The National Palliative Care Research Center

Curing suffering through palliative care research.


Elizabeth Dzeng MD, PhD, MPH

Assistant Professor

University of California, San Francisco

Grant Year
Grant Term
2 years
Grant Type
Junior Faculty Career Development

Project Description
Identifying Contributing Factors to Burdensome Treatments in Older Adults with Advanced Dementia Near the End of Life

Over 5 million Americans with dementia are at risk for receiving high intensity and potentially unwanted and burdensome treatments defined here as mechanical ventilation, ICU admission, and resuscitation at the end of life. Despite decades of research aimed at promoting informed, goals-aligned care, the trend over the past decade amongst older adults has been towards increased ICU usage and hospitalizations in the last months of life. There is a lack of research describing the systemic and cultural drivers of burdensome care amongst patients with advanced dementia near the end of life.

The first aim of this study is to understand factors that contribute to burdensome treatments in older adults with advanced dementia near the end of life. At two high and two low intensity academic hospitals in California, I will conduct a comparative ethnography (participant observation research) to identify institutional, clinician, patient, and family factors that differ between high and low intensity hospitals with respect to the provision of burdensome treatments in older adults with advanced dementia near the end of life. I will observe the day-to-day activities and behaviors of individuals involved in the care of patients with dementia to identify what constitutes burdensome care, explore how such care emerges in the course of everyday life at these hospitals, and compare how high and low intensity hospitals differ.

My second aim seeks to understand the barriers and facilitators of burdensome treatments in older adults with advanced dementia near the end of life through semi-structured in-depth interviews with key stakeholders at all levels of the healthcare system. The data from this project will allow for more effective targeting of modifiable factors for interventions that promote systems change towards high quality, goal-aligned end of life care.


Elizabeth Dzeng, MD, PhD, MPH, is an Assistant Professor at UCSF in the Division of Hospital Medicine and Social and Behavioral Sciences, Sociology program. She also directs the ethics curriculum for UCSF medical students. She completed her PhD in Medical Sociology at the University of Cambridge at King’s College as a Gates Cambridge Scholar and was a General Internal Medicine Post-Doctoral Clinical Research Fellow and Palliative Care Research Fellow at the Johns Hopkins School of Medicine. She wrote her dissertation on the influence of institutional cultures and policies on physicians’ ethical beliefs and how that impacts communication practices in end of life decision-making conversations. Her current research is focused on understanding the systemic factors that contribute to burdensome care at the end of life in older adults, as well as physician moral distress and ethical challenges at end of life.