Interview Chapters

Chapter 09: Shifting the Perception of Palliative Care and Related Services

Eduardo Bruera MD, FAAHPM, The University of Texas MD Anderson Cancer Center
Tacey A. Rosolowski PhD, The University of Texas MD Anderson Cancer Center

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Description

Dr. Bruera note that by 2008 and 2009, after a decade, the institution was more comfortable with palliative care. However, because the department had a perception problem, being known as a kind of "pre-hospice" with the result that clinicians were sending them patients too late in treatment. Dr. Bruera explains a survey the department conducted to assess the impact of the names "palliative care" versus "supportive care." Fewer than 30% said they would feel comfortable sending patients who were early in their treatment process to palliative care. He explains that that he was able to obtain official approval to change the name of the patient center and the mobile teams, and within six months the services had grown by 41%.

Next, Dr. Bruera talks about the wide range of patient issues that supportive care addresses. Dr. Bruera also explains that the Department's growth in business came exclusively from word of mouth referrals of patients and their success was totally unplanned by the institution. He notes that over the past eight years, the supportive care program has been the fastest growing program at MD Anderson, despite the resources that the institution has devoted to growing other areas.

Identifier

BrueraE_02_20180813_C09

Publication Date

8-13-2018

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Interview Session

Eduardo Bruera, MD, FAAHPM, Oral History Interview, August 13, 2018

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Overview; Leadership; On Leadership; MD Anderson Culture; The Researcher; Professional Practice; The Professional at Work; Working Environment; Collaborations; Multi-disciplinary Approaches; Survivors, Survivorship; Patients, Treatment, Survivors; Institutional Mission and Values

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Eduardo Bruera, MD:

By this time, the institution had gotten much more comfortable with us being around. What we noticed by the year 2008, 2009, was that still, we had a problem with getting the patients to us too late. We were perceived as a service that was a pre-hospice, pre-end of life. So what we did with a young faculty member we had --who then went out to become an endocrinologist somewhere else-- we did a survey of oncologists and nurses, an anonymous survey, at MD Anderson, of two hundred oncologists and advanced practice providers. We asked them how would you feel about a service named palliative care and a service named supportive care, to refer your patients? Close to the end of life, 92 percent of them said they would send us those patients. That to us was very reassuring because if we had done that survey ten years before, we would have found that 10 percent would have said they would send us a patient, because they were not entrusting us their patients. But by 2008, 2009, about nine years or ten years of me being here, that battle had been completely won. For people who had advanced cancer, who were not candidates for treatment, the vast majority of the doctors and nurses at Anderson would send us a patient. However, as the disease became earlier and earlier, fewer and fewer doctors and nurses were willing to refer to us a patient to a service named palliative care. For those with an early diagnosis, less than 30 percent were willing to send us a patient. On the other hand, when the name of that service—and that’s the only thing we asked them, the name. When the name was supportive care, the numbers increased dramatically for early patients, they were way more likely to send us earlier patients. So, we had to go to our Chief Medical Officer, who at that point was Dr. [Thomas A.] Burke [oral history interview] already, and tell him we’ve got a problem here, of perception. We are perceived as—we asked them, why is it, because 44 percent of them felt that the name palliative decreased hope for the patient and family. We’re not asking the patient, we were asking the referring doctors, but those were our real customers. So we went to him and said, listen, we need to change the name of the Outpatient Center, we need to call it the Supportive Care Center. We also need to change the name of our mobile teams, the consult teams. We need to call them supportive care teams. And then he said, “Well, who else is doing this,” and we said well, nobody yet but we are MD Anderson, we’re supposed to be leading things and we’re not supposed to do things only because other people are doing them.” He had a bit of a chuckle and then he said, “Well that’s okay, we’ll do that, okay.” So they sent us the authorization to change the name of our center and to change the name of our mobile teams. Our Palliative Care Unit remained Palliative Care Unit, because there was zero problem with people who were facing end of life care. Our survey clearly said that. The problem was with earlier patients.