1 OMB No. 0925-0001/0002 (Rev. 08/12 Approved Through 8/31/2015)
Provide the following information for the Senior/key personnel and other significant contributors. Follow this format for each person. DO NOT EXCEED FIVE PAGES.
NAME: LeBaron, Virginia T.
eRA COMMONS USER NAME (credential, e.g., agency login): virginialebaron POSITION TITLE: Assistant Professor, Roberts Scholar
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing,
include postdoctoral training and residency training if applicable. Add/delete rows as necessary.)
INSTITUTION AND LOCATION
DEGREE (if applicable) Completion Date MM/YYYY FIELD OF STUDY
University of Virginia, Charlottesville, Virginia University of Maryland, Baltimore, Maryland
Fulbright Fellow, MNJ Institute of Oncology & Regional Cancer Center, Hyderabad, India
University of Utah, Salt Lake City, Utah
Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, Massachusetts BSN MS n/a PhD Postdoctoral 05/1996 12/2002 06/2012 08/2013 07/2015 Nursing Oncology Nursing, Advanced Practice Nursing Science Nursing Science Cancer and Health Disparities
A. Personal Statement
The majority of my 18 year nursing career has been dedicated to caring for patients with advanced cancer and improving the delivery of palliative care to individuals coping with serious and life-limiting illness. The overall goal of my program of research is to inform effective health policy and educational interventions that will
reduce disparities in cancer care at the end of life, improve access to pain relief and opioid therapy, and lessen the suffering of patients dying from cancer, especially those who are socially, economically, or geographically isolated or marginalized. Since 2004, I have been involved with global oncology work, beginning as faculty with the Palliative Access Program of the International Network for Cancer Treatment and Research. In this
capacity I participated in collaborative, multidisciplinary educational initiatives to improve the delivery of palliative care in Nepal, India and Tanzania. I continued my work in global oncology as a Fulbright Scholar, where I conducted a 9-month ethnography in South India exploring barriers to cancer pain management and opioid availability in a government cancer hospital. I currently serve as an International Expert Collaborator with the Pain & Policy Studies Group, and helped mentor a team from Zambia develop and implement a country advocacy plan to improve access to opioids. I hold advanced practice certifications as an acute care nurse practitioner (ACNP-BC) and in oncology nursing (AOCN) and palliative care (ACHPN).
1. LeBaron, V., Blonquist, T., Hong, F., Halpenny, B., & Berry, D. (2015). Screening for pain in the
ambulatory cancer setting: Is 0-10 enough? Journal of Oncology Practice. Early release article on-line.
http:// jop.ascopubs.org/content/early/recent. doi: 10.1200/JOP.2015.004077
2. LeBaron, V., Beck, S., Black, F., & Palat, G. (2014). Nurse moral distress and cancer pain management: An ethnography of oncology nurses in India. Cancer Nursing, 37(3), 331-344. PMID: 24918627
3. LeBaron, V., Beck, S., Black, F., Maurer, M. & Palat, G. (2014). An ethnographic study of barriers to cancer pain management and opioid availability in India. The Oncologist, 19(5), 515-522. PMID: 24755460 4. Gilson, A., Maurer, M., LeBaron, V., Ryan, K., & Cleary, J. (2013). Multivariate analysis of countries’
government and healthcare system influences on opioid availability for cancer pain relief and palliative care: More than a function of human development. Palliative Medicine, 27(2),105-114. PMID: 23104512
2 B. Positions and Honors
Positions and Employment
1996 – 1999 Clinical Staff Research Nurse I – III, Neuroscience Program of Care, National Institutes of Health, Bethesda, MD
1999 – 2002 Clinical Staff Research Nurse III – IV, Outpatient Oncology Day Hospital, National Institutes of Health, Bethesda, MD
2001 – 2002 Graduate Research Assistant, Department of Education, Administration, Health Policy and Informatics, University of Maryland School of Nursing, Baltimore, MD,
2002 –2002 Graduate Teaching Assistant, Adult Health Nursing Department, University of Maryland School of Nursing, Baltimore, MD
2002 – 2002 Infusion Center Nurse, Outpatient Oncology Department, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
2003 – 2006 Palliative Care Nurse Practitioner, Palliative Care Program, Georgetown University Medical Center and Lombardi Comprehensive Cancer Center, Washington, D.C.
2006 – 2009 Clinical Assistant Professor, University of Arizona, College of Nursing, Bio-behavioral Health Science Division; Tucson, AZ
2006 – 2011 Palliative Care Nurse Practitioner, University Medical Center, Tucson, AZ
2009 – 2011 Clinical Associate Professor, University of Arizona, College of Nursing, Bio-behavioral Health Science Division; Clinical Associate Professor, College of Medicine, Department of Medicine; Clinical Affiliate, University of Arizona Center on Aging; Tucson, AZ
2011 – 2012 Fulbright Fellow, MNJ Institute of Oncology and Regional Cancer Center, Hyderabad, India 2013 – 2015 Post-Doctoral Research Fellow, Dana-Farber Cancer Institute, Phyllis F. Cantor Center for
Nursing & Patient Care Services Research; Research Fellow, Harvard Medical School, Department of Medicine; Boston, MA
2015 – present Assistant Professor, Roberts Scholar, University of Virginia School of Nursing, Department of Acute & Specialty Care; Charlottesville, VA
2015 – present Full Member, University of Virginia Cancer Center; Charlottesville, VA Other Experience and Professional Memberships
1996 – present Member, Sigma Theta Tau International, Honor Society of Nursing 2000 – present Member, Oncology Nursing Society
2004 – 2015 Advanced Practice Nurse Faculty, Palliative Access Program, International Network for Cancer Treatment and Research, Brussels, Belgium
2008 – present Member, American Academy of Hospice and Palliative Medicine
2008 – 2010 Governing Board, Southern Arizona Chapter, Oncology Nursing Society, Tucson, AZ 2010 – 2011 Research Assistant (volunteer), Pain & Policy Studies Group, University of Wisconsin,
2011 – present Member, American Academy of Nurse Practitioners 2013 – present Member, American Society of Clinical Oncology
2014 – present International Expert Collaborator, Pain & Policy Studies Group, University of Wisconsin, Madison, WI
2015 – present Member, Policy & Advocacy Committee, International Society for Nurses in Cancer Care 2015 – present Member, Scientific Advisory Committee, Models and Innovation Working Group,
Lancet Commission on Global Access to Palliative Care and Pain Control
2015 – present Associate Editor, Oncology Nursing Forum, Research Journal of the Oncology Nursing Society Honors
Scholarships & Traineeships
1994 Seventh Annual Edgar F. Shannon, Jr. Scholarship 1995 Helene Fuld Trust Fellow, Commonwealth of Virginia 2001 Stewart J. Greenebaum Scholarship in Oncology
2008 Center to Advance Palliative Care (CAPC) Leadership Training Scholarship 2009 Oncology Nursing Society (ONS) Foundation Doctoral Scholarship
3 2009 – 2010 University of Utah College of Nursing, Lawson Graduate Fellow
2010 – 2011 Advanced Education Nursing Traineeship, University of Utah College of Nursing 2011 – 2012 Fulbright Scholar Research Fellowship, India
2012 – 2013 Graduate Research Fellowship, University of Utah Graduate School 2009 – 2013 American Cancer Society Pre-Doctoral Fellowship
1996 Neuroscience Nurse Intern, National Institutes of Health
2004 Stacy Boylan Oncology Nursing Award, Georgetown University Hospital 2008 Tucson Fabulous 50, Tucson, Arizona
2008 Sigma Theta Tau, Beta Mu Chapter, Excellence in Clinical Practice Award 2008 Sigma Theta Tau, Beta Mu Chapter, Community Research Grant
2008 Tucson Nurses Week Foundation, Clinical Nursing Practice Improvement Award 2008 NurseWeek Excellence in Clinical Practice, Southwest Regional Winner
2010 Nurse of the Year, Patient Advocacy Finalist, March of Dimes 2011 Fellow in the American Academy of Nurse Practitioners (FAANP) 2013 Outstanding PhD Student, University of Utah College of Nursing
C. Contributions to Science
1. Examined access to palliative care services and cancer pain relief in resource-constrained settings. Historical background: The global cancer burden is growing exponentially, disproportionately impacting
countries that are the least resourced to cope with its impact. Approximately 70% of cancer patients in low and middle income countries (LMICs) present with late-stage, incurable disease and often cannot obtain basic pain relief, such as morphine. Subsequently, nurses in LMICs who care for dying cancer patients witness profound patient suffering over which they often have little control and are at high risk to experience moral distress. In my work to explore the potential relationship between cancer pain management, opioid availability and nurse moral distress, I conducted (as PI) a 9-month ethnography at a government cancer hospital in South India. Central Findings: This research provided an in-depth look at the on-the-ground situation of oncology nurses in India (a country home to roughly 20% of the world’s population) and explored cultural and micro-level barriers to pain relief. My research also challenged a Western view of moral distress, arguing for a greater appreciation of the cultural and contextual values that influence ethical dimensions of nursing practice. Influence: The results of this research provided data which were used to advocate for improved pain policies within the state of Andhra Pradesh at the Ministry of Health level, and to advocate for enhanced training and support for nurses practicing in similar contexts. The results have shaped conversations within professional organizations, such as the International Society of Nurses in Cancer Care, about the crucial importance of considering role, context and culture when planning and implementing educational initiatives for nurses in LMICs. This research has clarified the active and essential role family caregivers and auxiliary hospital staff play in managing cancer symptoms of hospitalized patients, and offers insights into alternative care delivery models to improve cancer pain management in LMICs. Additionally, this research suggests alternative models to implement evidence based pain management practices in LMICs to address micro-level barriers in pain management.
1. LeBaron, V., Iribarren, S., Perri, S., & Beck, S. (2015). A practical fieldguide to conducting nursing research in low-and middle income countries. Nursing Outlook, 63(4), 462-73.
2. LeBaron, V., Beck, S., Black, F., & Palat, G. (2014). Nurse moral distress and cancer pain
management: An ethnography of oncology nurses in India. Cancer Nursing, 37(3), 331-344. PMID: 24918627
3. LeBaron, V., Beck, S., Black, F., Maurer, M. & Palat, G. (2014). An ethnographic study of barriers to cancer pain management and opioid availability in India. The Oncologist, 19(5), 515-522. PMID: 24755460
4. Gilson, A., Maurer, M., LeBaron, V., Ryan, K., & Cleary, J. (2013). Multivariate analysis of countries’ government and healthcare system influences on opioid availability for cancer pain relief and palliative care: More than a function of human development. Palliative Medicine, 27(2),105-114. PMID: 23104512 2. Helped support and empower nurses who care for seriously ill patients. Historical background: Nurses are the largest healthcare workforce globally and are often highly accountable for patient outcomes, without commensurate power to directly influence the plan of care. For example, nurses often feel especially
4 disempowered when caring for dying patients when they cannot obtain adequate pain relief for the patient, or the family has not been adequately counseled about the realistic prognosis of the patient. In an effort to address these issues at an academic medical center, I led (as PI) an educational intervention to create and evaluate a Palliative Care Resource Nurse team, drawing upon principles of community-based participatory research. This project designed, implemented and evaluated a program of advanced training of a Palliative Care Resource Nurse (PCRN) team at an academic University Medical Center (UMC). The overall goal was to enhance PCRN ability to comprehensively care for seriously ill patients and their caregivers. Specific aims included: 1) foster community partnerships in building UMC’s capacity to deliver palliative care services; 2) enhance the ability of PCRNs to advocate for optimal and holistic symptom control of seriously ill patients, serve as mentors and disseminate knowledge to colleagues, and identify appropriate patients for referral to a palliative care service; and 3) provide a forum for professional collaboration among community stakeholders. The PCRN program was well-received and evaluated by nurse participants and provides a potential model for hospitals who wish to develop palliative care within their institution. Importantly, strategies to empower nurses to communicate regarding palliative care topics with patients and colleagues were identified as a major educational need by nurse participants. Central Findings: A key finding from this research was that nurses strongly linked the quality of inter-professional communication to palliative care outcomes, and felt current communication training did not adequately address the structural issues of power and hierarchy that greatly influence inter-professional interactions. Nurses reported a sense of ‘lack of permission’ to engage in palliative care related conversations with patients and family members and they reported that structured role plays, while helpful, often had limited applicability in the real-world clinical setting. Influence: Results from this research have contributed to the preparation of a grant proposal to investigate a Learning Health Systems technology-based intervention to improve inter-professional communication and patient symptom outcomes.
1. LeBaron, V., Beck, S., Black, F., & Palat, G. (2014). Nurse moral distress and cancer pain
management: An ethnography of oncology nurses in India. Cancer Nursing, 37(3), 331-344. PMID: 24918627
2. LeBaron, V., Bohnenkamp, S., & Reed, P. (2011). A community partnership approach to building and empowering a palliative care resource nurse team. Journal of Hospice and Palliative Nursing, 13(1),
1-40. doi: 10.1097/NJH.0b013e3181ff0bf8.
3. Helped improve cancer pain management. Historical background: Despite decades of research, cancer pain remains a pervasive problem. Patients with cancer are at high risk for inadequately managed cancer pain along the entire illness trajectory—from early stage disease to the end of life. In fact, it is estimated that between 60-80% of patients with metastatic cancer experience moderate to severe pain. Central Findings: I served as PI on a secondary analysis that explored congruence between patient self-report of pain using standard scales and subsequent discussions of pain during clinic visits. For all scales, patients discussed problematic pain in clinic more often than self-report scales indicated problematic pain. Influence: Clinical practice of relying on pain intensity scales to screen for problematic pain may be inadequate, and lower threshold values for identifying problematic pain and more emphasis on pain frequency may optimize pain management for cancer patients.
1. LeBaron, V., Blonquist, T., Hong, F., Halpenny, B., & Berry, D. (2015). Screening for pain in the ambulatory cancer setting: Is 0-10 enough? Journal of Oncology Practice, Early release article on-line.
http:// jop.ascopubs.org/content/early/recent. doi: 10.1200/JOP.2015.004077
2. LeBaron, V., Brody, J., Lee, E., Hardin, C. & Snyder, L. (2011). Pain and practicalities: The experience of transitioning a cancer patient from high-dose intravenous hydromorphone to intravenous methadone.
Journal of Pain and Palliative Care Pharmacotherapy, 25(4), 356-361. PMID: 22126165
Complete List of Published Work in MyBibliography:
5 D. Research Support
University of Virginia LeBaron (PI) 1/30/16 - present
Cancer Control & Population Health Research Program
Improving Cancer Control by Seeking a Balanced Approach to Pain Relief for Patients with Cancer in Rural Southwest Virginia
This secondary data analyses will longitudinally describe and map access to prescription opioid medications (POMs), practices of POM risk mitigation, and patterns of non-medical use and diversion of POMs in rural Southwest Virginia. The broad, long-term goals of this research are to: 1) leverage these data to inform culturally and contextually appropriate community-level, sustainable, measurable and scalable cancer control interventions to promote a balanced approach to pain relief – one that ensures access to needed pain relief while also mitigating POM risk; 2) reduce disparities for cancer patients who live in rural regions, such as Central Appalachia; and 3) inform POM policy and programmatic planning.
Role: Principal Investigator Completed
National Cancer Institute, Contract #14X064 Cleary (PI) 10/1/13 – 4/15/15 University of Wisconsin, Leidos Biomedical Research, Inc. and the National Cancer Institute
An African Pain Policy Fellowship: A Pilot Regional Collaboration to Improve Opioid Availability for the Treatment of Cancer Pain
This collaborative project between the Pain & Policy Studies Group (PPSG), a World Health Collaborating Center at the University of Wisconsin, Madison and the African Palliative Care Association aims to train clinicians and policy makers to effectively advocate to improve access to opioids in their home country. Selected government officials and healthcare providers from African countries are paired with mentors who have international palliative care and advocacy experience. Working together, mentors and fellows engage in intensive didactic lectures, Skype discussions, and hands-on workshops to create an implementation plan for their country. PPSG has led previous Pain and Policy Fellowship Programs, but this cohort is the first to be regionally focused and to have portions of Fellowship content delivered remotely.
Dana-Farber Cancer Institute LeBaron (PI) 9/15/13 – 5/15/14
Exploring Effectiveness of Screening for Pain in Cancer Patients Dana-Farber Cancer Institute, Phyllis F. Cantor Center, Boston, MA
This secondary analysis explored congruence between patient self-report of pain using standard scales and subsequent discussions of pain during clinic visits. For all scales, patients discussed problematic pain in clinic more often than self-report scales indicated problematic pain. Clinical practice of relying on pain intensity scales to screen for problematic pain may be inadequate, and lower threshold values for identifying
problematic pain and more emphasis on pain frequency may optimize pain management for cancer patients. Role: Principal Investigator
Fulbright Scholar Grant, University of Utah Graduate School LeBaron (PI) 8/1/09 – 5/15/13 American Cancer Society Grants #117214-DSCN-09-141-01-SCN; #121673-DSCNR-09-141-03-SCN Exploring the Relationship Between Moral Distress and Cancer Pain Management: An Ethnography of Oncology Nurses in India
University of Utah College of Nursing; MNJ Institute of Oncology & Regional Cancer Center, Hyderabad, India This research at a government cancer hospital in South India explored the experience of nurse moral distress and its potential relationship to opioid availability and pain management. This research offered insights into interventions to support nurses who practice in severely resource-limited settings and served as pilot data for an in-progress grant application related to improving cancer pain management in lower income countries. Role: Principal Investigator (PhD student)