My research interests include palliative care, value-based model of care, interprofessional collaboration, implementaion science, and nursing/professional ethics. In prior studies, I have studied integration of primary palliative care (e.g., advance care planning, care coordination) into nursing practice and interprofessional team care, looked at the end-of-life decision making process over illness trajectories of older adults, descriptions of quality nursing care for hospitalized patients with advance illness, and ethical practice by nurses in end-of-life care. My current project uses pragmatic trials and implementation science approach to examine implementation of advance care planning in primary care practice. Another project currently funded by American Nurses Foundation focuses on making nursing work visible and developing nurse-led care model to deliver care to improve health of people in communities. The goal of my program of research is to improve quality of care and reduce health inequity for patients and their families living with serious illness and complex care needs across health care settings.