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Elston Lafata Lab

Welcome to our website! The Elston Lafata Team is a multidisciplinary group of health care researchers, quality improvement leaders and analysts, students, and postdoctoral trainees. As a team, we work together to understand how patient-provider communication and decision-making affect the quality of healthcare delivered to and received by diverse populations of patients. We often work in partnership with health care delivery organizations and engage patients to develop, implement, and evaluate practice-integrated decision support innovations focused on improving cancer screening and treatment.

Check out these new publications.

Alishahi Tabriz A, Turner K,  Hong YR, Gheytasvand S, Powers BD, Elston Lafata J. Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients with Cancer in the US. JAMA Network Open. 2023 Jan 19;6(2):e2250423.

Fridman I, Smalls A, Fleming P, Elston Lafata J. Preferences for Electronic Modes of Communication Among Older Primary Care Patients: Cross-sectional Survey. JMIR Form Res 2023;7:e40709 doi: 10.2196/40709 PMID: 37223979

Hwang S, Lazard AJ, Reffner Collins MK, Brenner AT, Heiling HM, Deal AM, Crockett SD, Reuland DS, Elston Lafata J. Exploring the Acceptability of Text Messages to Inform and Support Shared Decision-making for Colorectal Cancer Screening: Online Panel Survey. JMIR Cancer 2023;9:e40917. doi: 10.2196/40917 PMID: 37145859 PMCID: 10199389

Stein JN, Dunham L, Wood WA, Ray E, Sanoff H, Elston-Lafata J. Predicting Acute Care Events Among Patients Initiating Chemotherapy: A Practice-Based Validation and Adaptation of the PROACCT Model. JCO Oncol Pract. 2023 May 22:OP2200721. doi: 10.1200/OP.22.00721. Epub ahead of print. PMID: 37216627.

Open Positions:

We appreciate your interest in joining our team. At this time, we are not currently hiring. However, we encourage you to check back with us in the future for any updates on job opportunities.


We do cancer care delivery research, which is at the intersection of decision-making and cancer care quality. We work closely with interdisciplinary research teams and those working in health systems.

Identifying Opportunities to Pursue Equity When Implementing Virtual Visits in Oncology Care

With funding from the Genentech Innovation Fund, this project uses a research-community partnership and mixed methods design to study the implementation of virtual visits in oncology care. Within the study, we evaluate how oncology virtual visits are addressing and meeting the needs of Black adults being treated for cancer. This project seeks to find how oncology care organizations are considering equity as they design new virtual visit programs, and how virtual visits may hinder or enhance care access and affect outcomes among Black adults diagnosed with cancer. Importantly, to our knowledge, this is the first study to explore barriers to and outcomes of virtual care in the context on cancer, a care context that is complex, emotionally laden, and one that often requires establishing new patient-provider relationships that are inclusive of family members or other loved ones.

Shared Decision-Making and Improved Patient Outcomes

With funding from the Agency for Healthcare Research and Quality (AHRQ) and in conjunction with the University of Michigan, we are working to develop novel patient-reported shared decision-making (SDM) support measures. Most SDM measures have been developed for research use and generate a single score, largely ignoring that the decision-making process contains multiple, distinct phases. We will synthesize our analysis of existing measures in the field with cancer patient feedback to create a multiphase model of SDM focusing on not only patient-doctor communication but the relational climate that fosters true SDM. This model will inform the creation of our own measure of SDM support which will be evaluated with diverse patient populations.

Testing Ways to Implement Navigation Decision Support to Enhance Oncology Care Equity

With funding from the American Cancer Society (ACS), we are seeking to implement and improve comprehensive oncology navigation services. While patient navigation services are known to improve cancer care equity and outcomes, there are still challenges relating to its efficiency and equitability. We will address these challenges by testing ways to implement electronic health record (EHR)-embedded navigation decision support tools that target inequities in access and efficacy. Our aim is to improve oncology patient outcomes across all UNC Health and beyond.

Medication Counseling and Adherence to Oral Chemotherapy

The Elston Lafata Team is committed to improving oral medication adherence and management in cancer care. Oral antineoplastic therapy, also known as oral chemotherapy, is unique in its frequent use of repeated treatment-rest cycles, concerns regarding toxicity, evidence of overuse, and need for ongoing symptom monitoring at home. With the use of oral antineoplastic therapy expanding, it is important to understand how best to support patients’ adherence to these oral agents. To date, we have launched a total of 3 projects to explore this complex issue.

Patient-Oncologist Communication regarding Oral Chemotherapy during Routine Office Visits

We recently completed a qualitative study to understand how oncologists discuss oral capecitabine with their patients with colorectal cancer. We were particularly interested in the medication counseling patients received and how the patient’s adherence to the prescribed regimen was discussed. Using medical office visit audio recordings/transcripts collected for the Verilogue™ database, we coded and analyzed transcript data and classified the content of patient-provider conversations about oral anticancer medications. A manuscript presenting findings from this study was published in the Journal of Oncology Practice in early 2020.

Patient-provider Communication and Oral Chemotherapy Adherence

We conducted a systematic review to identify key patient-provider communication strategies that support patients’ adherence to oral chemotherapy. Results from this review, identified multiple communication gaps in current practice as well as intervention opportunities to improve cancer care quality.

Patient-Targeted Colorectal Cancer Screening Decision Support

Colorectal cancer is the second leading cause of cancer death in the United States. While several effective screening methods exist, screening remains underutilized. Prior research has shown that more than 90% of primary care patients receive a physician recommendation for screening when they are due, but just over half of those who receive such recommendations go on to be screened in the next year. Since 2015, our team has worked in partnership with health care delivery organizations to close the gap between physician recommendation for screening and screening uptake among primary care populations. Our overarching goal is to develop effective practice-integrated decision support programs that are accessible and acceptable to broad segments of the population.

Leveraging the EHR and Patient Portal Infrastructure

With funding from the National Cancer Institute (R01 CA197205 Elston Lafata), we worked in partnership with Henry Ford Health to develop and test a patient-targeted, colorectal cancer screening decision-support program. The program, called e-assist: Colon Health is designed to facilitate the uptake of physician-recommended colorectal cancer screening by educating patients about their screening options and addressing individual barriers to screening. Findings have been published in:

Text Messaging to Enhance Decision Support among Diverse Populations 2019-2021

With developmental funding from the UNC Lineberger Comprehensive Cancer Center, we are working to examine the feasibility of text messaging to reach socio-demographically diverse patients at the time of a colorectal cancer screening decision and support them in making a decision to screen. Our text-messaging project consists of three phases. In the first phase, we employed an online cohort to evaluate candidate text messages for their relevance, salience, usability, and impact on participant’s intentions to use text-based decision support; these results can be found in the Journal of Medicine and Internet Research. In Phase II, we will pilot the program in partnership with the UNC Health Care System.

Cancer Care Quality Improvement

The overarching goal of the UNC Cancer Care Quality Initiative (CCQI) is to support the North Carolina Cancer Hospital’s ability to deliver value-based oncology care. In partnership with UNC Health Care practitioners, we are developing an informatics infrastructure to support oncology population management. We use data analytics to monitor the care quality delivered to UNC Health Care patients and to identify opportunities for improvement. CCQI strives to ensure the development of reliable and valid clinical performance metrics and other analytical capabilities to support care standards and the informatics infrastructure needed by practitioner teams to take appropriate actions and achieve measurable, desired outcomes. We strive to allow real time identification of patients throughout the cancer care continuum enabling:

  • Identification of gaps in evidence-based care
  • Patient risk stratification for targeted service delivery
  • Decision support for patients and clinicians
  • Continual performance monitoring and tracking of outcomes

Our current activities include:

  • Developing a system-wide Cancer Care Quality Dashboard that will be used as platform for real time communication of quality data
  • Developing the infrastructure to identify and attribute patients receiving cancer treatment at one UNC Health Care’s six locations across the state
  • Collaborating with clinical and other cancer care leaders to ensure our reporting meets the needs of clinical teams and adequately supports care quality efforts
  • Collaborating with QI teams to address disparities in unplanned visits to the emergency department and hospital (called acute care events) among patients receiving treatment for cancer.

Other Current Research

Implicit bias, communication behaviors and care outcomes among black patients with type 2 diabetes

Although we know that medication non-adherence is prevalent among African Americans with diabetes, and that patient-clinician communication contributes to patients’ medication adherence, we know little about how physician implicit bias may present during office visits. In this grant, we are collaborating with researchers at Virginia Commonwealth University and the University of Michigan (R01 DK112009 Hagiwara) to identify clinician communication behaviors associated with implicit bias and, in turn, studying the association between these communication behaviors and the outcomes of black patients with Type 2 diabetes, including patients’ medication adherence and diabetes self-management behaviors.

Understanding the lung cancer screening process

Numerous organizations, including the United States Preventive Services Task Force, recommend annual lung cancer screening with low-dose computed tomography (LDCT) for high-risk adults who meet specific criteria. Despite these recommendations, lung cancer screening remains underused in the United States. We are currently participating in two NCI-funded studies pertaining to lung cancer screening. Both of these projects while relying heavily on data from the electronic health record to understand opportunities to improve the quality of lung cancer screening delivered to diverse patients, also have a focus on the decision making process currently being used by patients and clinicians.

In the first (UMI-CA221939 Pearson-Ritzwoller and Vachani), we are collaborating with researchers in NCI’s Population-based Research to Optimize the Screening Process (PROSPR) consortium. As a member of the Lung PROSPR Research Consortium, we are working with five diverse healthcare systems in Colorado, Hawaii, Michigan, Pennsylvania, and Wisconsin to examine lung cancer screening use and outcomes across diverse populations. As part of this effort, we are assessing how variations in the implementation of LCS programs, including how shared decision making has been implemented, effect outcomes across the screening process.

In the second (R01 CA2220990 Carter-Harris), we are using a mixed methods study to understand the “active ingredients” in lung cancer shared decision making and examine the predictors of positive decisional and behavioral outcomes to enable the development of lung cancer screening decision support interventions. This grant is in collaboration with researchers at Memorial Sloan Kettering and Kaiser Permanente Washington.

Recent Publications


Sud S, Tan X, Tatko SS, Gu D, Harris S, Shen C, Lafata JE, Elmore SNC, Royce TJ. Associations With Virtual Visit Use Among Patients Receiving Radiation Therapy. Adv Radiat Oncol. 2023 Mar 28;8(5):101231. doi: 10.1016/j.adro.2023.101231. PMID: 37207168; PMCID: PMC10189086.

Selby K, Sedki M, Levine E, Kamineni A, Green BB, Vachani A, Haas JS, Ritzwoller DP, Croswell JM, Ohikere K, Doria-Rose VP, Rendle KA, Chubak J, Lafata JE, Inadomi J, Corley DA. Test performance metrics for breast, cervical, colon, and lung cancer screening: a systematic review. J Natl Cancer Inst. 2023 Apr 11;115(4):375-384. doi: 10.1093/jnci/djad028. PMID: 36752508; PMCID: PMC10086636.

Elston Lafata J, Nguyen B, Staresinic C, Johnson M, Gratie D, Muluneh B. Interpersonal communication-, education- and counselling-based interventions to support adherence to oral anticancer therapy: a systematic review. J Oncol Pharm Pract. 2023 Mar;29(2):358-369. doi: 10.1177/10781552211073576. Epub 2022 Jan 20. PMID: 35048768.

Alishahi Tabriz A, Turner K,  Hong YR, Gheytasvand S, Powers BD, Elston Lafata J. Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients with Cancer in the US. JAMA Network Open. 2023 Jan 19;6(2):e2250423.

Hwang S, Lazard AJ, Reffner Collins MK, Brenner AT, Heiling HM, Deal AM, Crockett SD, Reuland DS, Elston Lafata J. Exploring the Acceptability of Text Messages to Inform and Support Shared Decision-making for Colorectal Cancer Screening: Online Panel Survey. JMIR Cancer. 2023 May 5;9:e40917. doi: 10.2196/40917. PMID: 37145859; PMCID: PMC10199389.

Stein JN, Dunham L, Wood WA, Ray E, Sanoff H, Elston-Lafata J. Predicting Acute Care Events Among Patients Initiating Chemotherapy: A Practice-Based Validation and Adaptation of the PROACCT Model.JCO Oncol Pract. 2023 May 22:OP2200721. doi: 10.1200/OP.22.00721. Epub ahead of print. PMID: 37216627.


Margolis, MA*, Brewer, NT, Boynton, MH, Lafata, JE, Southwell, B & Gilkey, MB Provider Response and Follow-up to Parental Declination of HPV Vaccination. Vaccine, 2022 Jan 21:40(2):344-350. PMID: 34887133

Osterman C*, Sanoff HK, Wood WA, Fasold M, Lafata JE. Predictive Modeling for Adverse Events and Risk Stratification Programs for Patients Receiving Cancer Treatment. JCO Oncology Practice, 2022 Feb;18(2):127-136. PMID 34469180.

Elston Lafata J, Nguyen B*, Staresinic C*, Johnson M, Gratie D*, Muluneh B. Interpersonal communication-, educational- and counseling-based interventions to support adherence to oral anticancer therapy: a systematic review. J Oncol Pharm Practi. 2022 Jan 20: Online ahead of print.

Hwang, S*, Birken, SA, Nielsen, ME, Elston-Lafata, J, Wheeler, SB, & Spees, L P. Understanding the multilevel determinants of clinicians’ imaging decision-making: setting the stage for de-implementation of low-value imaging. BMC Health Serv Res 22, 1232 (2022).

Elston Lafata J, Shires DA, Shin Y, Flocke S, Resnicow K, Johnson M, Nixon E, Sun X*, Hawley S. Opportunities and Challenges When Using the Electronic Health Record for Practice-Integrated Patient-Facing Interventions: The e-Assist Colon Health Randomized Trial, Medical Decision Making. 2022 Nov;42(8):985-998.

Kamineni A, Doria-Rose P, Chubak J, Inadomi JM, Corley DA, Haas JS, Kobrin SC, Winer RL, Elston Lafata J, Beaber EF, Yudkin JS, Zheng Y, Sugg Skinner C, Schottinger JE, Ritzwoller DP, Croswell JM, Burnett-Hartman ANEvaluation of Harms Reporting in United States Cancer Screening Guidelines. Ann Intern Med. 2022. Nov;175(11):1582-1590.

Turner K, Bobonis Babilonia M, Naso C, Nguyen O, Gonzalez BD, Oswald LB, Robinson E, Elston Lafata J, Ferguson RJ, Alishahi Tabriz A, Patel KB, Hallanger-Johnson J, Aldawoodi N, Hong YR, Jim HSL, Spiess PE.Health Care Providers’ and Professionals’ Experiences with Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study. J Med Internet Res. 2022 Jan 19;24(1):e29635.


Miller CG*, Lafata JE, Thomson M. The Effects of Personalizing Colorectal Cancer Risk Communication on Risk Perceptions and Behavior Intentions: A Randomized Trial of Average Risk Adults, Journal of Cancer Education, 2021 Aud;36(4):719-727. PMID: 31997146.

Tabriz AA*, Neslund-Dudash C, Turner K, Rivera MP, Reuland DS, Elston Lafata JE. How Health-Care Organizations Implement Shared Decision-making When It Is Required for Reimbursement: Lung Cancer Screening, Chest, 2021 Jan; 159(1): 413-425. PMID 32798520.

Alpert JM, Wang S, Bylund CL, Markham MJ, Bjarnadottir RI, Lee JH, Lafata JE, Salloum RG. Improving secure messaging: A framework for support, partnership and information giving communicating election (SPICE). Patient Education and Counseling. 2021 June;104(6):1380-1386. PMID: 33280967

Elston Lafata J, Smith AB, Wood WA, Fitzpatrick B, Royce T. Virtual Visits in Oncology: Enhancing Care Quality While Designing for Equity. JCO Oncology Practice. 2021 May;16(5):e443-3455. PMID 33539180.

Park, J*, Jindal A, Kuo P, Tanana M, Elston Lafata J, Tai-Seale M, Atkins DC, Imel ZE, Smyth P. Automated Rating of Patient and Physician Emotion in Primary Care Visits. Patient Education and Counseling. 2021 Aug;104(9):2098-2195 PMID 33468364.

Croswell JM, Corely DA, Lafata JE, Haas JS, Inadonmi JM, Kamineni A, Ritzwoller DP, Vachani A, Zheng Y; National Cancer Institute Population-based Research to Optimize the Screening Process (PROSPR) II Consortium. Cancer Screening in the US through the COVID-19 pandemic, recover, and beyond. Prev Med. 2021 Oct;151:106595. PMID: 34217414.

Salloum RG, LeLaurin JH, Lee JH, Lafata JE, Williams M, Wany Y, Smith JM, Staras SAS, Strayer SM, Trasher JF. Primary Care Physician Perspectives on Recommending E-cigarettes to Smokers: a Best-Worst Discrete Choice Experiment. J Gen Intern Med. 2021 Feb 1. PMID:33523343.

Elston Lafata J, Smith AB, Wood WA, Fitzpatrick B, Royce TJ. Virtual Visits in Oncology: Enhancing Care Quality While Designing for Equity. JCO Oncol Pract. 2021 May:17(5):220-223. PMID 33539180.


Jennifer Elston Lafata 

(919) 966-9480

Jennifer Elston Lafata, Ph.D. is Professor and Executive Vice Chair in the Division of Pharmaceutical Outcomes and Policy at the UNC Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill. She also serves as the co-lead for the UNC Cancer Care Quality Initiative and Associate Director in the UNC Institute for Healthcare Quality Improvement. She conducts practice-integrated research to understand and improve patient-clinician communication and decision making, particularly in the context of cancer prevention and control.

Research Associates

Caroline Deal

Caroline Deal, MSW is a Social/Clinical Research Specialist with the UNC Eschelman School of Pharmacy. Caroline provides study coordination and management for various grants, including research related to cancer care quality improvement and shared decision-making. She has been with the Elston Lafata team since June 2022.


Lauren Barrow

Lauren Barrow, MHA is a doctoral student at Johns Hopkins Bloomberg School of Public Health in the Health Policy and Management department with a concentration in Health Services Research and Policy and the UNC Project Manager for the Genetech VVe Care project. Her research interests include ensuring equity in healthcare quality and the examining the role of hospital social responsibility on community health impact. Lauren received her MHA from UNC Chapel Hill and her BS from the University of Michigan. She is a native of Detroit, MI.


Iona Fridman

Dr. Ilona Fridman is a passionate advocate for health communication that empowers informed decisions and enables high-quality equitable patient care. She finds solutions to public health problems by designing interventions that improve communication between the patient and provider. With an educational background in engineering and Ph.D. from Columbia University, Dr. Fridman possesses a unique blend of quantitative skills for data analysis and theoretical knowledge that allows her to build a strong research portfolio that includes: a) developing and testing a theoretical framework to understand and guide complex conversations between healthcare providers and patients during clinical encounters b) implementing an automated text analysis to identify systemic biases in decision-making during clinical consultations, and c) developing a digital decision- support tool for patients with early-stage breast cancer to reduce overtreatment. She has authored over 20 publications, of which two-thirds as the first author. Her work has been accepted into high-impact journals such as JAMA Oncology, Health Psychology, JMIR Public Health, and Surveillance.

Graduate Students

Amy Barrett MSPHA

Amy Barrett, MSPH, MA, is a doctoral student in the UNC Eshelman School of Pharmacy Division of Pharmaceutical Outcomes and Policy. Ms. Barrett earned an MSPH from the University of Alabama at Birmingham and an MA in English from UNC Chapel Hill. Before beginning the doctoral program in Pharmaceutical Sciences, she worked for 17 years at RTI Health Solutions as a health outcomes researcher specializing in qualitative research, patient-centered outcomes assessment, and questionnaire development. Her work experience includes designing and conducting qualitative research studies, including conducting focus groups and in-depth interviews of patients, caregivers, and clinicians across multiple therapeutic areas, including cancer. This research has provided insight into the patient experience of disease and informed the selection and development of important and relevant patient-reported outcome (PRO) measures of symptoms and impacts of disease. She has also worked extensively in PRO measure selection and clinical trial measurement strategy related to a wide array of cancer therapies for pharmaceutical company clients of RTI Health Solutions.

Matthew Dunn

Matt Dunn is a PhD student in Epidemiology and pre-doctoral fellow in the Cancer Care Quality Training Program at the Lineberger Cancer Center at UNC Chapel Hill. Before attending UNC, he completed his MPH in Health Management and Policy and Bachelor’s in Cell and Molecular Biology, both at the University of Michigan, Ann Arbor. Matt’s research interests bridge cancer epidemiology and health services, aiming to leverage interdisciplinary methods to help improve quality and equity of cancer care. For his dissertation, Matt will assess how individual- and community-level healthcare access impacts frequency of delayed treatment in the Carolina Breast Cancer Study.

Soroush Ahmadi Fariman

Soroush Ahmadi Fariman graduated from Tehran University of Medical Sciences in 2022 with a PharmD/MSc in Medical Education. His passion about improving patient experience and outcomes inspired him to purse his PhD in the Division of Pharmaceutical Outcomes and Policy at the UNC Eshelman School of Pharmacy, particularly studying shared decision-making approaches in the context of cancer prevention and treatment at the Lafata lab.

Research Assistants

Tumi Akeke

Tumi Akeke graduated from The University of Edinburgh in 2022 with a BSc (Hons.) in Biochemistry. As a cancer control, health policy, and health equity advocate, Tumi is interested in ways we can use policy creation and reform to improve access to, and outcomes from, cancer care for low-income black women. This drove her to pursue her MPH in Health Policy with a graduate certificate in Women’s and Gender Studies. With many years of experience in the cancer research space, Tumi is excited to continue with her passions at the Lafata lab.

Becca Bosch

Becca Bosch graduated from Furman University in 2019 with a B.S. in Public Health and Spanish. She is in her second year at the Gillings School of Global Public Health pursuing an MPH with a concentration in Health Equity, Social Justice, and Human Rights. Becca is passionate about cancer prevention and control, particularly in communities facing significant barriers to care. She joined the Elston Lafata Team in August 2023. Her role involves evaluating predictive model development to aid providers in reducing acute care events among cancer patients.

Yomna Anan

Yomna Anan’s journey in the field of public health began at the University of Washington where she graduated in 2020 with a double major in Public Health-Global Health and Communications. After graduating with a concentration in health education and promotion, Yomna earned her Certified Health Education Specialist (CHES) certification and worked as a clinical research coordinator prior to pursuing her graduate studies at UNC. It was during this time that she discovered her true passion for research and prevention, with a particular interest in bridging the gap between healthcare providers/clinical practices and patient needs. These experiences provided her with a solid foundation in theoretical and practical aspects of public health, and deepened her understanding of research methods, data collection, and the critical importance of early intervention in improving health outcomes among populations. Yomna is thrilled to embark on the next phase of her research journey by joining the Elston Lafata lab!

Yishu Zhang

Yishu Zhang received her MS in Biostatistics from the Gillings School of Global Public Health at UNC and is currently pursuing her PhD in the same field. Yishu joined the Elston Lafata Team in August 2023. Her role involves developing predictive models to assist care providers in making informed decisions for cancer patients.