About

Jennifer Kapo, MD, holds the position of The Sherwin B. Nuland and Michael K. Vlock Professor of Medicine and serves as the Chief of Palliative Medicine within the Palliative Care Program at Yale School of Medicine. Her clinical work involves providing palliative medicine to patients at Smilow Cancer Hospital. She focuses on developing a research mission in palliative medicine and expanding teaching opportunities for Yale faculty, staff, fellows, residents, and medical students. Dr. Kapo has been charged with creating an ACGME-certified fellowship in hospice and palliative care. Her academic background includes appointments as Associate Professor of Clinical Medicine at the University of Pennsylvania and Yale University School of Medicine. Her research interests encompass medical oncology, palliative care, and palliative medicine, with a significant body of published work exploring topics such as hospital outcomes, communication in serious illness, opioid management, and integration of palliative care into cancer treatment. Her contributions include developing frameworks for serious illness communication, guiding opioid management in advanced cancer, and investigating the impact of palliative care consultations on hospital length of stay and patient outcomes.

Research topics

• Nursing
• Medicine
• Psychiatry
• Family medicine
• Internal medicine
• Intensive care medicine

Selected publications

• <i>Letter:</i> Implementing the Surprise Question in the Emergency Department: Reducing Time to Palliative Care Consultation and Hospital Length of Stay with Significant Cost Savings

  Journal of Palliative Medicine · 2025-04-03

  letter
  PublisherDOI

• Framework for Considering Primary and Subspecialty Palliative Care and Guiding Serious Illness Communication for Patients With Breast Cancer

  American Society of Clinical Oncology Educational Book · 2024-06-01 · 1 citations

  review

  Palliative care is a comprehensive approach aimed at enhancing the quality of life of patients and their families living with serious illnesses such as breast cancer. This approach includes assessing and managing pain and other physical symptoms, attending to psychosocial and spiritual aspects of care, fostering effective communication and decision making, and providing support in coordinating care that upholds a person's values and preferences from the time of diagnosis throughout the illness trajectory. This type of care can be provided by palliative care specialists (ideally an interprofessional team) working alongside the oncology team, referred to as subspecialty palliative care. Conversely, the fundamental aspects of this approach, which we sometimes call primary palliative care, are provided by all clinicians caring for patients with breast cancer. Given that access to subspecialty palliative care can vary globally, especially in rural and resource-constrained settings, it is imperative for all oncology clinicians to receive training in the core components of palliative care. This study aims to provide a basic framework to recognize what the core primary palliative care skills are in routine oncology practice, to delineate basic serious illness communication strategies, and to introduce when to consider the integration of subspecialty palliative care into the care of patients with breast cancer.

  PublisherDOI

• Advance care planning and hospital outcomes in solid tumour oncology inpatients

  BMJ Supportive & Palliative Care · 2023-07-27 · 2 citations

  article

  OBJECTIVES: To assess the association between advance care planning (ACP) and outcomes of in-hospital mortality, 30-day hospital readmission and 30-day emergency department (ED) visits among patients with cancer. METHODS: This observational cohort analysis included patients with solid tumour malignancies receiving oncology care and admitted at Yale New Haven Hospital between 1 January 2018 and 31 December 2021. RESULTS: Among 19 422 patients, 1283 (6.6%) had a documented ACP note. Compared with patients without an ACP, patients with an ACP tended to be older, have longer LOS, be admitted to an oncology inpatient team, subsequently admitted to intensive care unit and have a lower Rothman Index. Multivariable logistic regression identified ACP as independently associated with decreased 30-day readmission (OR=0.70 (95% CI: 0.60 to 0.82)) and 30-day ED visit (OR=0.79 (95% CI: 0.68 to 0.91)), adjusting for in-hospital mortality and patient characteristics. CONCLUSION: ACP documentation is associated with decreased readmissions and ED visits, independent of hospice utilisation.

  PublisherDOI

• Expert consensus‐based guidance on approaches to opioid management in individuals with advanced cancer‐related pain and nonmedical stimulant use

  Cancer · 2023-09-11 · 11 citations

  articleOpen access

  BACKGROUND: Clinicians treating cancer-related pain with opioids regularly encounter nonmedical stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence-based management guidance. The aim of the study is to identify expert consensus on opioid management strategies for an individual with advanced cancer and cancer-related pain with nonmedical stimulant use according to prognosis. METHODS: The authors conducted two modified Delphi panels with palliative care and addiction experts. In Panel A, the patient's prognosis was weeks to months and in Panel B the prognosis was months to years. Experts reviewed, rated, and commented on the case using a 9-point Likert scale from 1 (very inappropriate) to 9 (very appropriate) and explained their responses. The authors applied the three-step analytical approach outlined in the RAND/UCLA to determine consensus and level of clinical appropriateness of management strategies. To better conceptualize the quantitative results, they thematically analyzed and coded participant comments. RESULTS: Consensus was achieved for all management strategies. The 120 Experts were mostly women (47 [62%]), White (94 [78%]), and physicians (115 [96%]). For a patient with cancer-related and nonmedical stimulant use, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering. Buprenorphine/naloxone transition was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis. CONCLUSION: Study findings provide urgently needed consensus-based guidance for clinicians managing cancer-related pain in the context of stimulant use and highlight a critical need to develop management strategies to address stimulant use disorder in people with cancer. PLAIN LANGUAGE SUMMARY: Among palliative care and addiction experts, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering in the context of cancer-related pain and nonmedical stimulant use. Buprenorphine/naloxone transition as a harm reduction measure was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis.

  PublisherOA PDFDOI

• Association of palliative care and hospital outcomes among solid tumour oncology inpatients

  BMJ Supportive & Palliative Care · 2023-02-27 · 6 citations

  article

  Objectives We aimed to explore the association between receiving an inpatient palliative care consultation and hospital outcomes, including in-hospital death, intensive care unit (ICU) use, discharge to hospice, 30-day readmissions and 30-day emergency department (ED) visits. Methods We conducted a retrospective chart review of Yale New Haven Hospital medical oncology admissions from January 2018 through December 2021, with and without inpatient palliative care consultations. Hospital outcome data were extracted from medical records and operationalised as binary. Multivariable logistic regression was used to estimate ORs for the association between number of inpatient palliative care consultations and hospital outcomes. Results Our sample included 19 422 patients. Age, Rothman Index, site of malignancy, length of stay, discharge to hospice, ICU admissions, hospital death and readmissions within 30 days differed significantly between patients who received versus did not receive a palliative care consultation. On multivariable analysis, receiving one additional palliative care consultation was significantly associated with higher odds of hospital death (adjusted OR=1.15, 95% CI 1.12 to 1.17) and discharge to hospice (adjusted OR = 1.23, 95% CI 1.20 to 1.26), and lower odds of ICU admission (adjusted OR=0.94, 95% CI 0.92 to 0.97). There was no significant association between palliative care consultations and readmission within 30 days or with ED visits within 30 days. Conclusion Inpatients receiving palliative care had increased likelihood of hospital death. However, when controlling for significant differences in patient presentation, patients had nearly 25% greater odds of discharge to hospice and less odds to transition to ICU level of care.

  PublisherDOI

• Bystander Empowerment Workshop: How to Respond to Microaggressions in Clinical Environments (INV307)

  Journal of Pain and Symptom Management · 2023-04-13

  articleOpen access
  PublisherOA PDFDOI

• Lung Cancer Supportive Care and Symptom Management

  Hematology/Oncology Clinics of North America · 2023-04-05 · 15 citations

  review
  PublisherDOI

• Expert Consensus-Based Guidance on Approaches to Opioid Management in Individuals with Advanced Cancer-Related Pain and Opioid Misuse or Use Disorder: Results of a Delphi Study (RP305)

  Journal of Pain and Symptom Management · 2022-05-17

  articleOpen access
  PublisherDOI

• Improving Breast Cancer Family Caregivers’ Palliative Care Literacy: A Pilot Randomized Trial

  Journal of Family Nursing · 2022-06-07 · 7 citations

  article

  Self- and family management (SFM) refers to patients’ and family caregivers’ activities to co-manage illness. Two barriers to SFM are low palliative care literacy and lack of goals of care communication, which potentially result in SFM activities that are unsupportive of patients’ goals. Managing Cancer Care: A Caregiver’s Guide (MCC-CG) aims to improve palliative care literacy and communication within a SFM training program. In this pilot randomized trial, we enrolled breast cancer family caregivers and collected data at 0, 1, and 3 months on palliative care literacy, SFM engagement, communication, transitions management, uncertainty, caregiver burden, and caregiver competence/personal gain. Participants ( n = 35) had a mean age of 54 (range: 18–81) and were 66% white and 34% racial/ethnic minorities. Intervention participants improved their palliative care literacy and SFM engagement, reduced uncertainty and caregiver burden, increased competence/personal gain, and had more goals of care conversations over time. MCC-CG has preliminary efficacy, warranting further study.

  PublisherDOI

• Barriers to recruitment into emergency department-initiated palliative care: a sub-study of a multi-site, randomized controlled trial

  BMC Palliative Care · 2022 · 20 citations

  • Medicine
  • Family medicine
  • Nursing

  BACKGROUND: Emergency department (ED) visits among older adults are common near the end of life. Palliative care has been shown to reduce ED visits and to increase quality of life among patients, but recruitment into these programs is often challenging. This descriptive analysis explores the barriers to enrolling seriously ill patients scheduled for discharge from the ED into palliative care research. METHODS: This descriptive sub-study aims to assess the reasons why patients with advanced illness scheduled for discharge home from 11 EDs across the United States decline to participate in Emergency Medicine Palliative Care Access (EMPallA), a Phase IV randomized controlled trial (RCT) comparing two modes of palliative care delivery. Our aim was to understand why patients decline to enroll to improve future recruitment rates and expand care for patients discharged home from the ED. Research coordinators documented reasons that patients declined to enroll in the larger EMPallA trial; reasons for refusing participation were independently analyzed by two researchers to identify overarching themes. RESULTS: Enrollment rate across all sites was 45%; of the 504 eligible patients who declined participation, 47% (n = 237) declined for reasons related to illness severity. 28% of refusals (n = 143) were related to the mode of palliative care delivery, while 24% (n = 123) were due to misconceptions or stigma related to palliative care. Less commonly, patients refused due to general research barriers (16.5%), family/caregiver barriers (11.7%), and physician-related barriers (< 1%). CONCLUSIONS: Patients with advanced illnesses presenting to the ED often refuse to participate in palliative care research due to the severity of their illness, the mode of care delivery, and misconceptions about palliative care. In contrast with other studies, our study found minimal physician gatekeeping, which may be the result of both changing attitudes toward palliative care and the nature of the ED setting. Robust training programs are crucial to overcome these misconceptions and to educate patients and providers about the role of palliative care. Future palliative care programs and study designs should recognize the burden this vulnerable population endures and consider alternative modes of care delivery in an effort to increase participation and enrollment. CLINICAL TRIALS REGISTRATION: NCT03325985 , October 30, 2017.

  PublisherOA PDFDOI

Frequent coauthors

• Jason Karlawish

  California University of Pennsylvania

  24 shared

• Dena Schulman‐Green

  New York University

  22 shared

• Leslie Blatt

  22 shared

• David Casarett

  Duke University

  20 shared

• Sarah Linsky

  Yale University

  19 shared

• Sangchoon Jeon

  Yale University

  19 shared

• Anees B. Chagpar

  Yale University

  18 shared

• Jane deLima Thomas

  16 shared