I am a medical oncologist specializing in gynecologic oncology and a health outcomes researcher who studies the “overuse” of medical care in patients with advanced, incurable cancers. The goal of my research is to improve advanced cancer patients’ quality of life and medical outcomes by 1) creating an evidence base to guide chemotherapy decision-making at the end-of-life (EOL) and 2) developing interventions to ensure that advanced cancer patients’ EOL care is effective, patient-centered, and congruent with patients’ informed treatment preferences.
My early training in journalism gave me an appreciation for the power of effective communication, and its potential for improving patient outcomes. In medical school, I was awarded a Howard Hughes fellowship to examine the genotype of human placental cells that invade the uterus like tumors. This early research experience resulted in two empiric publications and cemented my decision to become an academic oncologist. During fellowship, I examined how EOL discussions shape advanced cancer patients’ mental health, medical outcomes, treatment goal attainment, and health care expenditures. We found that EOL discussions were associated with greater patient acceptance of terminal illness, better patient quality of life near death, and fewer intensive interventions at the EOL.
As a junior faculty member, I examined how patients’ place of death influences their quality of life at the EOL and their caregivers’ bereavement adjustment. We found that patients who die in intensive care units have significantly worse quality of life, compared to those who died at home with hospice, and their caregivers have 15-fold higher odds of developing post-traumatic stress disorder six months later. More recently, I have found that palliative chemotherapy is one of the most powerful predictors of the intensity of patients’ EOL care, and I am now focusing on understanding the structural, medical, social, and psychological determinants and outcomes of EOL chemotherapy with support from the American Cancer Society and the National Cancer Institute.
Communication is also a central focus of my work as an educator. As a junior faculty member, I have organized the Dana-Farber/Harvard Cancer Center’s Outcomes Research Seminar, and participated in OncoTalk Teach, an intensive communication course designed to teach oncologists how to 1) communicate more effectively with patients and 2) teach these skills to other physicians. This training has shaped my clinical work and educational work with medical residents and oncology fellows, improving my ability to offer “goal-directed” teaching and feedback. In the future, I plan to develop patient- and provider-based communication interventions to ensure that advanced cancer patients’ treatment decision-making and medical care reflect their informed preferences.