Rebecca Sudore, MD

Professor

OVERVIEW:
Dr. Rebecca Sudore is a geriatrician, palliative medicine physician, and clinician investigator. She also directs the Innovation and Implementation Center in Aging & Palliative Care (I-CAP) and the Vulnerable Populations for Aging Research Core of the NIA-funded Pepper Center.

Dr. Sudore conducts research to improve advance care planning and medical decision making for diverse, vulnerable older adults. To this end, she has designed, tested and disseminated innovative, patient centered tools including an easy-to-read advance directive in over 10 languages (http://www.iha4health.org/our-services/advance-directive/) and an interactive, advance care planning website called PREPARE (www.prepareforyourcare.org).

RESEARCH INTERESTS
Advance Care Planning
Health Literacy and Vulnerable Populations
Medical Decision Making and Health Communication
Health Disparities

Dr. Sudore has dedicated her research program to making medical information easier for patients and their families to understand. She published the first prospective study demonstrating the effect of limited literacy on mortality in the elderly, and has shown that elders with limited literacy have greater difficulty making medical decisions for informed consent and advance care planning. She has also designed and tested an informed consent process for patients with limited literacy and an advance directive that is both literacy and culturally appropriate. Both interventions have been shown to benefit patients - particularly those with literacy and/or language barriers. Even though her easy-to-read advance directive has been translated and widely disseminated, further research with patients and surrogate decision makers helped her realize that advance directives alone are not enough. In 2010, she published a study in the Annals of Internal Medicine calling for a shift in advance care planning from DNR/DNI checklists to preparing patients and their loved ones for medical decision making. Her current research program is focused on designing and testing interactive, web-based interventions (PREPAREforYourCare.org) to prepare patients and their surrogate decision makers to make difficult medical decisions.


CLINICAL ACTIVITIES:
Since 2002, Rebecca has provided primary care to vulnerable, older Veterans in the Geriatrics clinic at the San Francisco VA Medical Center. She also attends on the inpatient Palliative Care Service at the San Francisco VA. Although Dr. Sudore is a clinician researcher, her primary passion is first, and foremost, direct patient care for vulnerable older adults.
Education
Certificate in Implementation Science, 2013 - CTSI, University of California, San Francisco
Advance Training in Clinical Research, 2004 - School of Medicine, University of California, San Francisco
Geriatrics Clinical Fellowship, 2003 - School of Medicine, University of California, San Francisco
Residency, 2002 - School of Medicine, University of California, San Francisco
M.D., 1999 - School of Medicine, University of California, San Francisco
Honors and Awards
  • Induction into the American Society for Clinical Investigation, ASCI, 2016
  • Outstanding Scientific Achievement for Clinical Investigation, American Geriatrics Society, 2015
  • Junior Investigator of the Year, Society of General Internal Medicine, 2012
  • Physician Faculty Scholar, RWJ, 2009-2012
  • Junior Investigator of the Year, American Geriatrics Society, 2009
Websites
Publications
  1. Deconstructing the Complexities of Advance Care Planning Outcomes: What Do We Know and Where Do We Go? A Scoping Review.
  2. Prognostic Awareness and Goals of Care Discussions Among Patients With Advanced Heart Failure.
  3. A Toolkit for Community-Based, Medicaid-Funded Case Managers to Introduce Advance Care Planning to Frail, Older Adults: A Pilot Study.
  4. Anxious, Depressed, and Planning for the Future: Advance Care Planning in Diverse Older Adults.
  5. Association of motivations and barriers with participation and performance in a pedometer-based intervention.
  6. Patient-centered and efficacious advance care planning in cancer: Protocol and key design considerations for the PEACe-compare trial.
  7. Effectiveness of Advance Care Planning Group Visits Among Older Adults in Primary Care.
  8. Low Rates of Advance Care Planning (ACP) Discussions Despite Readiness to Engage in ACP Among Liver Transplant Candidates.
  9. Feasibility of a Brief Intervention to Facilitate Advance Care Planning Conversations for Patients with Life-Limiting Illness in the Emergency Department.
  10. Supporting In-Home Caregivers in Symptom Assessment of Frail Older Adults with Serious Illness: A Pilot Study.
  11. Making Medical Treatment Decisions for Unrepresented Patients in the ICU. An Official American Thoracic Society/American Geriatrics Society Policy Statement.
  12. During COVID-19, Outpatient Advance Care Planning Is Imperative: We Need All Hands on Deck.
  13. Advance Care Planning Prior to Death in Older Adults with Hip Fracture.
  14. Improving Medical-Legal Advance Care Planning.
  15. Barriers and Solutions to Advance Care Planning among Homeless-Experienced Older Adults.
  16. Empowering Older Adults to Discuss Advance Care Planning During Clinical Visits: The PREPARE Randomized Trial.
  17. Hospice Staff Perspectives on Caring for People with Dementia: A Multisite, Multistakeholder Study.
  18. Patterns and Trends in Advance Care Planning Among Older Adults Who Received Intensive Care at the End of Life.
  19. Effect of an Interactive Website to Engage Patients in Advance Care Planning in Outpatient Settings.
  20. Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review.
  21. Deep Natural Language Processing Identifies Variation in Care Preference Documentation.
  22. What Is a Medication-Related Problem? A Qualitative Study of Older Adults and Primary Care Clinicians.
  23. Thinking Outside the Visit: Primary Care Patient Perspectives on Helpful Advance Care Planning Methods.
  24. Leveraging In-Home Supportive Services Programs to Engage People in Advance Care Planning: Input from Staff, Providers, and Client Stakeholders.
  25. Brief English and Spanish Survey Detects Change in Response to Advance Care Planning Interventions.
  26. Association of Emergency Clinicians' Assessment of Mortality Risk With Actual 1-Month Mortality Among Older Adults Admitted to the Hospital.
  27. Population-Based Pragmatic Trial of Advance Care Planning in Primary Care in the University of California Health System.
  28. Health Literacy Matters More Than Experience for Advance Care Planning Knowledge Among Older Adults.
  29. What Matters? The Valued Life Activities of Older Adults Undergoing Elective Surgery.
  30. A Tool to Assess Patient and Surrogate Knowledge about the POLST (Physician Orders for Life-Sustaining Treatment) Program.
  31. Advance Care Planning in Older Adults With Multiple Chronic Conditions Undergoing High-Risk Surgery.
  32. Goals-of-Care Conversations for Older Adults With Serious Illness in the Emergency Department: Challenges and Opportunities.
  33. Short Graphic Values History Tool for decision making during serious illness.
  34. Preparing Surrogates for Complex Decision Making: The Often Neglected Piece of the Advance Care Planning Equation.
  35. Adaptation and Preliminary Validation of the Advance Care Planning Engagement Survey for Surrogate Decision Makers.
  36. Food Insecurity: A Key Social Determinant of Health for Older Adults.
  37. Living Wills: One Part of the Advance Care Planning Puzzle.
  38. Engaging Diverse English- and Spanish-Speaking Older Adults in Advance Care Planning: The PREPARE Randomized Clinical Trial.
  39. Functional Status and Survival After Breast Cancer Surgery in Nursing Home Residents.
  40. Empower Seriously Ill Older Adults to Formulate Their Goals for Medical Care in the Emergency Department.
  41. "Planting the Seed": Perceived Benefits of and Strategies for Discussing Long-Term Prognosis with Older Adults.
  42. "We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail.
  43. Increasing Advance Care Planning Using a Surgical Optimization Program for Older Adults.
  44. Advance care planning needs in patients with glioblastoma undergoing radiotherapy.
  45. Patient Activation: A Key Component of Successful Advance Care Planning.
  46. Emotional Impact of Illness and Care on Patients with Advanced Kidney Disease.
  47. Older Adult and Surrogate Perspectives on Serious, Difficult, and Important Medical Decisions.
  48. Improving A Full Range of Advance Care Planning Behavior Change and Action Domains: the PREPARE Randomized Trial.
  49. Advance Care Planning for Older Homeless-Experienced Adults: Results from the Health Outcomes of People Experiencing Homelessness in Older Middle Age Study.
  50. Care Planning for Inpatients Referred for Palliative Care Consultation.
  51. Advance Care Planning in Community-Dwelling Patients With Dementia.
  52. The relationship of health literacy to diabetes status differs by sex in older adults.
  53. Advance Care Planning Documentation Practices and Accessibility in the Electronic Health Record: Implications for Patient Safety.
  54. Evaluation of an advance care planning web-based resource: applicability for cancer treatment patients.
  55. Prognosis Communication in Late-Life Disability: A Mixed Methods Study.
  56. "Teach-to-Goal" to Better Assess Informed Consent Comprehension among Incarcerated Clinical Research Participants.
  57. A Research Agenda for Communication Between Health Care Professionals and Patients Living With Serious Illness.
  58. Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care.
  59. Outcomes That Define Successful Advance Care Planning: A Delphi Panel Consensus.
  60. Effect of the PREPARE Website vs an Easy-to-Read Advance Directive on Advance Care Planning Documentation and Engagement Among Veterans: A Randomized Clinical Trial.
  61. A Group Visit Initiative Improves Advance Care Planning Documentation among Older Adults in Primary Care.
  62. Financial Incentives to Increase Advance Care Planning Among Medicaid Beneficiaries: Lessons Learned From Two Pragmatic Randomized Trials.
  63. Development and Feasibility of a Structured Goals of Care Communication Guide.
  64. "Maybe They Don't Even Know That I Exist": Challenges Faced by Family Members and Friends of Patients with Advanced Kidney Disease.
  65. Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel.
  66. Measuring Advance Care Planning: Optimizing the Advance Care Planning Engagement Survey.
  67. Low Completion and Disparities in Advance Care Planning Activities Among Older Medicare Beneficiaries.
  68. The Quality of Physician Orders for Life-Sustaining Treatment Decisions: A Pilot Study.
  69. Preparing Older Adults with Serious Illness to Formulate Their Goals for Medical Care in the Emergency Department.
  70. Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study.
  71. Advance Care Planning: Understanding Clinical Routines and Experiences of Interprofessional Team Members in Diverse Health Care Settings.
  72. Improving advance care planning for English-speaking and Spanish-speaking older adults: study protocol for the PREPARE randomised controlled trial.
  73. Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study.
  74. Emergency Physicians' Experience with Advance Care Planning Documentation in the Electronic Medical Record: Useful, Needed, and Elusive.
  75. Clinician Factors Associated With Prostate-Specific Antigen Screening in Older Veterans With Limited Life Expectancy.
  76. Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?
  77. Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations.
  78. Advance Care Planning and Goals of Care Communication in Older Adults with Cardiovascular Disease and Multi-Morbidity.
  79. Erratum to: 'The advance care planning PREPARE study among older Veterans with serious and chronic illness: study protocol for a randomized controlled trial'.
  80. The advance care planning PREPARE study among older Veterans with serious and chronic illness: study protocol for a randomized controlled trial.
  81. "Doctor, Make My Decisions": Decision Control Preferences, Advance Care Planning, and Satisfaction With Communication Among Diverse Older Adults.
  82. Leisure activities and depressive symptoms in older adults with cognitive complaints.
  83. Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review.
  84. Ethnic Differences in Geriatric Conditions and Diabetes Complications Among Older, Insured Adults With Diabetes: The Diabetes and Aging Study.
  85. Advance care planning in the elderly.
  86. The future as a series of transitions: qualitative study of heart failure patients and their informal caregivers.
  87. Functional impairment and Internet use among older adults: implications for meaningful use of patient portals.
  88. Family involvement at the end-of-life and receipt of quality care.
  89. Authors' Reply to Swetz et al.
  90. Family matters: effects of birth order, culture, and family dynamics on surrogate decision-making.
  91. Development and validation of a questionnaire to detect behavior change in multiple advance care planning behaviors.
  92. A novel website to prepare diverse older adults for decision making and advance care planning: a pilot study.
  93. When previously expressed wishes conflict with best interests.
  94. Disregard of patients' preferences is a medical error: comment on "Failure to engage hospitalized elderly patients and their families in advance care planning".
  95. Literacy and race as risk factors for low rates of advance directives in older adults.
  96. Advance care planning and the quality of end-of-life care in older adults.
  97. Advance care planning beyond advance directives: perspectives from patients and surrogates.
  98. Symptom burden of adults with type 2 diabetes across the disease course: diabetes & aging study.
  99. Influence of patient age and comorbid burden on clinician attitudes toward heart failure guidelines.
  100. Responding to surrogate requests that seem inconsistent with a patient's living will.
  101. Correlates of quality of life in older adults with diabetes: the diabetes & aging study.
  102. Balancing punishment and compassion for seriously ill prisoners.
  103. Respecting elders by respecting their paid caregivers.
  104. Finances in the older patient with cognitive impairment: "He didn't want me to take over".
  105. Lost in translation: the unintended consequences of advance directive law on clinical care.
  106. Validation of self-reported health literacy questions among diverse English and Spanish-speaking populations.
  107. Redefining the "planning" in advance care planning: preparing for end-of-life decision making.
  108. Information-seeking at a caregiving website: a qualitative analysis.
  109. Sitting with you in your suffering: lessons about intractable pain at the end of life.
  110. Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review.
  111. Uncertainty about advance care planning treatment preferences among diverse older adults.
  112. A piece of my mind. Can we agree to disagree?
  113. Unraveling the relationship between literacy, language proficiency, and patient-physician communication.
  114. Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers.
  115. Palliative care for Latino patients and their families: whenever we prayed, she wept.
  116. A clinical framework for improving the advance care planning process: start with patients' self-identified barriers.
  117. Interventions to Improve Care for Patients with Limited Health Literacy.
  118. Reach and impact of a mass media event among vulnerable patients: the Terri Schiavo story.
  119. Engagement in multiple steps of the advance care planning process: a descriptive study of diverse older adults.
  120. Screening mammography in older women. Effect of wealth and prognosis.
  121. An advance directive redesigned to meet the literacy level of most adults: a randomized trial.
  122. Limited literacy and mortality in the elderly: the health, aging, and body composition study.
  123. Use of a modified informed consent process among vulnerable patients: a descriptive study.
  124. Limited literacy in older people and disparities in health and healthcare access.
  125. Being old and doing time: functional impairment and adverse experiences of geriatric female prisoners.