Exploring the frontiers of our field.

Palliative Care to the People: Partnering with a Patient Experience Department to Raise Awareness of Palliative Care in the Community

Project Lead: Grant Smith, MD

Co-authors: Stephanie Harman, MD, Ashley Bragg, Claire Bleymaier, MPH, RN & Rachelle Mirkin, MPH

Oral presentation at 2021 AAHPM Annual Assembly

Over 70% of U.S. adults have never heard of palliative care (PC). Of those who have heard of PC, less than 40% know what it is and can explain it to someone else. Lack of awareness and inadequate knowledge of PC is a barrier to accessing PC services. As part of a collaboration between our clinical department of palliative care and department of patient experience, we developed, implemented, and evaluated a multifaceted intervention aimed at increasing awareness about PC in the community surrounding our suburban academic medical center.

 Our intervention included 1) improving web-based and social media presence, 2) hosting public-facing lectures and webinars, and 3) developing partnerships with community organizations. To measure our impact, we monitored exposure (number of individuals who viewed our content), engagement (number of individuals who participated in an event), number of community partnerships, and likelihood to recommend scores measured by a 5-point Likert scale.

Over the course of 8 months, we launched a website, started a Twitter account, and posted 5 recorded lectures on YouTube. We facilitated 23 in-person and virtual lectures, webinars, or small group discussions. We developed partnerships with 2 community agencies. To date, 5,544 individuals have been exposed to our content and 26% (N=1469) of those individuals engaged further by participating in an event. Of those who participated, 1258 (86%) participated in one of several virtual events during the coronavirus pandemic. Our average likelihood to recommend score is 4.3, correlating to “likely” to recommend.

Partnering with a patient experience department provided our clinical PC team with the technical expertise needed to rapidly expand our reach in raising awareness of PC in the community. Further investigation of these efforts will include evaluating changes in participants’ knowledge and attitudes about PC.

Responding to Community Needs During COVID-19: A Virtual Interdisciplinary Palliative Care Education Series for the Public

Project Lead: Claire Bleymaier, MPH, BSN, RN

Co-authors: Ashley Bragg, Keri Brenner, MD, MPA, Amy Yotopoulos, MHA, MS, Charisse Lee, JD & Grant Smith, MD

Poster presentation at 2021 AAHPM Annual Assembly

COVID-19 raised public concerns about planning for and coping with serious illness and death. Social distancing and shelter-in-place orders made leveraging virtual platforms essential in providing the public with access to palliative care experts who could help address these concerns. The patient experience and palliative care departments partnered to develop, implement, and evaluate a virtual education series for the public on advance care planning (ACP), psychological distress, and caregiving.

Topics were chosen based on the perceived needs of the public and presenter expertise. Palliative care physicians, psychiatrists, caregiving professionals, and program staff presented. Offerings were an hour, delivered in English, and styled as a lecture followed by Q&A. The ACP webinar and workshops were a two part offering (initial and follow up). Webinar recordings were posted to YouTube and the palliative care department website, and one (ACP) was translated into Spanish. We recruited participants through department communication channels, community partners, social media, and personal networks. Survey evaluations included a likelihood to recommend (LTR) metric using a 5-point Likert scale (5= very likely). 

979 people attended a total of 12 webinars and workshops from April-June 2020. The survey response rate was 26.8%, and mean LTR, 4.03 (SD 1.36). The caregiving webinar had the highest LTR of 5, but only 6 survey respondents. LTR for the ACP and psychological distress webinar was around 4 (ACP mean LTR 4.03, SD 1.41, N=124; psychological distress mean LTR 3.96, SD 1.3, N=82). Attendees were largely white and female (81% white, 12% Asian, 4% Latinx, 3% Black; 81% female), and mean age was 59.95 (median 63, range 22-89, SD 14.01).  

Virtual education is an effective way to engage the public, reaching a large number of people. An effort to reach more diverse communities through outreach and providing multilingual offerings is needed. 

Integrating Interdisciplinary Teams into the VA Organizational Fabric and Clinical Practices, Stanford University and VA Palo Alto Healthcare System

Karleen Giannitrapani, PhD, MPH, MA is a new Instructor in the Stanford School of Medicine Department of Primary Care and Population Health and the Associate Director of QuIRC, the Quality Improvement Resource Center for Palliative Care supporting Geriatrics and Extended Care (GEC) for the department of Veterans Affairs nationally. She was selected to be one of the six 2020 Research Scholars by the American Academy of Hospice and Palliative Medicine for her project on Integrating interdisciplinary teams into the VA organizational fabric and clinical practices. This award is intended to advance the scientific endeavors of new/early investigators (who have applied for or will shortly apply for a Career Development Award) whose goal is to become independent scientists actively involved in palliative care research.

Virtual Palliative Care Education for the South Asian Community

Project Lead: Claire Bleymaier, MPH, BSN, RN

Co-authors: Mukund Acharya, PhD, Kavitha Ramchandran, MD, Ashley Bragg & Grant Smith, MD

Poster presentation at 2021 Stanford Community Health Symposium

The Palliative Care Health Education, Engagement, and Promotion program (PC-HEEP) partnered with non-profit organization Sukham ( in October 2020 to conduct an hourlong webinar on Palliative Care for South Asians.

South Asians typically have a poor understanding of, or are misinformed about this topic. They often share culture, traditions, and values that can impact their ability to handle serious illness, and may be ill-prepared to make difficult medical decisions. Sukham promotes healthy living and aging well by offering information and support, with a focus on the South Asian community.

The webinar presenter, palliative care physician Kavitha Ramchandran, is of South Asian origin. Sukham’s Mukund Acharya provided a contextual introduction. Sukham promoted the event via email, social media, and the readership of India Currents and India West.  PC-HEEP posted the event on Stanford calendars and their website.  A recording is publicly available on SHC’s YouTube channel.

42 of the 63 individuals who registered attended the event. A post-webinar survey (response rate 24%) included likelihood to recommend (Likert scale 1-5), demographic data, and open ended questions. The majority of respondents were older South Asian females (78% Asian Indian, 11% Chinese, 11% White, 70% female, 30% male, mean age 71, range: 60-78).  The YouTube recording has been viewed 460 times to date.  Some attendees provided Sukham unsolicited positive feedback via email.

I Can't Get No Satisfaction Data: The Trials and Tribulations of Obtaining Satisfaction Data in Our Outpatient Palliative Medicine Clinic

Project Lead: Kimberly Sickler, MS, RN, CNS, ACHPN

Co-authors: Mary Song, MPH & Ashley Bragg

There is limited patient satisfaction literature in the Palliative Medicine setting. We developed our own satisfaction survey, since our clinic was too small to use Press Ganey to assess our patient’s satisfaction with care. We also wanted something that would capture video visit data which Press Ganey did not.

We developed a 17-item survey tool. We engaged known patients to pilot our survey for clarity and ease of use. Then our survey was sent to all new patients using the hospital’s secure messaging portal. We created a standardized email with a link to our Qualtrics based survey. Our medical assistants sent the survey through our patient portal within 1-2 weeks of the patient visit. They documented weekly the number of messages sent and those unread. We reviewed weekly the number of responses. Six months in, we revised our process to send emails within two days of the visit.

Palliative Care Health Education, Engagement and Promotion

Project Lead: Grant Smith, MD

Co-Presenters: Ashley Bragg & Claire Bleymaier, MPH, RN

Oral presentation at 14th Annual Summit for Clinical Excellence: Bridging for Health Equity at Stanford Medicine.

In this session, we describe how a unique partnership between a clinical department of palliative care and a department of patient experience leveraged our clinical expertise and knowledge of patient outreach methods to increase awareness and knowledge of palliative care in the community within and beyond our medical center.

South Asian Family Approaches to Diseases (SAFAD): A Program to Enhance Caregiving among South Asian Women Living with Breast Cancer

The objective of Dr.  Trivedi's Sojourns Scholars Leadership Award project is to develop a culturally attuned web-based behavioral intervention that mitigates the unmet psychosocial and community resource needs of South Asian women living with breast cancer and their caregivers. The proposed project will accomplish this goal in three steps: first, to identify unmet needs and to evaluate culturally attuned resources; second, to use these insights to enhance my existing web-based self-management program to make it culturally attuned; and to evaluate its preliminary impact via a field test.  Project findings will support the care of South Asian women living with breast cancer at Stanford Women's Cancer Center, and beyond.

Palliative Care to the People: Partnering with a Patient Experience Department to Raise Awareness of Palliative Care in the Community

Project Lead: Grant Smith, MD

Co-Presenters: Ashley Bragg & Claire Bleymaier, MPH, RN

Oral presentation at 2021 California Hospice and Palliative Care Association Annual Conference

In this session, we describe how a unique partnership between a clinical department of palliative care and a department of patient experience leveraged our clinical expertise and knowledge of patient outreach methods to increase awareness and knowledge of palliative care in the community within and beyond our medical center.

• Describe the development and implementation of a novel partnership between a clinical department of palliative care and a department of patient experience.

• Describe a systematic approach to developing, implementing, and evaluating a multifaceted strategy to improve palliative care awareness in the community.

• Identify novel ways to increase awareness of palliative care in the community.

Perioperative Palliative Care Surrounding Cancer Surgery for Patients & Their Family Members

The study goal is to compare surgeon-palliative care team co-management, versus surgeon alone management, of patients and family members preparing for major upper gastrointestinal cancer surgery. The study also aims to explore, using qualitative methods, the impact of surgeon-palliative care team co-management versus surgeon alone management on the perioperative care experience for patients, family members, surgeons, and palliative care clinicians.

Palliative Care Research Resources

  • National Palliative Care Research Center (NPCRC) - The mission of the National Palliative Care Research Center (NPCRC) is to strengthen the evidence-based foundation needed for health policy and clinical practice in palliative care medicine by growing and supporting the community of palliative care research scientists and stimulating expanded research and innovation. Specifically, the NPCRC is providing a mechanism to: establish priorities for palliative care research, develop a new generation of researchers in palliative care, and coordinate and support studies focused on improving care for patients and families living with serious illness
  • Palliative Care Research Collaborative (PCRC) - The mission of the PCRC is to suppor the conduct of high quality, effective palliative care clinical research by: supporting investigators at all levels of experience in the conduct of clinical studies, conducting national representative, multi-institutional studies that include diverse populations, leveraging standardized data elements and de-identifed palliative care study data repository that amplifies the impact of any single study, and providing methodologic resources, participant access/recruitment, and the experise of the PCRC investigators from multiple disciplines.
  • Palliative Care Quality Collaborative (PCQC) - A national palliative care data registry that captures both program and patient-level quality data.