Top Docs Q&A: Susan Block

Block is developing a program to improve end-of-life care for patients with serious illnesses.

This post is part of our Top Docs Q&A series where we ask a physician who was selected as one of our Top Docs questions about their field, life as a doctor, and practicing in the Greater Boston area.

Name: Susan D. Block

Hospital Affiliations: Dana-Farber Cancer Institute, Brigham and Women’s Hospital

Title: Chair of the Department of Psychosocial Oncology and Palliative Care

Field: Psychiatry

Specialty: Palliative Care

Susan Block is a psychiatrist with a special focus in palliative care. She has played a key role in developing and testing the Serious Illness Care Program, an initiative which seeks to improve end-of-life care by equipping clinicians and patients to communicate more effectively.

Why did you choose to specialize in palliative care?

I was very attracted  to understanding the ways that serious medical illnesses affect and are affected by psychological factors. I thought that helping patients learn how to live as well as possible—how to find peace, how to make meaning, how to maintain their connections—even while they were very ill was one of the most important things that we could do as doctors.

What do you enjoy most about the field?

What I enjoy most is the incredible opportunity to see people struggling with some of the worst moments of their lives and demonstrating incredible resilience, and the beauty of relationships and caring in those moments. Working with people who are very seriously ill helps me keep my own life and priorities in perspective.

In the time that you’ve been practicing, how have you seen the field change?

When I started practicing medicine, there was no field of palliative care. There was a beginning field within psychiatry called psychosocial oncology which attended to the emotional needs of cancer patients. In the 30 plus years since then, we’ve created the field of palliative medicine which is now present in the majority of big hospitals across the country. Psychosocial oncology has grown and developed as well, and has a very rich evidence base.

What are the latest advancements in the field?

The biggest advance has been a recognition that there are many opportunities to improve the care of patients with serious illness and that specialists in palliative care and psychosocial oncology have a lot to teach our colleagues to help them raise their game, and are also really necessary to assuring the best possible care for our most complex patients.

What is your hope for the future?

Integration between psychiatry and palliative care will help broaden the access of patients to high quality management of symptoms and high quality mental health care for some of the emotional challenges that patients and families confront during this phase of life. This kind of integration and collaboration between the two fields is critically important.

You are the director of the Serious Illness Care Program, which has been described as a “groundbreaking initiative” to assist clinicians in discussing end-of-life care. What can you tell me about it?

Discussing end-of-life care with patients with a serious illness is one of the most challenging tasks that doctors confront. Most doctors aren’t well trained in doing this, so these conversations tend to be avoided or take place very late from the point of view of patients and families. The goal of the program is to help move these conversations upstream so patients can begin planning for the future and stay in control of the care they receive by thinking about what kind of care they want if their illness progresses. Patients frequently don’t understand how ill they are and if they did would make different decisions about how to use their time. Our goal is to help patients understand their illness and plan realistically about how to meet their personal goals.

What specific resources does the program offer?

We offer clinicians training and a seven-item structured conversation guide that helps them ask the most important questions. To patients, we provide information and a guide to talking about serious illness with their loved ones. We also have a documentation system in the electronic health record that makes it easy for a doctor in the emergency department to know what’s most important to that patient in the context of their illness so that those priorities and values can guide decisions about the patient’s care.

Where is this program being used?

Our program is very new and is still being tested with patients at Dana-Farber Cancer Institute and Brigham and Women’s Hospital. We’re beginning testing in other settings, but it hasn’t been universally disseminated yet. If the program proves to be successful when we do the scientific analysis of its impact, we hope to disseminate it broadly in the U.S. and maybe even internationally.

Based on preliminary testing of the program, what have you observed?

We’ve observed that patients are very receptive to these conversations, that clinicians value the opportunity to learn more and practice new skills in having these conversations, and that this is a feasible way of getting more patients to have these conversations earlier on in the trajectory of their illnesses.

What does the future hold?

We’re conducting a randomized control trial, which is the most rigorous kind of scientific evaluation that you can conduct in medicine. We hope that this program helps patients get the care that is consistent with what’s important to them, and improves their ability to live well even with serious illness. That’s the goal.