Bio

Bio


Dr. Harman graduated from Case Western Reserve University School of Medicine. She then completed a residency in Internal Medicine at Stanford and a Palliative Care fellowship at the Palo Alto VA/Stanford program. She is the section head for Palliative Care in the Division of General Medical Disciplines and Associate Program Director for Stanford's Internal Medicine Residency Program. Her research and educational interests include communication in healthcare and bioethics in end-of-life care.

Clinical Focus


  • Palliative Care
  • Internal Medicine

Academic Appointments


Administrative Appointments


  • Stanford Commitee on Professional Satisfaction and Support, Stanford University Medical Center (2012 - Present)
  • Ethics Committee, Co-Chair, Stanford University Medical Center (2007 - Present)
  • Associate Residency Program Director, Department of Medicine (2011 - Present)
  • Chairperson, Jonathan King Lectureship Committee (2011 - Present)

Honors & Awards


  • Arnold P. Gold Professorship, Arnold P. Gold Foundation (2011-2014)
  • Isaac Stein Award for Compassionate Care, Stanford Hospital and Clinics Board of Directors (September 23, 2009)

Professional Education


  • Residency:Stanford University Hospital -Clinical Excellence Research Center (2006) CA
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2006)
  • Board Certification: Hospice and Palliative Medicine, American Board of Internal Medicine (2008)
  • Fellowship:Palo Alto VA Healthcare System (2007) CA
  • Medical Education:Case Western Reserve University School of Medicine (2003) OH

Research & Scholarship

Clinical Trials


  • A ProspectiveTrial Using Video Images in Advance Care Planning in Hospitalized Seriously Ill Patients With Advanced Cancer Not Recruiting

    The purpose of this study is to compare the decision making of hospitalized subjects with advanced cancer having a verbal discussion about CPR compared to subjects using a video.

    Stanford is currently not accepting patients for this trial. For more information, please contact Ryan Oden, (650) 725 - 5417.

    View full details

Teaching

2014-15 Courses


Graduate and Fellowship Programs


Publications

All Publications


  • Curricular Innovations for Medical Students in Palliative and End-of-Life Care: A Systematic Review and Assessment of Study Quality JOURNAL OF PALLIATIVE MEDICINE DeCoste-Lopez, J., Madhok, J., Harman, S. 2015; 18 (4): 338-349

    Abstract

    Recent focus on palliative and end-of-life care has led medical schools worldwide to enhance their palliative care curricula.The objective of the study was to describe recent curricular innovations in palliative care for medical students, evaluate the quality of studies in the field, and inform future research and curricular design.The authors searched Medline, Scopus, and Educational Resource Information Center (ERIC) for English-language articles published between 2007 and 2013 describing a palliative care curriculum for medical students. Characteristics of the curricula were extracted, and methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).The sample described 48 curricula in 12 countries. Faculty were usually interdisciplinary. Palliative care topics included patient assessment, communication, pain and symptom management, psychosocial and spiritual needs, bioethics and the law, role in the health care system, interdisciplinary teamwork, and self-care. Thirty-nine articles included quantitative evaluation, with a mean MERSQI score of 9.9 (on a scale of 5 to 18). The domain most likely to receive a high score was data analysis (mean 2.51 out of 3), while the domains most likely to receive low scores were validity of instrument (mean 1.05) and outcomes (mean 1.31).Recent innovations in palliative care education for medical students represent varied settings, learner levels, instructors, educational modalities, and palliative care topics. Future curricula should continue to incorporate interdisciplinary faculty. Studies could be improved by integrating longitudinal curricula and longer-term outcomes; collaborating across institutions; using validated measures; and assessing higher-level outcomes including skills, behaviors, and impact on patient care.

    View details for DOI 10.1089/jpm.2014.0270

    View details for Web of Science ID 000351274500008

    View details for PubMedID 25549065

  • Patients Who Lack Capacity and Lack Surrogates: Can They Enroll in Hospice? JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Effiong, A., Harman, S. 2014; 48 (4): 745-U277
  • Late referral to palliative care consultation service: length of stay and in-hospital mortality outcomes. The Journal of community and supportive oncology Humphreys, J., Harman, S. 2014; 12 (4): 129-136

    Abstract

    Palliative care services in the United States are increasing in their prevalence but continue to vary in their implementation, with different referral policies and timing of patient access to services.To better define a late referral and to understand the association of late referrals to palliative care with patient health outcomes, including postreferral length of hospital stay and in-hospital mortality.We performed a retrospective study using multiple linear and logistic regressions on 1,225 patients with pre-existing oncologic diagnoses who received a referral to Stanford Hospital's palliative care service.Those oncologic patients who were referred to palliative care in the first week following admission had significantly shorter lengths of stay after referral, as well as lower in-hospital mortality, compared with patients who were referred later than 1 week following admission. Regression analyses, adjusted for demographic variables, DNR status, and sickness, revealed that waiting 1 week or longer to refer a patient was associated with an overall increased length of stay of 2.70 days (P < .001). This increased to 3.40 days (P < .001) when patients who died in the hospital were removed from the data, suggesting that in-hospital mortality was not solely responsible for the trend. Waiting 1 week to refer was associated with increased odds of a patient's dying in the hospital vs being discharged alive by a factor of 3.04 (P < .001).This study was limited to analyzing inpatient palliative care consultation services with a emphasis on patients with metastatic solid tumors. We used a proxy for patient sickness burden but did not analyze outcomes specific to cancer stage or individual oncologic diagnosis separately.Our study suggests that late referrals may have a marked negative impact on health outcomes, which argues for the design and implementation of hospital policies that encourage early referral to palliative care for advanced cancer patients.

    View details for PubMedID 24971422

  • Update in Palliative Care-2011 JOURNAL OF GENERAL INTERNAL MEDICINE Harris, P. F., Arnold, R. M., Braun, U. K., Fromme, E., Ghermay, R., Harman, S., Jayes, R. L., Walling, A. M. 2012; 27 (5): 582-587

    Abstract

    The aim of this update is to summarize scientifically rigorous articles published in 2010 that serve to advance the field of palliative medicine and have an impact on clinical practice.We conducted two separate literature searches for articles published between January 1, 2010 and December 31, 2010. We reviewed title pages from the Annals of Internal Medicine, British Medical Journal, Journal of the American Geriatrics Society, JAMA, Journal of Clinical Oncology, JGIM, Journal of Pain and Symptom Management, Journal of Palliative Medicine, Lancet, New England Journal of Medicine, PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care). We also conducted a Medline search with the key words "palliative," "hospice," and "terminal" care. Each author presented approximately 20 abstracts to the group. All authors reviewed these abstracts, and when needed, full text publications. We focused on articles relevant to general internists. We rated the articles individually, eliminating by consensus those that were not deemed of highest priority, and discussed the final choices as a group.We first identified 126 articles with potential relevance. We presented 20 at the annual SGIM update session, and discuss 11 in this paper.

    View details for DOI 10.1007/s11606-011-1929-9

    View details for Web of Science ID 000302869300019

    View details for PubMedID 22127796

  • Palliative Care Rounds: Toward Evidence-Based Practice JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Dy, S. M., Harman, S. M., Braun, U. K., Howie, L. J., Harris, P. F., Jayes, R. L. 2012; 43 (4): 795-801

Stanford Medicine Resources: