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:

Increasing physical activity in Cancer Survivors through a Text-messaging Exercise motivation Program (ICanSTEP).

PURPOSE: Cancer survivors are often sedentary. Self-monitoring may promote physical activity through self-activation. We conducted a pilot trial to evaluate whether wearable activity tracker with personalized text message feedback would increase physical activity. METHODS: We enrolled 30 patients with solid tumor cancers into a non-randomized prospective intervention trial (NCT02627079): 15 had completed treatment in the past year and 15 under active treatment. Each participant received an activity tracker and daily text messages personalized to their activity level. We assessed patient-reported outcomes and 6-min walk (6 MW) at baseline and 3 months. RESULTS: Twenty-six participants completed the study. There was substantial variation in baseline activity. Overall, 39% of participants increased their steps taken by at least 20%, and 23% increased their 6 MW distance by 20% or more. More participants who had completed treatment strongly agreed (73%) that the intervention increased their exercise levels than those receiving active treatment (47%). At 3 months, there was a significant improvement in median Beck Depression Inventory-II and Godin Leisure Index composite scores. At 6 months, 72% still wore their activity tracker at least 4 days per week. CONCLUSION: We found that the intervention was well-accepted with a high completion rate at 3 months and continued self-use at 6 months. In this pilot study of combined activity tracker and motivational messaging, we found a signal for increased physical activity over a 3-month period. Future research is needed to study this technique for its impact on activity and other physical and psychological measures of well-being. IMPLICATION FOR CANCER SURVIVORS: Activity tracker with personalized motivational messaging may be useful in promoting physical activity in cancer survivors.
Authors
Koontz, BF; Levine, E; McSherry, F; Niedzwiecki, D; Sutton, L; Dale, T; Streicher, M; Rushing, C; Owen, L; Kraus, WE; Bennett, G; Pollak, KI
MLA Citation
Koontz, Bridget F., et al. “Increasing physical activity in Cancer Survivors through a Text-messaging Exercise motivation Program (ICanSTEP).Support Care Cancer, vol. 29, no. 12, Dec. 2021, pp. 7339–49. Pubmed, doi:10.1007/s00520-021-06281-y.
URI
https://scholars.duke.edu/individual/pub1484312
PMID
34050402
Source
pubmed
Published In
Support Care Cancer
Volume
29
Published Date
Start Page
7339
End Page
7349
DOI
10.1007/s00520-021-06281-y

Triadic agreement about advanced cancer treatment decisions: Perceptions among patients, families, and oncologists.

OBJECTIVES: When patients make cancer treatment decisions, they consider the needs and preferences of family caregivers and clinicians. We examined how much all three triad members agreed about goals of treatment and caregivers' influence on decision-making. METHODS: We surveyed 70 triads of patients, caregivers, and oncologists who had recently made an advanced cancer treatment decision. We assessed each triad member's perception of the goal of treatment and the caregiver's influence on the decision. Participants also completed scales related to decisional conflict, satisfaction, and regret. RESULTS: In only 28/70 triads (40%), all three agreed on the goal of treatment with the most common goal being to live longer (n = 22). Whereas patients and caregivers tended to think the goal was to cure or live longer, oncologists were less optimistic. In only 22 triads (31%), all three agreed on how much influence the caregiver had on decision-making. Oncologists tended to underestimate caregiver influence. Patients and caregivers had low decisional conflict (M=15.40, SD=4.51; M=17.09, SD=6.34, respectively). CONCLUSIONS: Advanced cancer treatment decision-making occurs amid incomplete understanding among patients, caregivers, and oncologists. PRACTICE IMPLICATIONS: Confirming agreement about goals of care and influence on treatment decision-making may increase the likelihood of goal-concordant care throughout the illness trajectory.
Authors
Tulsky, JA; Steinhauser, KE; LeBlanc, TW; Bloom, N; Lyna, PR; Riley, J; Pollak, KI
MLA Citation
Tulsky, James A., et al. “Triadic agreement about advanced cancer treatment decisions: Perceptions among patients, families, and oncologists.Patient Educ Couns, Aug. 2021. Pubmed, doi:10.1016/j.pec.2021.08.001.
URI
https://scholars.duke.edu/individual/pub1493745
PMID
34384640
Source
pubmed
Published In
Patient Educ Couns
Published Date
DOI
10.1016/j.pec.2021.08.001

Facilitating communication for critically ill patients and their family members: Study protocol for two randomized trials implemented in the U.S. and France.

BACKGROUND: Critically-ill patients and their families suffer a high burden of psychological symptoms due, in part, to many transitions among clinicians and settings during and after critical illness, resulting in fragmented care. Communication facilitators may help. DESIGN AND INTERVENTION: We are conducting two cluster-randomized trials, one in the U.S. and one in France, with the goal of evaluating a nurse facilitator trained to support, model, and teach communication strategies enabling patients and families to secure care consistent with patients' goals, beginning in ICU and continuing for 3 months. PARTICIPANTS: We will randomize 376 critically-ill patients in the US and 400 in France to intervention or usual care. Eligible patients have a risk of hospital mortality of greater than15% or a chronic illness with a median survival of approximately 2 years or less. OUTCOMES: We assess effectiveness with patient- and family-centered outcomes, including symptoms of depression, anxiety, and post-traumatic stress, as well as assessments of goal-concordant care, at 1-, 3-, and 6-months post-randomization. The primary outcome is family symptoms of depression over 6 months. We also evaluate whether the intervention improves value by reducing utilization while improving outcomes. Finally, we use mixed methods to explore implementation factors associated with implementation outcomes (acceptability, fidelity, acceptability, penetration) to inform dissemination. Conducting the trial in U.S. and France will provide insights into differences and similarities between countries. CONCLUSIONS: We describe the design of two randomized trials of a communication facilitator for improving outcomes for critically ill patients and their families in two countries.
Authors
Curtis, JR; Kentish-Barnes, N; Brumback, LC; Nielsen, EL; Pollak, KI; Treece, PD; Hudson, L; Garzio, G; Im, J; Weiner, BJ; Khandelwal, N; Resche-Rigon, M; Azoulay, E; Engelberg, RA
MLA Citation
Curtis, J. Randall, et al. “Facilitating communication for critically ill patients and their family members: Study protocol for two randomized trials implemented in the U.S. and France.Contemp Clin Trials, vol. 107, Aug. 2021, p. 106465. Pubmed, doi:10.1016/j.cct.2021.106465.
URI
https://scholars.duke.edu/individual/pub1484781
PMID
34091062
Source
pubmed
Published In
Contemp Clin Trials
Volume
107
Published Date
Start Page
106465
DOI
10.1016/j.cct.2021.106465

Assessment of parent understanding in conferences for critically ill neonates.

OBJECTIVES: This study aimed to characterize the use and impact of assessments of understanding in parent-clinician communication for critically ill infants. METHODS: We enrolled parents and clinicians participating in family conferences for infants with neurologic conditions. Family conferences were audio recorded as they occurred. We used a directed content analysis approach to identify clinician assessments of understanding and parent responses to those assessments. Assessments were classified based on an adapted framework; responses were characterized as "absent," "yes/no," or "elaborated." RESULTS: Fifty conferences involving the care of 25 infants were analyzed; these contained 374 distinct assessments of understanding. Most (n = 209/374, 56%) assessments were partial (i.e. okay?); a minority (n = 60/374, 16%) were open-ended. When clinicians asked open-ended questions, parents elaborated in their answers most of the time (n = 55/60, 92%). Approximately three-quarter of partial assessments yielded no verbal response from parents. No conferences included a teach-back. CONCLUSIONS: Although common, most clinician assessments of understanding were partial or close-ended and rarely resulted in elaborated responses from parents. Open-ended assessments are an effective, underutilized strategy to increase parent engagement and clinician awareness of information needs. PRACTICE IMPLICATIONS: Clinicians hoping to facilitate parent engagement and question-asking should rely on open-ended statements to assess understanding.
Authors
Barks, MC; Schindler, EA; Ubel, PA; Jiao, MG; Pollak, KI; Huffstetler, HE; Lemmon, ME
MLA Citation
Barks, Mary C., et al. “Assessment of parent understanding in conferences for critically ill neonates.Patient Educ Couns, 2021. Pubmed, doi:10.1016/j.pec.2021.06.013.
URI
https://scholars.duke.edu/individual/pub1486001
PMID
34130892
Source
pubmed
Published In
Patient Educ Couns
Published Date
DOI
10.1016/j.pec.2021.06.013

Actual and Missed Opportunities for End-of-Life Care Discussions With Oncology Patients: A Qualitative Study.

Importance: Early discussion of end-of-life (EOL) care preferences improves clinical outcomes and goal-concordant care. However, most EOL discussions occur approximately 1 month before death, despite most patients desiring information earlier. Objective: To describe successful navigation and missed opportunities for EOL discussions (eg, advance care planning, palliative care, discontinuation of disease-directed treatment, hospice care, and after-death wishes) between oncologists and outpatients with advanced cancer. Design, Setting, and Participants: This study is a secondary qualitative analysis of outpatient visits audio-recorded between November 2010 and September 2014 for the Studying Communication in Oncologist-Patient Encounters randomized clinical trial. The study was conducted at 2 US academic medical centers. Participants included medical, gynecological, and radiation oncologists and patients with stage IV malignant neoplasm, whom oncologists characterized as being ones whom they "…would not be surprised if they were admitted to an intensive care unit or died within one year." Data were analyzed between January 2018 and August 2020. Exposures: The parent study randomized participants to oncologist- and patient-directed interventions to facilitate discussion of emotions. Encounters were sampled across preintervention and postintervention periods and all 4 treatment conditions. Main Outcomes and Measures: Secondary qualitative analysis was done of patient-oncologist dyads with 3 consecutive visits for EOL discussions, and a random sample of 7 to 8 dyads from 4 trial groups was analyzed for missed opportunities. Results: The full sample included 141 patients (54 women [38.3%]) and 39 oncologists (8 women [19.5%]) (mean [SD] age for both patients and oncologists, 56.3 [10.0] years). Of 423 encounters, only 21 (5%) included EOL discussions. Oncologists reevaluated treatment options in response to patients' concerns, honored patients as experts on their goals, or used anticipatory guidance to frame treatment reevaluation. In the random sample of 31 dyads and 93 encounters, 35 (38%) included at least 1 missed opportunity. Oncologists responded inadequately to patient concerns over disease progression or dying, used optimistic future talk to address patient concerns, or expressed concern over treatment discontinuation. Only 4 of 23 oncologists (17.4%) had both an EOL discussion and a missed opportunity. Conclusions and Relevance: Opportunities for EOL discussions were rarely realized, whereas missed opportunities were more common, a trend that mirrored oncologists' treatment style. There remains a need to address oncologists' sensitivity to EOL discussions, to avoid unnecessary EOL treatment.
Authors
Knutzen, KE; Sacks, OA; Brody-Bizar, OC; Murray, GF; Jain, RH; Holdcroft, LA; Alam, SS; Liu, MA; Pollak, KI; Tulsky, JA; Barnato, AE
MLA Citation
Knutzen, Kristin E., et al. “Actual and Missed Opportunities for End-of-Life Care Discussions With Oncology Patients: A Qualitative Study.Jama Netw Open, vol. 4, no. 6, June 2021, p. e2113193. Pubmed, doi:10.1001/jamanetworkopen.2021.13193.
URI
https://scholars.duke.edu/individual/pub1484780
PMID
34110395
Source
pubmed
Published In
Jama Network Open
Volume
4
Published Date
Start Page
e2113193
DOI
10.1001/jamanetworkopen.2021.13193