Personal Statement

My research is informed by my personal experiences of caring for my parents at the end of their lives. The experience of my mother’s death led me to leave an established career in high-tech to pursue a vocation in nursing. With my parents, I saw first-hand how different approaches to making decisions led to very different outcomes and experiences. As death moves from an abstract concept to a reality, older adults frequently find it difficult to make these very onerous decisions that come with such significant consequences. In turn, they often prefer to delegate end-of-life decisions to others, and use indirect means to communicate their goals and preferences. This is an intense challenge to our current view of personal autonomy and can lead to “de facto” decisions that do not achieve patients’ desires. I believe that in order to change outcomes, we must first understand older adults' perceptions, using them as the starting point for communication and decision making.


Originally from the San Francisco Bay area, Dr. Romo is a former high-tech professional and a second-career nurse who completed his nursing training and master's at the University of San Francisco, earned his PhD at the University of California, San Francisco, and completed a post-doc at the San Francisco Veterans Affairs Medical Center.

His research interest focuses on the decision-making processes used by culturally diverse older adults with limited life expectancy, and how these processes impact the care received prior to death. By working specifically among older adults who are near the end of life, Romo explores the in-the-moment decisions about their end-of-life care, work that contrasts with most research focused on healthier older adults for whom end-of-life decisions are abstract ideas.

Romo's aim is to help clinicians and other providers to better support older adults as they make decisions and to ensure these patients receive quality care at the end of their lives, no matter what clinical setting they find themselves in.

Honors and Awards

  • 2015 Distinguished Dissertation Award, UCSF School of Nursing
    Awarded to one nursing graduate in recognition of scholarliness, innovation, and contribution to nursing
  • Building Academic Geriatric Nursing Capacity Scholar, John A. Hartford Foundation
    One of thirteen pre-doctoral fellowship awarded nationally, 2011-2013
  • Graduate Dean’s Health Science Fellowship
    A merit-based award given each academic year at UCSF, 2009, 2010, 2013
  • Program for the Aging Century
    A merit-based funding grant, Division of Geriatrics, UCSF, 2012
  • Hartford Center for Nursing Excellence Scholarship
    A merit-based scholarship, UCSF/Hartford Center, UCSF, 2009

Research Focus

Decision-making processes used by culturally diverse old adults with limited life expectancy; gerontological nursing; palliative care; end-of-life decision-making; end-of-life care.

Clinical Focus

Gerontology, end-of-life care.


Journal Articles

Romo, R. D., Cenzer, I. S, Williams, B. A., & Smith, A. K. (2018). Relationship between expectation of death and location of death varies by race/ethnicity. American Journal of Hospice &Palliative Medicine, 35(10), 1323-1329. doi:10.1177/1049909118773989

Wong, T. W., Lang-Brown, S., Romo, R. D., Au-Yeung, A., Lee, S. J., Moran, P. J., Karlawish, J., Sudore, R., Clayton, J., & Smith, A. K. (2017). Prognosis communication in late-life disability: A mixed methods study. Journal of the American Geriatrics Society, 65(11), 2496-2501. doi:10.1111/jgs.15025

Romo, R. D., & Lynn, J. (2017). The utility and value of the “surprise” question for patients with serious illness. CMAJ: Canadian Medical Association Journal, 189(33), E1072-1073. doi:10.1503/cmaj.733231

Romo, R. D., Allison, T. A., Smith, A. K., & Wallhagen, M. I. (2017). Sense of control in end-of-life decision making. Journal of the Geriatric Society of America, 65(3), e70-75. doi:10.1111/jgs.14711

Romo, R. D., Dawson-Rose, C. S., Mayo, A. M., & Wallhagen, M. I. (2016). Decision making among older adults at the end of life: A theoretical perspective. ANS Advances in Nursing Science, 39(4), 308-319. doi:10.1097/ANS.0000000000000139

Romo, R.D. & Lee, S.J. (2016). Changes in social function as a trigger to screen for cognitive impairment. Journal of General Internal Medicine, 31(8), 826-827. doi:10.1007/s11606-016-3755-6

Romo, R. D., Wallhagen, M. I., & Smith, A. K. (2016). Viewing hospice decision making as a process. American Journal of Hospice & Palliative Medicine, 33(5), 503-510. doi:10.1177/1049909115569592

Romo, R. D., Lee, S. J., Miao, Y., Boscardin, W. J., & Smith, A. K. (2015). Subjective, objective, and observed long-term survival: A longitudinal cohort study. JAMA Internal Medicine, 175(12), 1986-1988. doi:10.1001/jamainternmed.2015.5542

Romo, R. D., Wallhagen, M. I., Yourman, Y., Yueng, C., Eng, C., Micco, G., Pérez-Stable, E. J., & Smith, A. K. (2013). Perceptions of successful aging among diverse elders with late-life disability. The Gerontologist, 53(6), 939-949. doi:10.1093/geront/gns160

Romo, R., & Gifford, L. (2007). A cost-benefit analysis of music therapy in a home hospice. Nursing Economics, 25(6), 353-358.