Timothy P. Daaleman, DO, is a family physician researcher with expertise in examining the influence of religious and spiritual variables in healthcare settings. This application will provide a period of mentored training comprised of: a research practicum within the Center on Aging at the University of Kansas Medical Center (KUMC); coursework in the Masters in Public Health (MPH) program and at the University of Kansas in Lawrence; and a research project to test a theoretical model of the relationship between spirituality and patient conceptualization of death and dying in a population of community-dwelling elders with serious illness. The plan outlines the training and research experience he will require, in order to develop and launch a fully independent research career that will focus on understanding and improving the dying process and end-of-life care among elders in the United States. Career Development Plan: Course work from MPH program forms the core portion of the didactic training period and will be complimented by practical training in study design, subject recruitment, data collection and analysis, and project management within the KUMC Center on Aging. Research Program: The SUPPORT trial not only awakened American medicine to reexamine the way it cares for seriously ill and dying patients, but also has indirectly promoted a rapprochement among the realms of spirituality, religion, and the practice of medicine. An understanding of the psychological, social, cultural, and now spiritual elements and processes that are involved in the composition of death and dying attitudes holds promise in comprehending and potentially improving the difficult transition that older patients make from serious illness to dying. The overall objective of this research project is to describe and understand the determinants of elders attitudes toward serious illness, death, the dying process, and discussions of advance care planning. Both rural and urban primary care physicians (N=10) who have been members of the Kansas Hartford Geriatric Project, and older community-dwelling patients with serious illness from their practices (N=270), will participate in three phases of the study: a cross-sectional survey, a prospective, longitudinal cohort study, and qualitative semi-structured interviews. The primary aim is to determine the social, psychological, spiritual, and cultural influences that comprise attitudes towards death and the dying process in older persons. Our hypothesis is that patient spirituality is a significant explanatory factor in death attitudes after accounting for multiple covariates, i.e. social support, mental health status. Secondary aims include learning how a baseline measure of patient spirituality predicts future death attitudes and discussions of advance care planning.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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National Institute on Aging Initial Review Group (NIA)
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Stahl, Sidney M
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University of North Carolina Chapel Hill
Family Medicine
Schools of Medicine
Chapel Hill
United States
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Daaleman, Timothy P (2012) A health services framework of spiritual care. J Nurs Manag 20:1021-8
Daaleman, Timothy P; Williams, Christianna S; Preisser, John S et al. (2009) Advance care planning in nursing homes and assisted living communities. J Am Med Dir Assoc 10:243-51
Hamilton, V Lee; Daaleman, Timothy P; Williams, Christianna S et al. (2009) The Context of Religious and Spiritual Care at the End of Life in Long-term Care Facilities. Sociol Relig 70:
Daaleman, Timothy P (2008) The medical home: locus of physician formation. J Am Board Fam Med 21:451-7
Daaleman, Timothy P; Emmett, Catherine P; Dobbs, Debra et al. (2008) An exploratory study of advance care planning in seriously ill African-American elders. J Natl Med Assoc 100:1457-62
Daaleman, Timothy P; Usher, Barbara M; Williams, Sharon W et al. (2008) An exploratory study of spiritual care at the end of life. Ann Fam Med 6:406-11
Daaleman, Timothy P; Williams, Christianna S; Hamilton, V Lee et al. (2008) Spiritual care at the end of life in long-term care. Med Care 46:85-91
Hanson, Laura C; Dobbs, Debra; Usher, Barbara M et al. (2008) Providers and types of spiritual care during serious illness. J Palliat Med 11:907-14
Daaleman, Timothy P; Elder Jr, Glen H (2007) Family medicine and the life course paradigm. J Am Board Fam Med 20:85-92
Biola, Holly; Sloane, Philip D; Williams, Christianna S et al. (2007) Physician communication with family caregivers of long-term care residents at the end of life. J Am Geriatr Soc 55:846-56

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