Palliatively Speaking

Summary:

In this episode of "Palliatively Speaking" host Toby Campbell interviews Dr. Judith Paice, the director of the Cancer Pain Program at Northwestern Memorial Hospital and co-chair of the 2023 American Society of Clinical Oncology guideline on opioid use for cancer pain. The conversation explores Dr. Paice's 25-year involvement with the End-of-Life Nursing Education Consortium (ELNEC), a train-the-trainer program that has reached millions of healthcare professionals worldwide.

Dr. Paice discusses how ELNEC  started with five planned courses, and then expanded to over 300 courses translated into multiple languages. The curriculum has been adapted for various audiences, including pediatric nurses, advanced practice nurses, and faculty.

Using personal stories and anecdotes, Dr. Paice gives a closer look at the critical challenges in pain management, particularly the tension between managing cancer pain and the opioid epidemic. She emphasizes that oncology clinicians face unique pressures as they navigate both cancer pain management and opioid safety concerns. The conversation then shifts to a discussion about the importance of primary palliative care education for all oncology providers, not just specialist palliative care teams.

Later in the episode, Dr. Paice is joined by Sarah Lowery, a nurse practitioner at OHSU and ELNEC international trainer, and a mentee of Dr. Paice. Both speakers reflect on mentorship as essential to professional development and organizational sustainability. Dr. Paice advises emerging leaders to recognize their unique contributions, overcome imposter syndrome, and offers tips for identifying potential mentees for a successful collaborative relationship.

In this special episode, Toby Campbell sits down with palliative care legend Dr. Ira Byock for a candid, far-reaching conversation about the field's origins, its current challenges, and the path forward. Joined by the CEO of the Center to Advance Palliative Care (CAPC),  Brynn Bowman, Byock reflects on his early days as a rural family medicine resident drawn to patients "put down the hall" and forgotten—a pull that would lead him to become one of hospice and palliative care's most influential voices.

Forty years later, Byock pulls no punches in assessing the field he helped build. He calls out the "epidemic" of fraudulent hospice programs, the unacceptable variability in quality, and what he sees as palliative care's timidity in advocating for itself. According to Dr. Byock, the solution to these challenges lies in establishing clear clinical and programmatic standards and a willingness to embrace, rather than hide from, healthcare's capitalist reality.

Brynn Bowman offers a generational counterpoint, acknowledging the field's growing pains while finding reasons for optimism: culture change, an undeniable value proposition, and emerging work on quality standards that could finally separate excellent care from the merely mediocre.

This episode is a master class in leadership, honesty, and the courage to speak truth—even to the field you love.

In this thoughtful and engaging episode, geriatric and palliative care nurse scientist Dr. AB Brody shatters illusions about dementia care with hard-won wisdom. Having witnessed his own grandparents suffer through a system that prioritized medical protocols over human dignity, Brody now leads a quiet revolution in how we support caregivers.

The most important revelation? In the marathon of supporting caregivers, we've been asking the wrong question. Not "What's wrong?" but "What's going right?". This simple flip was honed through years of house calls and hospice work. It uncovers hidden reservoirs of strength in both patients and caregivers. 

Through his nonprofit Oliviato Health, Brody bridges the dangerous gap between research and reality, developing tools and resources that reach caregivers where they are and help healthcare systems adopt evidence-based practices that would elevate hospice care. Dr. Brody recounts how hospice teams, when properly supported, can transform from crisis managers to guardians of quality life. 

Dr. Brody is joined by the community leader, Elder Denise Lawson. His community engagement work with Elder Denise proves that true change happens not in ivory towers, but in church basements and living rooms where caregivers gather.

We're failing dementia families not from lack of science, but lack of imagination. The solution lies in listening to caregivers' wisdom, to patients' unspoken needs, and to those fleeting moments of connection that make the unbearable bearable. As Brody puts it: "Caregiving isn't a problem to solve. It's a relationship to honor."

Title: From Founder to Successor

Summary: 

Guest: Matt Gonzales

Guest’s guest: Ira Byock

This episode offers a masterclass in humanizing healthcare. Join host Dr. Campbell for a fascinating conversation with Dr. Matt Gonzalez, a software engineer, a palliative care physician, and a leader overseeing 51 hospitals on the West Coast.

The conversation begins with a discussion on the future of empathetic care and the critical importance of presence. Dr. Gonzales argues that the system must be redesigned to allow clinicians to do what they entered medicine to do: connect. He shares the monumental success of scaling goals-of-care conversations from 7% to 85% across the Providence health system, which is an accomplishment he attributes not to lecturing clinicians, but to dismantling systemic barriers and "making the right way easy."

The discussion shifts to lessons about leadership as Dr. Gonzales is joined by his mentor, Dr. Ira Byock. Together, they unpack the secrets to a successful leadership transition—built on trust, joy, and the courage to lead from a place of love, not fear. Dr. Byock shares the crucial wisdom for a founder to truly let go, allowing the next leader to step into their own authentic skin.

To close, our guests explore a future in which AI handles paperwork, freeing doctors for the sacred work of listening. But Matt issues a crucial caveat: AI can generate the perfect empathetic words, but without genuine human intent and authenticity behind them, they are remain empty words.

This episode is an inspiring look at the leaders who are putting the "care" back into healthcare.

Guest: Steven Pantilat

Guest’s guest: Gretchen Schwarze

What does it take to build not just a career, but an entire field of medicine?

In this new episode, we sit down with a true pioneer, Dr. Steven Pantilat, the founder of the Division of Palliative Medicine at UCSF.

Dr. Pantilat takes us back to the early days of palliative care, a time before it even had a name, when he and a small cohort of innovators sort of made it up through the groundbreaking Project on Death in America (PDIA).

He reveals how this experience of finding his tribe; was a revelation that shaped his lifelong commitment to mentorship.

We explore his philosophy that transformed him from a mentee into the Uber mentor as described by his guest and mentee, Dr. Gretchen Schwarze.

Dr. Pantilat shares his core principles for powerful mentorship, including the crucial difference between being & nice and being kind,, why the best mentors care about the whole person, and how to give feedback that truly helps people grow.

Join us for a deeply human look at the art of mentorship, the birth of the palliative care movement, and the wisdom that comes from understanding that our time, and our tribe, are everything.

Guest: Cardinale Smith

Guest’s guest: Melissa Mazor

In a compelling episode, Dr. Cardi Smith, Chief Medical Officer at Memorial Sloan Kettering and a leader in oncology and palliative care, shared her journey, from her mother’s unfulfilled dream of becoming a physician to her own rise in medicine. Driven by a legacy of resilience, she emphasized leadership as a tool for systemic change, not personal power.

As one of few palliative care physicians in executive roles, she highlighted the "minority tax", which is the burden of representing marginalized identities in leadership. Yet, her palliative care skills, like empathy and communication, helped her navigate these challenges. Dr. Smith’s leadership philosophy is rooted in servant leadership which includes elevating others, creating opportunities, and measuring success by collective progress rather than individual accolades.

After being joined by mentee Dr. Melissa Mazur, the discussion shifted to the urgent need to move beyond pilot programs in health equity, advocating for sustainable solutions like patient navigation, which has proven effective for decades but remains underfunded. To achieve this, there is an urgent need for implementation science and measurable community engagement. 

In closing, the guests emphasized that equity work cannot rely on temporary grants or goodwill. It requires embedding anti-racist practices into healthcare’s infrastructure, a challenge that demands courage from leaders and institutions alike.

Guest: Rachelle Bernacki

Guest’s guest: Stephanie Harman

Summary: In this engaging podcast episode, Dr. Toby Campbell interviews Dr. Rachelle Bernacki, a palliative care physician and Associate Professor at Harvard Medical School, alongside guest Dr. Stephanie Harman. Dr. Bernacki shares her journey into palliative care and geriatrics, mentorship, and systemic change. She reflects on the development and scaling of the Serious Illness Conversation Guide, a tool now used globally, despite initial rejections and challenges in publishing the foundational research.

The interview shifts to a discussion about Dr. Bernacki’s transition to geriatric surgery and her collaboration with Dr. Zara Cooper to improve care for older surgical patients. This 16-million-dollar grant from the West Health Foundation focuses on practical changes like reducing harmful medications and preventing delirium among surgical patients. Dr. Bernacki emphasized the importance of persistence and curiosity to learn about a new clinical area and drive meaningful change.

Dr. Harman adds deeper insights into Dr. Bernacki’s leadership and their shared commitment to fostering supportive spaces in medicine. The episode closes with the ongoing national and global impact of Dr. Bernacki’s work, from New Zealand’s nationwide adoption of the Serious Illness Care Program to her current efforts in transforming hospital care for older adults.

Guest: Carey Candrian

Guest’s Guest: Linda Kotsaftis

Dr. Carey Candrian, a communications scientist at the University of Colorado, discusses her mission to improve healthcare for LGBTQ+ individuals, particularly those facing serious illness and end-of-life care.  She is a storyteller, in words and pictures and film.  She shares a poignant story about same sex couple whose marriage was disregarded by the healthcare system, leading to poor care and disenfranchised grief. The story serves as a source of inspiration for Dr. Candrian’s work on the challenges faced by LGBTQ+ individuals in healthcare, including stigma, silence, and the lack of inclusive environments.  Dr. Candrian discusses how she uses the power of storytelling and creative media, such as her Eye to Eye photo project and documentary Just Us, to humanize LGBTQ+ individuals and foster empathy.

We welcome her guest, Linda Kotsaftis, a Colorado-based journalist who has worked with Dr. Candrian on several projects. Linda shares her personal experience of witnessing Dr. Candrian's profound impact on the community, particularly older LGBTQ+ women who had previously felt invisible or unheard.  We hear about Dr. Candrian's ability to connect with people and bring about change through her powerful ability to use narrative stories as a means of delivering a message.  Linda has seen emotional transformations take place for those who interact with Dr. Candrian and she reveals how Dr. Candrian's work has raised awareness and created a space for honest conversation and mutual support, helping people see the humanity in each other's stories.

Guest: Gretchen Schwarze

Guest’s guest: Amy Zelenski

Episode Title: Better Conversations, Better Care

Summary 

This conversation explores the challenges and strategies involved in helping clinicians, particularly surgeons, improve their communication and decision-making practices to provide better patient-centered care. Dr. Gretchen Schwarze, a vascular surgeon and medical ethicist, and Dr. Amy Zelenski, an education researcher, discuss how their collaborative work aims to shift clinicians' mindsets and behaviors around informed consent, prognostic communication, and shared decision-making. They share how surgeons often struggle to move beyond a "fix it" mentality to meaningful improvements in patients' lives. Dr. Schwarze advocates reframing the surgeon's role as assessing whether an operation can help the patient achieve their goals, rather than just fixing a problem. With background in theater, Dr. Zelenski discusses the power of improv-based strategies like the "two-minute rant" and other techniques in cultivating empathy and empowering clinicians to respond rather than react to what is happening in their surrounding environment.

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