Member Biography

Palliative Care and Supportive Oncology Research: The Institute of Medicine's 2001 Report, "Improving Palliative Care for Cancer," defines the skill sets that make up palliative care. I use these to define the areas of clinical research for PC&SO: Communication, including breaking bad news; Advanced Care Planning; Symptoms related to cancer; Symptoms related to therapy; Psychosocial care, including bereavement support and grief; and Care of the imminently dying. These areas together with Health Services and Implementation/Dissemination Research are all areas that will be fostered and developed within the PC&SO Program. Collaboration with the existing palliative care, Cancer Center and Regenstrief Institute researchers will be critical. Interaction around communication, Health Information Technology, medicine safety and clinical decision making are already defined as key areas of the Cancer Center and Regenstrief researcher. Bringing these established researchers into regular interaction with the PC&SO Service, through clinical and research conferences will foster translational research, (primarily Type II and III) in the discipline. Examples of this based on my own research experience will be symptom management, patient-reported and -entered symptom data into the EMR and teaching of Communication skills to established clinicians using virtual learning tools. To foster the development of this research, the program should have at least a dedicated clinical research nurse (especially for symptom related studies) and two clinical research officers (CROs) to ensure the incorporation of such efforts in the Simon Cancer Center. These staff will work within the established structure of the Clinical Trials Research Office. It is imperative that the Center's leadership support this research alongside NCI-designated "therapeutic" clinical trials. Within the NCI Cancer Center Core Grant funding, the establishment of a Communications shared service will be considered, allowing the video recording and subsequent analysis of clinician-patient interactions within the Cancer Center clinics. This is currently the largest "unknown" in the continuum of cancer care (what is said? how is it said? what is the use of empathy in these settings? how do clinicians break bad news? how are therapies explained to patients?) Understanding these interactions will help greatly in improving clinical services, health care utilization and potentially, research trial accrual. Global Palliative Care and Supportive Oncology. A further critical area of health services, implementation research and policy research, and indeed a great personal research passion, is global palliative care. The global health community is slowly awakening to the lack of access to palliative care and cancer pain relief. The Pain and Policy Studies Group (PPSG), which I lead at the UW, has been an instrumental player in global opioid availability in the context of palliative care, and the home of the WHO Collaborating Center for Pain Policy and Palliative Care since 1996. Since then, various UN Agencies have addressed palliative care needs including the World Health Assembly that passed a Palliative Care resolution in 2014, calling on member states (nations) to address palliative care. Despite this resolution, there is currently a leadership vacuum due to the lack of resources to address these needs, including a lack of essential medicines, including opioids, and radiotherapy. The IUSM "Global Institute for Supportive Oncology & Palliative Care" will combine the already stellar commitment of IU, through its AMPATH program, and the commitment of the Simon Cancer Center, to the new Cancer Center, in Eldoret, Kenya, with the global work of the PPSG. This would involve relocating the PPSG to IU (at minimum, virtually) as part of the establishment the Institute. This transition quickly brings the "brand recognition" of PPSG to the Institute. PPSG's reputation is highlighted by statements at recent international meetings including the UN Office on Drugs and Crime where it was stated that PPSG has been primarily responsible for bringing the world's attention to the global lack of opioids for cancer pain relief, and at a meeting of the Pontifical Academy of Life, where all of the regional speakers referenced either their collaboration with or the work of PPSG. The Institute will be the global leader in improving access to supportive oncology and palliative care. This will be through the creation of a core of clinical and policy experts who will lead and assist staff who work within the six WHO regions of the world; AFRO (Africa) AMRO (Americas), EMRO (East Mediterranean), EURO (Europe), SEARO (South East Asia) and WPRO (Western Pacific). The greatest need for development is in Africa and Asia, resulting in a number of staff for those regions (e.g. Western or French-speaking Africa; South Eastern Africa and Northern or Arabic-speaking Africa). The appropriately qualified and trained staff ould be employed out of IU, spending approximately 25% of their time in region, establishing relationships with government officials, clinical champions and the leadership of national and regional palliative care associations. With the core staff, regionally based International Pain Policy and Palliative Care fellowship programs will be established based on the existing International Pain Policy Fellowships (IPPF). In these, clinician champions work with government officials to bring about the necessary changes in regulations, clinical education and practice, and medicine availability to improve access to palliative care. Ongoing interaction with UN agencies such as the WHO and the International Atomic Energy Agency will be essential. There are real opportunities to linking the institute with already established collaboration through IU Global Health, especially the AMPATH program and its associations with Eastern Africa. I personally commit to assisting Dr. Loehrer in applying for NCI funding to create a Cancer resource center for Africa based at the Moi Teaching Hospital.

M.B.B.S. - University of Adelaide, South Australia 1984