• Department of Psychosocial Oncology and Palliative Care

    Alexi Wright, MD and Holly Prigerson, PhD  

    In 2008, Dana-Farber created the Department of Psychosocial Oncology and Palliative Care. This was done in recognition of the growth and evolution of these fields and their centrality to cancer care.

    Department goals

    The mission of the Department is to support patients of all ages who are living with a life-threatening illness, along with their families. The goals are to enhance quality of life and well-being, and to relieve suffering in all its dimensions throughout illness, survivorship, and bereavement. This is accomplished by providing expert, compassionate clinical care. The Department aims to contribute to the knowledge base guiding psychosocial and palliative interventions across the illness spectrum, train the next generation of leaders in psychosocial oncology and palliative care, and share expertise with students and colleagues in other disciplines.

    Research focus

    A unique feature of the Department is the focus on providing care across the life cycle. The expert interdisciplinary team of faculty and other clinicians within the department includes pediatricians, general internists, geriatricians, oncologists, psychiatrists, psychologists, social workers, nurses, chaplains, pharmacists, and physician assistants. The group shares a focus on prevention and relief of suffering, as well as promotion of quality of life for patients who are living with cancer.

    The Department is organized into four clinical divisions: Adult Psychosocial Oncology; Pediatric Psychosocial Oncology; Adult Palliative Care; and Pediatric Palliative Care. Because research cuts across all four programs, research efforts are organized and integrated through the Center for Psycho-Oncology and Palliative Care Research.

    Under the leadership of Holly Prigerson, PhD, the Center's research program focuses on understanding the factors affecting quality of life and quality of care of cancer patients and their family members. The general approach to research is the application of clinical epidemiology methods and perspectives of social psychology to advance understanding of the dynamics among patients, their family members, oncologists, and others involved in patient care. The Center also provides junior faculty, residents, and medical students with support in their research through mentorship, databases, measures, and analysis.

    Research achievements

    Recently published, high-impact research from the Center includes:

    • The associations of physician communication about end-of-life issues with improved quality of life, hospice utilization, reduced use of aggressive care, and improved caregiver bereavement outcomes
    • The relationship between end-of-life communication and costs of care at the end of life
    • Religious coping and its association with the receipt of intensive life-prolonging care
    • The impact of young children on parents' end-of-life treatment decisions and quality of life
    • The impact of terminal illness acknowledgement, religiousness, and treatment preferences on advance care planning among racial and ethnic minorities
    • An empirical examination of the stage theory of grief
    • Symptom assessment in pediatric palliative care
    • Outcomes of pediatric palliative care programs
    • Short- and long-term evaluations of palliative care educational interventions

    Ongoing research

    Prigerson has developed a research program that capitalizes on the Coping with Cancer (CwC) database, a multisite, NCI/NIMH-funded prospective, longitudinal cohort study of advanced cancer patients that is designed to investigate topics as varied as patient and family caregiver mental health, disparities in medical care, and the effects of spirituality on treatment preferences and intensity of medical care near death. The CwC has resulted in more than 50 publications in journals such as JAMA, Journal of Clinical Oncology,Cancer, and Critical Care Medicine. It has become a well-known research resource and template for advancing the evidence base in the fields of psycho-oncology and palliative care.

    Prigerson and Susan Block, MD, together with Brett Litz, PhD, are developing an online intervention for bereaved family survivors of Dana-Farber patients. They have conducted studies of the effects of coping styles, particularly religious coping, on care near death. The influence of pastoral care visits, dependent children at home, and acculturation have also been identified as clinically important determinants of the aggressiveness of end-of-life care received by cancer patients. A study is currently underway to examine gender differences in communication at the end of life, and in Asian-Americans coping with cancer. Several Dana-Farber junior faculty, including Tracy Balboni, MD, MPH, Alexi Wright, MD, and Elizabeth Trice, MD, PhD, lead studies on spiritual care, communication, and ethnic disparities, respectively.

    Using retrospective methods, Joanne Wolfe, MD, MPH, found that children with advanced cancer experience substantial suffering from both cancer-directed therapies and symptoms, resulting in poor quality of life. The NCI has now identified supportive care research aimed at easing suffering in cancer patients as a high priority. Wolfe and colleagues are currently conducting the Pediatric Quality of Life and Evaluation of Symptoms Technology (PediQUEST) Study at three large pediatric oncology centers: Dana-Farber/Children's Hospital Cancer Center, Children's Hospital of Philadelphia, and Seattle Children's Hospital. PediQUEST is a computerized data collection system on a tablet PC platform that tracks symptoms (using age adapted Memorial Symptom Assessment Scales) and Quality of Life (QoL) (using the PedsQLT) in children with advanced cancer, generating feedback reports and email alerts. Using this system, Wolfe is conducting a randomized supportive care feasibility trial aimed at preliminarily assessing the effect of routinely feeding back QoL and symptom data on the child's experience of suffering. The PediQUEST system will become a powerful resource to advance supportive care research in children with cancer.

    Training future researchers

    The Department offers varied educational programs for medical students, residents, fellows, and faculty. In addition to two ACGME-accredited fellowship programs in palliative medicine and psychosomatic medicine, the Department offers training for fellows in medical oncology, psychiatry, cardiology, anesthesia/pain management, and gynecologic oncology. The Department also offers extensive programs for internal medicine, pediatric, and psychiatry residents.

    In collaboration with the Harvard Medical School Center for Palliative Care, the Department offers the Program in Palliative Care Education and Practice, a two-week, intensive leadership and education program designed specifically for faculty, and a three-day continuing medical education course on practical aspects of palliative care, which provides clinicians with basic and advanced palliative care competencies. For the past several years, the Department has also trained German palliative care faculty through a faculty development program in collaboration with the Ludwig Maximilian University and the German Cancer Fund.

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