Deborah Fisher

Overview:

As Associate Director for Gastroenterology Research at the Duke Clinical Research Institute I am building on the success of the Hepatology research program at DCRI GI and expanding the research portfolio to GI medical devices and GI luminal (e.g., upper GI, colorectal) research. My own research focus is colorectal cancer prevention, detection, and surveillance.  My research, advocacy, and clinical work are connected by the goal to improve the quality, efficiency, and effectiveness of medical care and in particular colorectal cancer screening and surveillance programs.  My work has been recognized by several awards and I am funded by NIH and VA.  I have served on national committees including chairing the National VA GI Field Advisory Committee and am currently a member of the American Gastroenterology Association (AGA) Publications Committee and the American Society for Gastrointestinal Endoscopy (ASGE) Quality in Endoscopy committee. My current educational work includes clinical teaching in medicine, clinical gastroenterology and endoscopy, directing the Department of Medicine MENTORS program for clinical research fellows and research mentoring individual fellows and residents.  I am faculty of the GI Division T32 training grant and of the Duke Clinical Research Training Program. Finally, I am the Director of Social and Digital Media for the GI Division.

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
Role
Principal Investigator
Start Date
End Date

Understanding recommendations for screening colonoscopy intervals

Administered By
Medicine, Gastroenterology
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Colorectal Cancer Screening Behavior in VA Population

Administered By
Medicine, General Internal Medicine
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Publications:

An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial.

BACKGROUND: Colorectal cancer is the fourth most commonly diagnosed cancer in the United States. Approximately 3-10% of the population has an increased risk for colorectal cancer due to family history and warrants more frequent or intensive screening. Yet, < 50% of that high-risk population receives guideline-concordant care. Systematic collection of family health history and decision support may improve guideline-concordant screening for patients at increased risk of colorectal cancer. We seek to test the effectiveness of a web-based, systematic family health history collection tool and decision support platform (MeTree) to improve risk assessment and appropriate management of colorectal cancer risk among patients in the Department of Veterans Affairs primary care practices. METHODS: In this ongoing randomized controlled trial, primary care providers at the Durham Veterans Affairs Health Care System and the Madison VA Medical Center are randomized to immediate intervention or wait-list control. Veterans are eligible if assigned to enrolled providers, have an upcoming primary care appointment, and have no conditions that would place them at increased risk for colorectal cancer (such as personal history, adenomatous polyps, or inflammatory bowel disease). Those with a recent lower endoscopy (e.g. colonoscopy, sigmoidoscopy) are excluded. Immediate intervention patients put their family health history information into a web-based platform, MeTree, which provides both patient- and provider-facing decision support reports. Wait-list control patients access MeTree 12 months post-consent. The primary outcome is the risk-concordant colorectal cancer screening referral rate obtained via chart review. Secondary outcomes include patient completion of risk management recommendations (e.g. colonoscopy) and referral for genetic consultation. We will also conduct an economic analysis and an assessment of providers' experience with MeTree clinical decision support recommendations to inform future implementation efforts if the intervention is found to be effective. DISCUSSION: This trial will assess the feasibility and effectiveness of patient-collected family health history linked to decision support to promote risk-appropriate screening in a large healthcare system such as the Department of Veterans Affairs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02247336 . Registered on 25 September 2014.
Authors
Goldstein, KM; Fisher, DA; Wu, RR; Orlando, LA; Coffman, CJ; Grubber, JM; Rakhra-Burris, T; Wang, V; Scheuner, MT; Sperber, N; Datta, SK; Nelson, RE; Strawbridge, E; Provenzale, D; Hauser, ER; Voils, CI
MLA Citation
Goldstein, Karen M., et al. “An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial..” Trials, vol. 20, no. 1, Oct. 2019. Pubmed, doi:10.1186/s13063-019-3659-y.
URI
https://scholars.duke.edu/individual/pub1414998
PMID
31590688
Source
pubmed
Published In
Trials
Volume
20
Published Date
Start Page
576
DOI
10.1186/s13063-019-3659-y

Methods of extraction of optical properties from diffuse reflectance measurements of ex-vivo human colon tissue using thin film silicon photodetector arrays.

Spatially resolved diffuse reflectance spectroscopy (SRDRS) is a promising technique for characterization of colon tissue. Herein, two methods for extracting the reduced scattering and absorption coefficients ( μ s ' ( λ ) and μ a ( λ ) ) from SRDRS data using lookup tables of simulated diffuse reflectance are reported. Experimental measurements of liquid tissue phantoms performed with a custom multi-pixel silicon SRDRS sensor spanning the 450 - 750 nm wavelength range were used to evaluate the extraction methods, demonstrating that the combined use of spatial and spectral data reduces extraction error compared to use of spectral data alone. Additionally, SRDRS measurements of normal and tumor ex-vivo human colon tissue are presented along with μ s ' ( λ ) and μ a ( λ ) extracted from these measurements.
Authors
LaRiviere, B; Ferguson, NL; Garman, KS; Fisher, DA; Jokerst, NM
MLA Citation
LaRiviere, Ben, et al. “Methods of extraction of optical properties from diffuse reflectance measurements of ex-vivo human colon tissue using thin film silicon photodetector arrays..” Biomed Opt Express, vol. 10, no. 11, Nov. 2019, pp. 5703–15. Pubmed, doi:10.1364/BOE.10.005703.
URI
https://scholars.duke.edu/individual/pub1421764
PMID
31799041
Source
pubmed
Published In
Biomedical Optics Express
Volume
10
Published Date
Start Page
5703
End Page
5715
DOI
10.1364/BOE.10.005703

Assessing Colorectal Cancer Screening Adherence of Medicare Fee-for-Service Beneficiaries Age 76 to 95 Years.

INTRODUCTION: There are concerns about potential overuse of colorectal cancer (CRC) screening services among average-risk individuals older than age 75 years. MATERIALS AND METHODS: Using a 5% random noncancer sample of Medicare beneficiaries who resided in the SEER areas, we examined rates of CRC screening adherence, defined by the Medicare coverage policy, among average-risk fee-for-service beneficiaries age 76 to 95 years from 2002 to 2010. The two outcomes are the status of overall CRC screening adherence, and the status of adherence to colonoscopy (v other modalities) conditional on patient adherence. RESULTS: Overall CRC screening adherence rates of Medicare beneficiaries age 76 to 95 years increased from 13.0% to 21.4% from 2002 to 2010. In 2002, 2.2% of beneficiaries were adherent to colonoscopy, and 10.7%, by other modalities; the corresponding rates were 19.5% and 1.9%, respectively, in 2010. Specifically, rates of adherence to colonoscopy were 1.1% for those age 86 to 90 years and almost nil for those age 91 to 95 years in 2002, but the rates became 13.5% and 8.2%, respectively, in 2010. Compared with white beneficiaries, black beneficiaries age 76 to 95 years had a 7-percentage-point lower adherence rate. However, overall adherence rates among blacks increased by 168.6% from 2002 to 2010, whereas rates among whites increased by 63.0%. Logistic regressions showed that blacks age 86 to 95 years were less likely than whites to be adherent (odds ratio, 0.56; 95% CI, 0.47 to 0.59) but were more likely to be adherent to colonoscopy (odds ratio, 2.34; 95% CI, 1.47 to 3.91). CONCLUSION: High proportions of average-risk Medicare fee-for-service beneficiaries screened by colonoscopy may represent opportunities for improving appropriateness and allocative efficiency of CRC screening by Medicare.
Authors
Bian, J; Bennett, C; Cooper, G; D'Alfonso, A; Fisher, D; Lipscomb, J; Qian, C-N
MLA Citation
Bian, John, et al. “Assessing Colorectal Cancer Screening Adherence of Medicare Fee-for-Service Beneficiaries Age 76 to 95 Years..” J Oncol Pract, vol. 12, no. 6, June 2016, pp. e670–80. Pubmed, doi:10.1200/JOP.2015.009118.
URI
https://scholars.duke.edu/individual/pub1288885
PMID
27189357
Source
pubmed
Published In
J Oncol Pract
Volume
12
Published Date
Start Page
e670
End Page
e680
DOI
10.1200/JOP.2015.009118

The role of endoscopy in the patient with lower GI bleeding.

Authors
ASGE Standards of Practice Committee,; Pasha, SF; Shergill, A; Acosta, RD; Chandrasekhara, V; Chathadi, KV; Early, D; Evans, JA; Fisher, D; Fonkalsrud, L; Hwang, JH; Khashab, MA; Lightdale, JR; Muthusamy, VR; Saltzman, JR; Cash, BD
MLA Citation
ASGE Standards of Practice Committee, Brooks D., et al. “The role of endoscopy in the patient with lower GI bleeding..” Gastrointest Endosc, vol. 79, no. 6, June 2014, pp. 875–85. Pubmed, doi:10.1016/j.gie.2013.10.039.
URI
https://scholars.duke.edu/individual/pub1041620
PMID
24703084
Source
pubmed
Published In
Gastrointest Endosc
Volume
79
Published Date
Start Page
875
End Page
885
DOI
10.1016/j.gie.2013.10.039

Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps.

BACKGROUND: EMR is an effective alternative to surgery for the removal of nonampullary duodenal polyps (NADPs). Cap-assisted EMR (EMR-C) has been rarely performed in the duodenum because of the risk of perforation. OBJECTIVE: To evaluate the safety and effectiveness of EMR-C for the removal of large (≥ 15 mm) NADPs. DESIGN: Retrospective study. SETTING: Tertiary-care referral center. PATIENTS: Between 2000 and 2010, 26 consecutive patients with sporadic NADPs underwent EMR-C. INTERVENTION: EMR with the cap technique. MAIN OUTCOME MEASUREMENTS: Complete eradication of polyps, complications, and recurrence. RESULTS: A total of 14 sessile polyps (53.8%), 7 lateral spreading type nongranular tumors (26.9%), and 5 lateral spreading type granular tumors (19.2%) were treated. The median size of lesions was 15 mm. Five lesions involved one-half of the luminal circumference. Post-EMR histologic assessment showed low-grade dysplasia in 5 patients (19.2%) and high-grade dysplasia in 18 patients (69.2%). Three patients (11.5%) had well-differentiated endocrine tumors. Complete eradication was obtained in 25 of 26 (96%) patients. No perforations occurred. Three cases of intraprocedural bleeding were managed endoscopically. Median follow-up was 6 years (range 1-10 years). Residual adenomatous tissue was observed in 3 patients in lesions of 50 mm. In one of these cases, an adenocarcinoma occurred after 8 months, which was managed surgically. LIMITATIONS: Retrospective design, single center. CONCLUSION: This study supports the efficacy and safety of EMR-C for removing NADPs. Regular follow-up is mandatory because of the high risk of residual or recurrent adenomatous tissue and even cancer.
Authors
Conio, M; De Ceglie, A; Filiberti, R; Fisher, DA; Siersema, PD
MLA Citation
Conio, Massimo, et al. “Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps..” Gastrointest Endosc, vol. 76, no. 6, Dec. 2012, pp. 1160–69. Pubmed, doi:10.1016/j.gie.2012.08.009.
URI
https://scholars.duke.edu/individual/pub771269
PMID
23021169
Source
pubmed
Published In
Gastrointest Endosc
Volume
76
Published Date
Start Page
1160
End Page
1169
DOI
10.1016/j.gie.2012.08.009

Research Areas:

Activities of Daily Living
Adaptation, Psychological
Adolescent
Adult
Algorithms
Ambulatory Care Facilities
Attitude of Health Personnel
Barrett Esophagus
Blood
Chi-Square Distribution
Colonoscopy
Community Health Services
Constriction, Pathologic
Continental Population Groups
Data Mining
Databases as Topic
Decision Support Techniques
Diet
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
Hypopharynx
Intubation, Gastrointestinal
Liver
Lower Gastrointestinal Tract
Mass Screening
Melena
Mental Health
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