Tira Oskoui is a senior pursuing Community Health and Biology majors at Tufts University. She works with Dr. Keren Ladin at the REACH Lab at Tufts, where she researches the impact of advance care planning. In addition to research, Tira serves as the Editor-in-Chief of the TuftScope journal.
1. How did you get involved with your research in the first place? Why did you choose to work in public health rather than any other field?
I knew going into Tufts that I wanted to pursue research in some health-related setting, but I always envisioned it as being within a biology lab, mixing test tubes and such. However, once I started taking community health classes, I fell in love with the field and realized that I wanted to conduct research that involved human interaction and allowed me to actually connect with my participants. I found Dr. Keren Ladin’s REACH Lab (Research on Ethics, Aging, & Community Health) on the department website the summer after my first year, and the combination of public health work in a clinical setting with chronic disease patients appealed well to my intersection of interests in community health, biology, and medicine. I reached out to Dr. Ladin, and started working in the lab that fall!
2. Can you tell me about your thesis project?
Overall, the projects I’ve been involved with in the REACH Lab have focused on decision-making among older patients with advanced chronic kidney disease (CKD). For my thesis, I’m working off of data we collected through a series of surveys last year at Tufts Medical Center, where we are investigating the effects of a decision-aid for these patients, their care-partners, and their clinicians in the treatment decision-making process. In particular, I’m investigating advance care planning among this population — that is, whether and how clinicians guide these patients and their care-partners through understanding their options and outlining their values and treatment goals in advance of the time when these decisions may become critical. Advance care planning is particularly important for this population, since elderly CKD patients often experience high comorbidity and cognitive impairment, and they sometimes experience unexpected complications that require a treatment decision to be made quickly. By having their goals and preferences decided upon prior to an emergency or a loss of ability to consent to care, the treatment they receive can best align with their values, allowing them maximum autonomy in these challenging medical situations.
3. What are some of the findings that have surprised you the most in your research?
This patient population faces several difficult treatment decisions, such as whether or not to initiate dialysis, and due to factors such as comorbidity, cognitive impairment, and unforeseen complications. Issues of capacity and consent to decision-making often come into play. They are often put on dialysis, despite findings that for many of these patients, dialysis may not grant much extended life expectancy, and most of these patients and their care-partners have indicated a preference for comfort care over life-sustaining treatment in these cases. For me, it has been very interesting to investigate the reasons why this discrepancy exists between care preferred and care received. We have found that patients often want to be engaged in advance care planning discussions, including transparency from their clinicians regarding elements such as prognosis. However, our surveyed patients most often report not being involved in such conversations with their doctors. They report rarely being asked about their values, fears, and concerns in their clinical care, and they seem to be having these discussions more often with their families than with their clinical team. Based on our findings, we are recommending that nephrologists put more focus on transparent, holistic advance care planning with this patient population and that they involve care-partners and/or families in these decision-making discussions.
4. What are some of the challenges you’ve faced as you collected data for your research? How did you overcome your obstacles?
One challenge we’ve faced is in recruiting patients and care-partners to enroll in our study. The study takes time, and understandably, some of our potential participants would prefer not to spend additional time in the hospital and would rather not answer a long survey that asks difficult questions, such as about their end-of-life preferences. However, we have found that many of our participants appreciate the study and enjoy learning about their options via the decision-aid. We try to communicate this generally positive experience to our potential participants and to include their clinicians in our recruitment strategy. Patients generally trust their doctors, so if their nephrologist is the person to initiate the recruitment process for our study, we tend to have a higher success rate.
5. How do you think your experiences surveying patients about their decisions with chronic kidney disease will affect your long-term career goals?
One of my favorite aspects of my research is the patient-interaction component, which I am sure will prove beneficial in my long-term goal of being a physician. I’ve had the chance to interview many patients and care-partners, and since these conversations deal with very serious subjects due to the nature of end-of-life decision-making, I have had to learn how to approach such topics with empathy and in a way that preserves the patients’ dignity. In addition, since our research is in a way critical of the current medical system, I have had the chance to think seriously and learn about what it means to be a compassionate care provider, and I hope I will be able to take these lessons forward with me as I venture into a clinical provider role. Lastly, I hope to continue to incorporate research into my career through medical school and beyond, and I am very grateful to have had this hands-on research experience as a first step toward this goal.
6. Do you have any advice for other rising seniors who are looking to pursue a senior thesis, or anything you want to say to undergraduates who want to get into public health research?
My main piece of advice is to just take the plunge and go for it! I was a bit nervous as a first-year student about reaching out to professors, but it’s important to remember that they want to teach and mentor students, and chances are, they’ll be excited to hear of your interest. I am certainly biased, but I think that research relating to public health provides an underrated and invaluable opportunity for pre-med students, since thinking critically about the health care system is, in my opinion, crucial to becoming a good clinician. As for pursuing a senior thesis, it is definitely not an easy task, but if you have the time and energy to commit to it, I think it can be a very rewarding experience. I am excited to have a final product to cap off my past three years of research, and I believe the scientific writing experience it provides is very useful, especially considering that we typically do not get many other opportunities to practice those skills. My feeling is that if you have a passion for something, you may as well pursue it to its fullest!
If you would like to have your own research featured on the TuftScope blog, you can reach Kurtis at firstname.lastname@example.org