of decisional regret and conflict.
Authors
Barlet, MH; Ubel, PA; Weinfurt, KP; Glass, HC; Pollak, KI; Brandon, DH; Lemmon, ME
MLA Citation
Barlet, Margaret H., et al. “Decisional Satisfaction, Regret, and Conflict Among Parents of Infants with Neurologic Conditions.J Pediatr, vol. 245, June 2022, pp. 81-88.e3. Pubmed, doi:10.1016/j.jpeds.2022.02.043.
URI
https://scholars.duke.edu/individual/pub1511742
PMID
35227757
Source
pubmed
Published In
J Pediatr
Volume
245
Published Date
Start Page
81
End Page
88.e3
DOI
10.1016/j.jpeds.2022.02.043

Effects of Smoking Reduction and Cessation on Birth Outcomes in a Scheduled Gradual Reduction Cessation Trial.

INTRODUCTION: Smoking during pregnancy can affect infant birthweight. We tested whether an intervention that promoted scheduled gradual reduction improved birth outcomes among pregnant women who smoked. We also examined race differences in birth outcomes. METHODS: We conducted a 2-arm randomized controlled trial where pregnant women who smoked received either SMS text-delivered scheduled gradual smoking reduction (SGR) program plus support texts or support messages only throughout their pregnancy. The outcomes for this paper were birth outcomes including birth weight and gestational age obtained from chart review. Analyses were conducted using chi-square and t-tests in SAS. RESULTS: We approached 2201 pregnant women with smoking history. Of the 314 women recruited into the study, 290 completed a medical release form (92%). We did not find any significant differences in birth outcomes by arm or race. The majority of participants reduced smoking by the 80%. Women who reduced more than 50% of their baseline cigarettes per day had a birth weight increase of 335 g compared to those that did not (p = 0.05). The presence of alcohol/drug use in prenatal visit notes was associated with low infant birth weight (p = 0.05). DISCUSSION: The scheduled gradual reduction intervention did not improve birth outcomes. Additional research is needed to help improve birth outcomes for pregnant women who engage in tobacco and illicit substance use. CLINICAL TRIAL #: NCT01995097.
Authors
Kennedy, DL; Lyna, P; Gao, X; Noonan, D; Bejarano Hernandez, S; Fish, LJ; Swamy, GK; Pollak, KI
MLA Citation
Kennedy, Danielle L., et al. “Effects of Smoking Reduction and Cessation on Birth Outcomes in a Scheduled Gradual Reduction Cessation Trial.Matern Child Health J, vol. 26, no. 5, May 2022, pp. 963–69. Pubmed, doi:10.1007/s10995-022-03386-6.
URI
https://scholars.duke.edu/individual/pub1511978
PMID
35235142
Source
pubmed
Published In
Matern Child Health J
Volume
26
Published Date
Start Page
963
End Page
969
DOI
10.1007/s10995-022-03386-6