Palliative Care Communication Research Initiative (PCCRI)

The purposes of this multi-site observational cohort study are to understand how patients, families and palliative care clinicians discuss prognoses in the setting of advanced cancer and to identify the approaches that are most strongly associated with patient-centered outcomes in the setting of advanced cancer.

PI: Bob Gramling MD, DSc

Funder: American Cancer Society. Grant #: RSG-13-239-01-PCSM

Project Team: (UVM) Bob Gramling (PI), Jeffrey Priest (University of Rochester) Sally Norton, Susan Ladwig, Liz Gajary-Coots, Ronald Epstein, Kevin Fiscella, Susan Stanek, Nathalie Dougoud, Heather Pyke (Purdue University) Stewart Alexander, Luke Ingersoll (University of California, San Francisco) Wendy Anderson, Jenica Cimino (University of Arizona) David Gramling (University of Pennsylvania) Elise Tarbi

Machine Learning

Machine-Learning to Identify Moments of Connectional Silence in Serious Illness Conversations

In order to understand, disseminate, support and incentivize high quality communication in serious illness, we need measurement methods that can be scaled for larger clinical studies and routine health service quality reporting. This project develops a machine learning pipeline to develop such measures using existing cohort data that includes more than 12,000 minutes of audio-recorded palliative care conversations from the Palliative Care Communication Research Initiative. We focus initially on conversational pauses that are indicative of human connection in serious illness conversations. 

Funders:  Holly & Bob Miller Endowed Chair in Palliative Medicine, University of Vermont College of Engineering, University of Vermont Department of Family Medicine

Project Team: Viktoria Manukyan, Brigitte Durieux, Cailin Gramling, Lindsay Ross, Larry Clarfeld, Michelle Nyland, Aidan Ryan, Donna Rizzo, Maggie Eppstein, Stewart Alexander (Purdue University), Bob Gramling

Natural Language Processing for Characterizing Palliative Care Conversations

Clinical conversations are information-dense sources of clinical data. This project leverages audio-recordings of more than 350 palliative care consultations from the Palliative Care Communication Research Initiative to develop automated Natural Language Processing methods for measuring fundamental features of palliative care conversations, beginning with expressions of uncertainty, prognosis, and emotion.

Funders: Holly & Bob Miller Endowed Chair in Palliative Medicine, University of Vermont College of Engineering, University of Vermont Department of Family Medicine

Project Team: Lindsay Ross, Laura Hirsch, Bennet Cazayoux, Larry Clarfeld, Bridger Banco, Brigitte Durieux, Cailin Gramling, Christopher Danforth, Donna Rizzo, Maggie Eppstein, Bob Gramling


Vision: Every seriously ill patient will be surrounded by clinicians who can skillfully discuss what matters most.


TalkVermont is a multi-component intervention to improve conversations between clinicians and seriously ill patients throughout Vermont and the Adirondack region of New York. TalkVermont uses evidence-based methods to coach clinicians in state-of-the-art serious illness communication and re-engineer the practice environment to support timely and effective communication. 


TalkVermont Family Communication Guide

TalkVermont Patient Prep Guide

TalkVermont REMAP Pocket Card

TalkVermont SIC Guide


TalkVermont Phone Number:


TalkVermont E-mail:


Northern New England Palliative Care TeleConsult Research Network

Rural Northern New Englanders lack access to specialty palliative care and TeleHealth technology can overcome these geographic barriers. The purposes of this award are to evaluate the feasibility of specialty palliative care TeleConsultation with people who have advanced cancer or heart failure and to understand the technological, aesthetic, and environmental factors that promote a sense of human connection in conversations that happen via TeleHealth.

PI’s: Bob Gramling MD, DSc; Paul Han MD, MPH

Funder:Northern New England Clinical & Translational Research Network (NIH U54 GM115516; PI’s Gary Stein & Cliff Rosen)

Project Team: (UVM) Liam John, Maggie Eppstein, Donna Rizzo, Bob Gramling. (Maine) Rebecca Hutchinson, Eric Anderson, Paul Han. (New York) Liz Gajary-Coots. 

Telemedicine Facilitated Palliative Care Consultations in Rural Dialysis Patients

The purposes of this award are (a) to test the feasibility and acceptability of TelePalliative Care consultation with patients in rural dialysis units, and (b) to describe the content of such conversations and their association with patient-centered outcomes.

PI: Katherine Cheung MD, PhD

Funder: National Palliative Care Research Center Career Development Award

Project Team: Katharine Cheung (PI), Bob Gramling (Primary Mentor), Michael Lamantia, Renee Stapleton, Terry Rabinowitz

Telecoaching Palliative Care Communication Skills for Rural Clinicians

The purposes of this award is to create a longitudinal telecoaching model for palliative care communication skills that is effective, feasible, scalable, and specifically targets rural community primary care providers who have limited access to palliative care specialists.

PI: Stephen Berns, MD

Funder: Cambia Health Foundation Sojourns Scholar Leadership Award

Project Team: Stephen Berns (PI), Bob Gramling (Primary Mentor), Robert Arnold (University of Pittsbugh), Anthony Black (University of Washington), Allan Ramsay


Loved ones often need to make decisions at end-of-life for patients who cannot communicate for themselves. A brief storytelling intervention (based on NPR’s StoryCorps) has demonstrated promising findings for lowering surrogate decision-makers’ risk of complicated grief (e.g. major depression, generalized anxiety, PTSD). This project implements the storytelling intervention among those at high risk of complicated grief who met our team prior to their loved one’s death.

Co-PI: Bob Gramling M.D., D.Sc. and Francesca Arnoldy

Funder: Holly & Bob Miller Chair in Palliative Medicine and the Larner College of Medicine EOL Doula Program

Project Team: Francesca Arnoldy, Bob. Gramling, Ryan McGinnis, Donna Rizzo