Meet our doctors: Dawn Gross on supportive care and palliative care
A cancer diagnosis and its treatment can be overwhelming. It's normal for patients to experience burdensome physical symptoms and psychological distress, both from their disease and from the cancer treatment. Sometimes these symptoms require specialized care in addition to primary cancer treatment.
Dawn Gross, M.D., Ph.D., the Arthur M. Coppola Family Chair in Supportive Care Medicine and chair of City’s of Hope’s Department of Supportive Care Medicine, explains that medical treatment isn’t just about a cancer directed therapy. It's also about the total care of body, mind and spirit. The inclusion of supportive and palliative care in cancer treatment can provide patients not only with a better quality of life, but also a happier one, she says.
What is supportive and palliative care medicine?
Supportive medicine is another name often used to encompass palliative care medicine. Supportive medicine is aggressive care focused on comfort, and is designed to support patients and their families experiencing a life-altering illness. It is intended to be delivered simultaneously with all other forms of medical care. By discovering what people wish, we can deliver the care they want. In order to achieve this, we must first focus on alleviating all forms of suffering, including physical, mental and spiritual distress. This then allows for patient and family goals of care to be explored and supported.
Supportive medicine is delivered by a diverse, interdisciplinary team of health care professionals that typically includes a physician or advanced practice nurse who specialize in palliative medicine, social workers and chaplains. Additional multidisciplinary specialists available in the Department of Supportive Care Medicine include child life specialists, health educators, psychologists, psychiatrists, patient navigators, volunteers and more.
How has the clinical practice of supportive/palliative care changed over the last decade? And which of those developments would you say is most important?
Hospice and palliative medicine is the newest board-certified specialty in medicine. Dramatic advances have already been achieved in demonstrating quality-of-life benefits, as well as extension of life, since its formal inception in 2008.
Furthermore, with these achievements, palliative medicine has also demonstrated substantial cost savings to our health care system without compromising care. As much as targeted therapies, such as Gleevec, created the first example of a silver bullet for cancer therapy that is easy to swallow, palliative medicine has a similar potential for being at the very heart of positively impacting health care reform, while improving patient quality of life.
What are your goals and priorities for the Department of Supportive Care Medicine at City of Hope?
The Department of Supportive Care Medicine is uniquely poised to be a world leader in delivery of supportive medicine. Celebrating its fifth anniversary, the Sheri & Les Biller Patient and Family Resource Center offers patients an enhanced range of multidisciplinary providers, empowering us to provide comprehensive support to patients and families experiencing life-altering illness.
Our goal is to dynamically support patients and families in discovering what they wish and fostering the delivery of the care they want. As our health care system continues to become increasingly complex, and advances in medicine foster the clinical enterprise, one professional cannot possibly discern all the complex needs of an individual or family. It truly takes a village of experts to listen and communicate from different training and skill-sets to be able to comprehensively care for people directly or indirectly experiencing life-altering illness.
This team approach allows for the development of creative programs and tools, including innovative technology and research to demonstrate the difference we are making in quality of life for the patients and families we serve, as well as for our colleagues.
What do you think are the most exciting developments underway?
We are in the process of piloting an interdisciplinary consult team to foster a 360-degree model of support for hospitalized patients and their families. A team-based approach will enhance our ability to support increased patient and family needs with greater continuity of care and seamless communication. This team is also intended to support our colleagues at the bedside.
We are fortunate to have collaborators throughout the institution generously offering their expertise and mentorship to support our own developing research and educational platforms. Bonnie Freeman, D.N.P., N.P., in collaboration with Betty Ferrell, Ph.D., R.N., director of nursing research and education, is in the process of launching a new teaching paradigm called CARES, for nurses at the bedside who find themselves faced with caring for patients at the end of life.
A core skill and service supportive medicine provides is in the arena of advanced care planning and facilitation of goals of care conversations. On April 16, the Sheri & Les Biller Patient and Family Resource Center will be honoring National Healthcare Decisions Day by providing a series of events including fun (yes, I said fun) and inspiring hands-on experiences to engage everyone and anyone in conversations about what matters most to us in life and facilitate completion of advance care documents. Volunteers and staff within the Department of Supportive Care Medicine have been busy planning what promises to be only the beginning of a joyful campaign to engage all of us in sharing what we wish for with the people who matter most in our lives.
What’s on your wish list for palliative care as a specialty in the next five to 10 years?
To quote a radiant woman living with advanced cancer who was one of the recipients of this year’s American Academy of Hospice and Palliative Medicine President’s Award, “Palliative care: It’s a no-brainer!”
In some respects, I would love to be put out of a job with knowing that palliative care principles and skills are taught in all stages of medical training such that all health care providers are comfortable and well-versed in the delivery of and referral for palliative care and hospice services.
Why did you choose this field? What inspires you to do the work you do?
“If I had a magic wand and could do anything for you today, what would it be?”
It was an unlikely question for me to ask patients during my hematology fellowship. But even more surprising is that to this day, no one has ever answered what I would have expected. No one has ever asked to be cured! Not once. And everyone has an answer right on the tip of their tongue. It is a privilege to get to do this work.
I became a hospice physician after my father passed away in 2006. My vision is to change the landscape of end-of-life care conversations, such that they are the portals to living inspiring lives now and having wishes come true. One of my most favorite tools for facilitating this conversation is called GoWish, an easy, even entertaining game that uses cards to talk about what is most important to you. The cards help to find words to talk about what is important if you were to be living a life that may be shortened by serious illness. To not assume but rather discover what our loved one wants or values is the key to this tool. It inspires storytelling and deep relatedness. For me, it is the most amazing conversation I will ever get to have. And to keep having for the rest of my life, well, that is pure joy.
To learn more about the supportive care and palliative medicine services offered at City of Hope, visit cityofhope.org/biller-resource-center.