Carine Davila, MD, MPH


Assistant in Medicine, Massachusetts General Hospital; Instructor, Harvard Medical School, Boston, MA

Carine Davila, MD was most recently a Palliative Care Clinical Fellow through Harvard’s Interprofessional Palliative Care Fellowship at Massachusetts General Hospital, Brigham and Women’s Hospital, and Dana Farber Cancer Institute. In three separate years, Dr. Davila was recognized as a Young Scholar in SGIM (Society for General Internal Medicine), a national award presented to a group of 25 promising young scholars based on academic achievement and research interest, and she presented her work at the SGIM annual meetings. For the presidential election in 2016, Dr. Davila mobilized resources to bolster the voting rights of patients in a safety-net hospital; she expanded those efforts to reach an even greater number of patients for the election in 2018. Dr. Davila seeks to gain the skills and experience necessary to narrow disparities in serious illness and end-of-life care for Latinx patients and families. Dr. Davila received her medical degree in 2016 from Icahn School of Medicine at Mount Sinai, and completed her internal medicine residency at University of California, San Francisco in 2019, where she received the Keith Johnson Award, given to the second-year resident who best exemplifies the personal and professional qualities of a UCSF physician.

August 28, 2020 | Massachusetts General Hospital
August 28, 2020 | Massachusetts General Hospital

“Serious Illness Care in A Time of COVID-19: Understanding Experiences among At-risk Communities”


1.  To understand individual’s experiences with health care system, specifically around feeling heard & understood by clinicians, and trust and respect by health care system & clinicians.
2.  To understand the greatest perceived medical, social and financial needs when it comes to improving serious illness care in the US.
3.  To identify how individual engagement rates in advance care planning have changed ~1 year into the COVID-19 pandemic


High quality communication, shared decision-making, and advance care planning are crucial to the well-being and quality of life for individuals facing serious illness. Identifying whether an individual has a serious illness is a necessary first step, as there is not a single, consensus definition. We know that the COVID-19 pandemic has prompted more conversation and engagement around serious illness care and communication, particularly from consumer-facing advance care planning web applications. Similarly, many health care systems began to do proactive outreach calls to check-in on high-risk and complex patients, including elements of advance care planning and serious illness conversations. These observations suggest there is a potential increase in advance care planning engagement rates. However, it is not clear whether people consider COVID-19 to be a serious illness in the same way as other serious illnesses such as cancer, heart disease or stroke, and advanced lung disease. The Massachusetts Coalition for Serious Illness Care (MCSIC, host organization) agreed there is still much to learn about how people are engaging in advance care planning in the context of the pandemic.
Despite this uptick in advance care planning engagement, there is reason to believe that previously documented disparities in advance care planning may have increased during the COVID-19 pandemic. Prior research has shown that for at-risk communities who have not engaged in this activity, especially among low-income communities of color, the driving reasons were a lack of trust in the health care system, feelings of overwhelm and anxiety regarding other life priorities, and low confidence when it comes to navigating the health care system and clinical interactions. All these experiences and perceptions have been impacted since the pandemic.
MCSIC sought to understand patient experiences about engaging with the health care system and their clinicians, including: if they feel heard & understood by clinicians, if they have trust in their clinicians and the health care system, and what they feel are the greatest medical, social, and financial needs to improve serious illness care. We plan to engage in a quantitative survey to sample both a national population, as well as a Massachusetts-based sample, with intentional oversampling of specific population subgroups (low-income Blacks, low-income Latinx, people with disabilities, people who live in nursing homes or assisted living facilities, and caregivers of individuals with disabilities and/or who live in nursing homes or assisted living facilities) to better understand their experiences. The purpose of this research is to offer insight of individuals’ experiences, particularly those from specific at-risk communities, to help inform strategies for how clinicians can improve the serious illness care experience for these patients.  


1. Reviewed existing MCSIC surveys and performed a literature review to identify how “serious illness” is defined and how issues of trust and respect for and by providers has been queried in the past.
2. Engaged stakeholders to identify areas of focus for the quantitative survey and how we can explore issues of trust, feeling heard and understood, and the greatest perceived medical, social, and financial needs.