Dr Elizabeth Dzeng
Dr Dzeng is a Senior Research Fellow at the Cicely Saunders® Institute at King’s College London, an Associate Professor of Medicine and Sociology at the University of California, San Francisco (UCSF), and a Senior Atlantic Fellow for Equity in Brain Health.
Dr Dzeng’s research focuses on understanding the systems-level factors that contribute to potentially non-beneficial, high-intensity end-of-life care in older adults with and without dementia in the US and UK. Additionally, she employs human-centred design to develop interventions that mitigate the culture of high-intensity care.
One focus of this research is on the effects of neoliberalism and financialization on the culture and ethics of healthcare institutions and how such social-level influences contribute to patterns of potentially non-beneficial high-intensity end-of-life care.
Her research also focuses on using community-based participatory methods to understand how structural racism influences goal concordance near the end of life in older Black adults.
Dr. Dzeng completed her MPhil and PhD as a Gates Cambridge Scholar at the University of Cambridge and her MD, MPH, and General Internal Medicine Fellowship at Johns Hopkins.
Her design experience stems from her work as an undergraduate and graduate student at Stanford, where she invented a medical device to non-invasively cool the heart through the oesophagus to prevent myocardial damage during a myocardial infarction (US Patent 7,758,623; 2010). In August 2019, this patent was licensed to Attune Medical. She holds multiple leadership roles nationally in the US, including sitting on the Governing Council of the Society of General Internal Medicine (SGIM), the Executive Committee of the Research Centers Cooperative Network (RCCN), and as a co-investigator of the Research Education Core of the ASCENT palliative care research consortium.
Selected publications
Dzeng E, Batten JN, Dohan D, Blythe J, Ritchie C, Curtis JR. Hospital Culture and Intensity of End-of-Life Care at Three Academic Medical Centers. JAMA Intern Med. 2023, 183(8): 839-848. DOI:10.1001/jamainternmed.2023.2450.
Weiss Goitiandia S*, Sun A*, Rosenwohl-Mack A, Ly C, Sleeman K, Dohan D, Dzeng, E. Systemic Strategies to Prevent Non-beneficial Treatments Near the End of Life: A Qualitative Study. JAMA Network Open, 2025; 8(7):e2519771. doi:10.1001/jamanetworkopen.2025.19771.
Brender TD, Axelrod JK, Weiss Goitiandia S, Batten JN, Dzeng EW. Clinicians’ Perceptions About Institutional Factors in Moral Distress Related to Potentially Nonbeneficial Treatments. JAMA Network Open. 2025;8(6):e2516089. doi:10.1001/jamanetworkopen.2025.16089
Dzeng E, Lopez L, John M. “Novel Strategies to Promote Alignment Between Healthcare and Social Care Systems by Addressing the Social Drivers of Health”. Journal of General Internal Medicine. 2024, DOI: 10.1007/s11606-024-09055-4
Chehab L, Weiss Goitiandia S, Pereira L, Jung K, Chen A, Patel D, Axelrod J, Li L, Williams I, Dohan D, Sammann A, Dzeng E. “Using Human-Centered Design to Improve Serious Illness Care for Older Adults with Advanced Dementia.” Journal of Pain and Symptom Management. 2024, 69(3):e228-e239. 10.1016/j.jpainsymman.2024.11.015
Current research
Financialization at the Bedside: A Qualitative Study of Clinician Perspectives on Serious Illness Care at Private Equity-Owned Hospitals in the United States
This is a qualitative research project examining the impact of private equity (PE) ownership on the delivery of care for patients with serious illnesses in US hospitals. Serious illness care is resource- and personnel-intensive, often involves prolonged hospital stays and care across multiple specialties, and is associated with high costs. These features may make it especially sensitive to organizational and operational changes that can accompany PE ownership, such as efforts to improve efficiency. Despite PE’s rapid expansion in the hospital sector, there remains limited empirical evidence about how this ownership model affects hospital-based care for seriously ill patients.
Using rigorous qualitative methods, the project seeks to understand how hospital-based clinicians experience and interpret the impact of PE ownership on their ability to provide high-quality, patient-centered serious illness care in line with their professional and ethical codes of conduct. The study combines in-depth ethnographic interviews with clinicians working in PE-owned hospitals across the US with the Delphi panel method to enable clinicians to identify and prioritize key challenges, opportunities, and areas for policy, regulatory, and clinical attention associated with PE involvement in hospital-based serious illness care. Findings will be disseminated to policymakers, hospital leaders and administrators, professional societies, and the public to advance knowledge about healthcare financialization and to inform evidence-based discussions about hospital ownership, governance, and high-quality care delivery.
Racism, Illness, and Standing for Equity: Studying Serious Illness Care in Partnership with Older Black Adults
This project addresses enduring racial inequities in serious illness care experienced by Black Americans. While these inequities, including worse communication, pain management, and access to care, have been thoroughly documented, far less progress has been made in developing approaches to address their underlying causes. This project starts from the premise that such inequities cannot be fully understood or remedied without attending to how structural racism affects Black Americans’ experiences of health and healthcare across the life course.
Using community-based participatory research (CBPR) methods, the project prioritizes close collaboration with Black communities in the San Francisco Bay Area. Community members are engaged as partners throughout the research process, contributing to the design, application, and interpretation of the study. Through in-depth qualitative research with older Black adults, hospital clinicians, health system leaders, and Black community leaders, the project seeks to develop a richer understanding of how structural racism influences experiences of serious illness care in older Black adults. The ultimate goal is to create institutional interventions to address structural racism and racial inequities at their roots, facilitating more equitable serious illness care for Black Americans.
Health Advocate Program: Mitigating Anti-Black Racism at the University of California, San Francisco (UCSF) Hospitals
Within the US healthcare system, including at UCSF, patients who identify as Black experience stark and enduring inequities. Many of these inequities can be traced to the existence and interactions of interpersonal, institutional, and structural anti-Black racism, which can be both implicit and explicit.
As a result of these inequities, many Black patients experience undue challenges in navigating hospitalization and, ultimately, receive lower quality healthcare, which risks worse health outcomes.
To address a root cause of inequities in health and healthcare, namely, racism, our team at UCSF created a ‘Health Advocate’ program, which ran from November 2022 to October 2023. The program introduced a Health Advocate from the local community to work in UCSF hospitals and support Black patients throughout their hospitalization journey, from admission to the wards to discharge.
The Health Advocate worked to improve patient experience, communication, and quality of care for Black patients, including by helping patients with self-advocacy. The program was developed with a Community Advisory Board of Black community members based in the Bay Area.
The Health Advocate program successfully improved several outcomes for patients, such as experiences of care and communication between patients and clinical teams. We believe that the program is an innovative and important model for taking action toward mitigating the effects of racism in the hospital for Black patients. We further consider that the program would be scalable to address the structural root causes of inequities faced by patients with other historically marginalised identities. We are currently advocating for this model to ensure future funding streams and expand.
Targeting System-Level Factors to Mitigate Potentially Nonbeneficial High-Intensity Life-Sustaining Treatments near the End-of-Life for Older Adults with Advanced Dementia
For older adults with advanced dementia, serious illness and end-of-life care increasingly entails high-intensity treatments that offer limited benefits, may cause harm, and are often not aligned with patient wishes. Efforts to curb this trend in the United States (US) by targeting individual patient and clinician behaviors have yielded only marginal improvements. In contrast to traditional approaches, our research charts a fresh course by investigating the influence of structural (e.g., policies, protocols, practices, and resource allocation) and cultural factors as driving forces behind high-intensity, potentially nonbeneficial life-sustaining treatments near the end of life for patients with advanced dementia.
We implement an innovative combination of methods to explore this premise. Through comparative ethnographic research conducted in the US and the United Kingdom (UK) and human-centered design, we investigate how different clinical cultures across hospitals and healthcare systems shape the intensity of serious illness and end-of-life care. Building upon the insights gained, we use human-centered design to develop system-level interventions to effectively reduce the administration of potentially nonbeneficial life-sustaining treatments. At present, we are particularly interested in how structural and cultural factors that may lower default treatment intensities in the UK can be adapted to the US context to reduce treatment intensity there.
Through this research, we hope to pave the way for meaningful change in serious illness and end-of-life care for older adults with advanced dementia, enhancing patients’ and caregivers’ experiences and ensuring that cares align with patients’ goals, values, and best interests.