Deborah Fisher

Overview:

1) Clinical interests and focus: I am a general gastroenterologist with a particular interest in colorectal cancer screening/surveillance and quality improvement.  I recently served on the ASGE Assessment of Quality in Endoscopy committee and currently serve on the AGA Clinical Practice Updates committee.

2) Research focus: Outcomes, big data, and health services research as applied to a variety of GI areas including weight-loss devices, NAFLD, colorectal cancer screening, choledocholithiasis.  I conduct clinical research (outcomes, clinical trials, diagnostic studies) in colorectal cancer screening and have collaborated with the School of Engineering on GI clinical applications of new technology.

3) Educational activities:  Clinical teaching in gastroenterology and endoscopy, directing the Department of Medicine MENTORS program for research fellows, mentoring trainees and junior faculty in research.  I am faculty of the GI T32 training grant and of the Duke Clinical Research Training Program. In my role as the GI Director of Social and Digital Media, I train and advise in using social media for medical education and professional development.

Positions:

Associate Professor of Medicine

Medicine, Gastroenterology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Member in the Duke Clinical Research Institute

Duke Clinical Research Institute
School of Medicine

Education:

M.D. 1996

Vanderbilt University

Medical Resident, Medicine

University of Virginia

Fellow in Gastroenterology, Medicine

Duke University

Grants:

H9X-MC-GBGL

Administered By
Duke Clinical Research Institute
Awarded By
Eli Lilly and Company
Role
Principal Investigator
Start Date
End Date

Core variable Assessment Towards a NatIonal evaluation Program (CATNIP) - Subcontract with Weill Cornell

Administered By
Duke Clinical Research Institute
Awarded By
Weill Cornell Medicine
Role
Principal Investigator
Start Date
End Date

Duke Training Grant in Advanced Gastrointestinal Endoscopy

Administered By
Medicine, Gastroenterology
Awarded By
Boston Scientific Corporation
Role
Mentor
Start Date
End Date

Publications:

Healthcare Costs of Colonoscopy With and Without Complications Among Patients at Average Risk for Colorectal Cancer in the United States (US)

Authors
Fisher, DA; Princic, N; Miller-Wilson, L-A; Wilson, K; DeYoung, K; Fendrick, M; Limburg, PJ
MLA Citation
Fisher, Deborah A., et al. “Healthcare Costs of Colonoscopy With and Without Complications Among Patients at Average Risk for Colorectal Cancer in the United States (US).” American Journal of Gastroenterology, vol. 115, 2020, pp. S287–S287.
URI
https://scholars.duke.edu/individual/pub1474103
Source
wos-lite
Published In
American Journal of Gastroenterology
Volume
115
Published Date
Start Page
S287
End Page
S287

Predicted Colorectal Cancer Outcomes With Reported Adherence to Follow-Up Colonoscopy After a Positive Stool-Based Test

Authors
Fendrick, M; Fisher, DA; Saoud, L; Ozbay, AB; Limburg, PJ
MLA Citation
Fendrick, Mark, et al. “Predicted Colorectal Cancer Outcomes With Reported Adherence to Follow-Up Colonoscopy After a Positive Stool-Based Test.” American Journal of Gastroenterology, vol. 115, 2020, pp. S135–36.
URI
https://scholars.duke.edu/individual/pub1474104
Source
wos-lite
Published In
American Journal of Gastroenterology
Volume
115
Published Date
Start Page
S135
End Page
S136

A stepped randomized trial to promote colorectal cancer screening in a nationwide sample of U.S. Veterans.

BACKGROUND: Colorectal cancer (CRC) screening (CRCS) facilitates early detection and lowers CRC mortality. OBJECTIVES: To increase CRCS in a randomized trial of stepped interventions. Step 1 compared three modes of delivery of theory-informed minimal cue interventions. Step 2 was designed to more intensively engage those not completing CRCS after Step 1. METHODS: Recruitment packets (60,332) were mailed to a random sample of individuals with a record of U.S. military service during the Vietnam-era. Respondents not up-to-date with CRCS were randomized to one of four Step 1 groups: automated telephone, telephone, letter, or survey-only control. Those not completing screening after Step 1 were randomized to one of three Step 2 groups: automated motivational interviewing (MI) call, counselor-delivered MI call, or Step 2 control. Intention-to-treat (ITT) analyses assessed CRCS on follow-up surveys mailed after each step. RESULTS: After Step 1 (n = 1784), CRCS was higher in the letter, telephone, and automated telephone groups (by 1%, 5%, 7%) than in survey-only controls (43%), although differences were not statistically significant. After Step 2 (n = 516), there were nonsignificant increases in CRCS in the two intervention groups compared with the controls. CRCS following any combination of stepped interventions overall was 7% higher (P = 0.024) than in survey-only controls (55.6%). CONCLUSIONS: In a nationwide study of Veterans, CRCS after each of two stepped interventions of varying modes of delivery did not differ significantly from that in controls. However, combined overall, the sequence of stepped interventions significantly increased CRCS.
Authors
Vernon, SW; Del Junco, DJ; Coan, SP; Murphy, CC; Walters, ST; Friedman, RH; Bastian, LA; Fisher, DA; Lairson, DR; Myers, RE
MLA Citation
Vernon, Sally W., et al. “A stepped randomized trial to promote colorectal cancer screening in a nationwide sample of U.S. Veterans.Contemp Clin Trials, vol. 105, Apr. 2021, p. 106392. Pubmed, doi:10.1016/j.cct.2021.106392.
URI
https://scholars.duke.edu/individual/pub1478235
PMID
33823295
Source
pubmed
Published In
Contemp Clin Trials
Volume
105
Published Date
Start Page
106392
DOI
10.1016/j.cct.2021.106392

Lowering the Colorectal Cancer Screening Age Improves Predicted Outcomes in a Microsimulation Model.

AIMS: While most guidelines still recommend colorectal cancer (CRC) screening initiation at age 50 years in average-risk individuals, guideline-creating bodies are starting to lower the recommended age of initiation to 45 years to mitigate the trend of increasing CRC rates in younger populations. Using CRC-AIM, we modeled the impact of lowering the CRC screening initiation age, incorporating theoretical and reported adherence rates, for triennial multi-target stool DNA (mt-sDNA) or annual fecal immunochemical test (FIT) screening.Methods and Materials: Screening strategies were simulated for individuals without CRC at age 40 and screened from ages 50-75 or 45-75 years. Outcomes included CRC incidence, CRC mortality, and life-years gained (LYG) per 1000 individuals screened (compared with no screening). Models used theoretically perfect (100%) and previously reported (71% mt-sDNA; 43% FIT) adherence rates. RESULTS: With perfect adherence, mt-sDNA and FIT resulted in 22.2 and 23.4 more predicted LYG, respectively, with screening initiation at age 45 versus 50 years; reported adherence resulted in 23.9 and 24.4 more LYG, respectively.With perfect adherence, screening initiation at age 45 versus 50 years resulted in 26.1 and 28.6 CRC cases, respectively, with mt-sDNA and 22.8 and 25.5 cases with FIT; with reported real-world adherence there were 28.5 and 31.2 cases, respectively, with mt-sDNA and 37.1 and 40.2 cases with FIT. Similar patterns were observed for CRC deaths.With screening initiation at age 45 and reported adherence, mt-sDNA averted 8.6 more CRC cases and 3.3 more deaths per 1000 individuals than FIT. CONCLUSIONS: Estimated CRC screening outcomes improved by lowering the initiation age from 50 to 45 years. Incorporating reported adherence rates yields greater benefits from triennial mt-sDNA versus annual FIT screening.
Authors
Fisher, DA; Saoud, L; Finney Rutten, LJ; Ozbay, AB; Brooks, D; Limburg, PJ
MLA Citation
Fisher, Deborah A., et al. “Lowering the Colorectal Cancer Screening Age Improves Predicted Outcomes in a Microsimulation Model.Curr Med Res Opin, Mar. 2021, p. 1. Pubmed, doi:10.1080/03007995.2021.1908244.
URI
https://scholars.duke.edu/individual/pub1477397
PMID
33769894
Source
pubmed
Published In
Curr Med Res Opin
Published Date
Start Page
1
DOI
10.1080/03007995.2021.1908244

Index Symptoms and Prognosis Awareness of Patients With Pancreatic Cancer: A Multi-Site Palliative Care Collaborative.

BACKGROUND: Pancreatic cancer has a poor 5-year survival and carries significant morbidity. Pain is a commonly studied symptom in pancreatic cancer; however, few studies examine the frequency of multiple patient-reported symptoms. Our aim is to ascertain patient-reported symptom burden at initial consultation with a palliative care provider and compare patient prognostic awareness to provider estimation of prognosis. METHODS: Data were extracted from the standardized Quality Data Collection Tool (QDACT). Adults with pancreatic cancer seen by a palliative care provider were included. Descriptive statistics were used to describe demographic features, symptom prevalence and burden, as well as assess patient prognosis awareness defined by congruence or incongruence with provider estimated prognosis. RESULTS: 285 patients were included in our analysis. The average age was 68 years (SD: 12.4), 87.2% were white, 50% male. The mean number of moderate/severe symptoms was 2.6 (SD: 2) out of 9 symptoms. Tiredness (66.7%), appetite (64.5%) and pain (46.2%) had the highest rates of moderate/severe symptom burden. Patients with a prognosis of 1-6 months had the lowest proportion of congruence with provider estimation (56.5%). CONCLUSION: Our study suggests targets to improve patient-centered care of pancreatic cancer. Patients commonly have multiple symptoms that are moderate/severe at time of palliative care referral. While pain has been well-reported, tiredness and decreased appetite are more prevalent at initial visit. This emphasizes the importance of assessing multiple symptoms and working closely with palliative care for early referral. Overall, one third of patient prognosis estimates differed from the provider assessment of prognosis. Our data support the importance of early referral to palliative care to manage symptoms and better prepare patients for end-of-life care.
Authors
Johnson, AM; Wolf, S; Xuan, M; Samsa, G; Kamal, A; Fisher, DA
MLA Citation
Johnson, Alyson M., et al. “Index Symptoms and Prognosis Awareness of Patients With Pancreatic Cancer: A Multi-Site Palliative Care Collaborative.J Palliat Care, Mar. 2021, p. 8258597211001596. Pubmed, doi:10.1177/08258597211001596.
URI
https://scholars.duke.edu/individual/pub1476651
PMID
33730892
Source
pubmed
Published In
J Palliat Care
Published Date
Start Page
8258597211001596
DOI
10.1177/08258597211001596

Research Areas:

Adult
Algorithms
Ambulatory Care Facilities
Attitude of Health Personnel
Barrett Esophagus
Chi-Square Distribution
Colonoscopy
Community Health Services
Continental Population Groups
Data Mining
Databases as Topic
Decision Support Techniques
Dilatation
Early Detection of Cancer
Early Diagnosis
Endoscopy, Digestive System
Epidemiologic Methods
Feces
Gastrointestinal Diseases
Gastrointestinal Hemorrhage
Guideline Adherence
Health Behavior
Health Care Costs
Health Resources
Health Services Accessibility
Health Services Misuse
Health Services Research
Health Status
Healthcare Disparities
Hemostasis, Endoscopic
Humans
Intubation, Gastrointestinal
Liver
Lower Gastrointestinal Tract
Mass Screening
Melena
Needs Assessment
Neoplasm Recurrence, Local
Neoplasm Staging
Occult Blood
Odds Ratio
Outcome and Process Assessment (Health Care)
Patient Selection
Physical Examination
Preventive Health Services
Prognosis
Quality Assurance, Health Care
Quality Indicators, Health Care
Quality of Health Care
Quality of Life
Questionnaires
Reproducibility of Results
Research Design
Risk Reduction Behavior
Sensitivity and Specificity
Social Class
Socioeconomic Factors
Standard of Care
Stents
Surveys and Questionnaires
Survivors
Time Factors
Treatment Outcome
Upper Gastrointestinal Tract
Veterans