Arif Kamal

Overview:

health services and outcomes research, information-technology enabled registries, supportive oncology and palliative care, quality assessment and improvement

Positions:

Associate Professor of Medicine

Medicine, Medical Oncology
School of Medicine

Associate Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Core Faculty in Innovation & Entrepreneurship

Duke Innovation & Entrepreneurship
Institutes and Provost's Academic Units

Member in the Duke Clinical Research Institute

Duke Clinical Research Institute
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2005

University of Missouri Kansas City, School of Medicine

M.H.S. 2015

Duke University

M.B.A. 2016

University of Massachusetts - Amherst

Resident, Internal Medicine

Mayo Clinic, Alix School of Medicine

Fellowship, Hematology/ Oncology

Mayo Clinic, Alix School of Medicine

Grants:

Validating TOGETHER CARE, a mobile application ("app") for caregivers to implement home-based follow-up care for cancer survivors

Administered By
Duke Cancer Institute
Awarded By
Medable Inc.
Role
Principal Investigator
Start Date
End Date

Randomized Trial of Stepped Palliative Care versus Early Integrated Palliative Care in Patients with Advanced Lung Cancer

Administered By
Duke Cancer Institute
Awarded By
Massachusetts General Hospital
Role
Principal Investigator
Start Date
End Date

Developing and testing a web-based tool to engage advanced cancer patients in palliative care (PCforMe-Upstream)

Administered By
Duke Cancer Institute
Awarded By
Mayo Clinic
Role
Principal Investigator
Start Date
End Date

Which palliative care quality measures improve patient-centered outcome?

Administered By
Duke Cancer Institute
Awarded By
Cambia Health Foundation
Role
Principal Investigator
Start Date
End Date

Development of national registry for patients receiving primary care in the home

Administered By
Duke Clinical Research Institute
Awarded By
University of California - San Francisco
Role
Principal Investigator
Start Date
End Date

Publications:

Characteristics of Advance Care Planning in Patients With Cancer Referred to Palliative Care.

PURPOSE: Advance care planning (ACP) is a process in which patients share their values, goals, and preferences regarding future medical care. ACP can improve care quality, yet may be challenging to address for patients with cancer. We sought to characterize key components of ACP in patients with cancer as compared with patients with noncancer serious illness referred to palliative care (PC). METHODS: We performed a retrospective cross-sectional analysis of initial outpatient PC visits from the Quality Data Collection Tool for PC database from 2015 to 2019. Quality Data Collection Tool is a web-based point-of-care specialty PC registry to track quality metrics. RESULTS: We analyzed 1,604 patients with cancer and 1,094 patients without cancer: 44% of patients were female, 87% were White, and 98% were non-Hispanic. The average age was 72.2 years (standard deviation [SD] 15.4). Patients with cancer were on average younger than patients without cancer (66.5 [SD: 13.9] v 80.5 [SD: 13.8]) and had a higher Palliative Performance Scale (PPS) (59.5 [SD: 22.4] v 33.4 [SD: 25.1]). In our unadjusted comparison, patients with cancer were less likely to be DNR/DNI (37% v 53%; P < .0001) and less likely to have an advance directive (53% v 73%; < .0001); rates of healthcare proxy identification were similar (92.8% v 94.5%; P = .10). These differences did not persist when we accounted for age, race, sex, and PPS, with age being the primary explanatory factor. CONCLUSION: Despite having serious illness meriting PC referral, many patients with cancer in our study lacked advance directives. This highlights both the important role of oncologists in facilitating ACP and the utility of PC playing a complementary role.
Authors
Berkowitz, CM; Wolf, SP; Troy, J; Kamal, AH
MLA Citation
Berkowitz, Callie M., et al. “Characteristics of Advance Care Planning in Patients With Cancer Referred to Palliative Care.Jco Oncol Pract, vol. 17, no. 2, Feb. 2021, pp. e94–100. Pubmed, doi:10.1200/OP.20.00657.
URI
https://scholars.duke.edu/individual/pub1471326
PMID
33439744
Source
pubmed
Published In
Jco Oncol Pract
Volume
17
Published Date
Start Page
e94
End Page
e100
DOI
10.1200/OP.20.00657

Associations of Patient Characteristics and Care Setting with Complexity of Specialty Palliative Care Visits.

Background: Information routinely collected during a palliative care consultation request may help predict the level of complexity of that patient encounter. Objectives: We examined whether patient and consultation characteristics, as captured in consultation requests, are associated with the number of unmet palliative care needs that emerge during consultation, as an indicator of complexity. Design: We performed a retrospective cohort analysis of palliative care consultations. Setting: We analyzed quality-of-care data from specialty palliative care consultations contained in the Quality Data Collection Tool of the Global Palliative Care Quality Alliance from 2012 to 2017. Measurements: Using 13 point-of-care assessments of quality of life, symptoms, advance care planning, and prognosis, we created a complexity score ranging from 0 (not complex) to 13 (highest complexity). Using multivariable linear regression, we examined the relationships of consultation setting and patient characteristics with complexity score. Results: Patients in our cohort (N = 3121) had an average complexity score of 6.7 (standard deviation = 3.7). Female gender, nonwhite race, and neurological (e.g., dementia) and noncancer primary diagnosis were associated with increased complexity score. The hospital intensive care unit, compared with the general floor, was associated with higher complexity scores. In contrast, outpatient and residence, compared with the general floor, were associated with lower complexity scores. Conclusion: Patient, disease, and care setting factors known at the time of specialty palliative care consultation request are associated with level of complexity, and they may inform teams about the right service provisions, including time and expertise, required to meet patient needs.
Authors
Kamal, AH; Check, DK; Bull, J; Wolf, S; Troy, J; Samsa, G; Nicolla, JM; Harker, M; Taylor, DH
MLA Citation
Kamal, Arif H., et al. “Associations of Patient Characteristics and Care Setting with Complexity of Specialty Palliative Care Visits.J Palliat Med, vol. 24, no. 1, Jan. 2021, pp. 83–90. Pubmed, doi:10.1089/jpm.2020.0149.
URI
https://scholars.duke.edu/individual/pub1450796
PMID
32634037
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
24
Published Date
Start Page
83
End Page
90
DOI
10.1089/jpm.2020.0149

Top Ten Tips Palliative Care Clinicians Should Know about Implementing a Team Wellness Program.

Palliative care (PC) providers often face challenging and emotional cases while operating in the structures that are not ideally resourced. This combination can lead to burnout and further jeopardize resources from turnover, morale, and decreased productivity. Although many wellness efforts have focused on building personal resilience skills for individuals, programmatic approaches to improve a culture wellness are equally important in supporting clinical teams. This article brings together the perspectives of PC leaders with expertise in wellness to collate practical pearls for interventions that impact the culture of well-being in their organizations. In this article, we use a "Top 10" format to highlight the interventions that PC leaders can implement to support the well-being of clinical staff and promote program sustainability.
Authors
Edwards, KE; Misra, SK; Hyman, K; Albers, A; Kamal, AH
MLA Citation
Edwards, Kristin E., et al. “Top Ten Tips Palliative Care Clinicians Should Know about Implementing a Team Wellness Program.J Palliat Med, vol. 24, no. 1, Jan. 2021, pp. 116–21. Pubmed, doi:10.1089/jpm.2020.0628.
URI
https://scholars.duke.edu/individual/pub1464643
PMID
33146569
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
24
Published Date
Start Page
116
End Page
121
DOI
10.1089/jpm.2020.0628

Hospice Use Among Patients With Cancer: Trends, Barriers, and Future Directions.

Patients with advanced cancer and their families frequently encounter clinical and logistical challenges related to end-of-life care. Hospice provides interdisciplinary and holistic care to meet patients' biomedical, psychosocial, and spiritual needs in the last phases of life. Despite increasing general acceptance and use among patients with cancer, hospice remains underused. Underuse stems from ongoing misconceptions regarding hospice and its purpose, coupled with the rapid development of novel anticancer treatments, such as immunotherapies and targeted therapies, that have changed the landscape of possibilities. Furthermore, rapid evolutions in how end-of-life care is structured and reimbursed for will affect how oncology patients will intersect with hospice care. In this review, we explore the current and future challenges to greater integration of hospice care in the care of patients with advanced cancer and propose five recommendations as part of the path forward.
Authors
Patel, MN; Nicolla, JM; Friedman, FAP; Ritz, MR; Kamal, AH
MLA Citation
Patel, Mihir N., et al. “Hospice Use Among Patients With Cancer: Trends, Barriers, and Future Directions.Jco Oncol Pract, vol. 16, no. 12, Dec. 2020, pp. 803–09. Pubmed, doi:10.1200/OP.20.00309.
URI
https://scholars.duke.edu/individual/pub1465696
PMID
33186083
Source
pubmed
Published In
Jco Oncol Pract
Volume
16
Published Date
Start Page
803
End Page
809
DOI
10.1200/OP.20.00309

Evaluation of a Virtual Learning Collaborative to Integrate Palliative Care Into Routine Oncology Practice.

PURPOSE: The integration of palliative care into usual oncology care is a best practice, but implementation can be challenging. METHODS: We convened a virtual learning collaborative (VLC) of oncology practices with a focus on integrating palliative care. The entire program was virtual, with teams meeting via online Webinar and conference call and accessing content via an online portal. Because of the need to pause and retool after the first 5 months, the VLC evolved into 2 phases, with feedback after the first phase informing the second. We primarily evaluated the reaction of participants and project team members after the completion of the VLC using 2 quantitative surveys (after each phase) and semistructured interviews with participants. RESULTS: A total of 24 oncology practices entered the VLC. Evaluation after each of 2 phases was conducted. For the first evaluation, 67% of respondents agreed a quality improvement coach was helpful to complete the program; 61% agreed a palliative care expert was helpful. The most common reasons for withdrawal involved organizational and VLC factors. Organizational factors included: time constraints, personnel changes (turnover), loss of the champion, and lack of team engagement. Twenty-two active participants and 8 former participants completed the second survey. Of those, 79% agreed the experience with the VLC was valuable, and 74% agreed the virtual delivery mode was useful. We identified 3 themes to drive future improvements related to structure, engagement, and content. CONCLUSION: VLCs are a potential mechanism to disseminate information and facilitate learning in oncology. Further study of program characteristics that promote acceptance of VLCs are needed.
Authors
Kamal, AH; Bossley, H; Blum, R; Berman, AJ; von Gunten, C; Von Roenn, J
MLA Citation
Kamal, Arif H., et al. “Evaluation of a Virtual Learning Collaborative to Integrate Palliative Care Into Routine Oncology Practice.Jco Oncol Pract, vol. 16, no. 11, Nov. 2020, pp. e1371–77. Pubmed, doi:10.1200/JOP.19.00254.
URI
https://scholars.duke.edu/individual/pub1447968
PMID
32552317
Source
pubmed
Published In
Jco Oncol Pract
Volume
16
Published Date
Start Page
e1371
End Page
e1377
DOI
10.1200/JOP.19.00254