Susan D Block

Susan D Block
Dana-Farber Cancer Institute, Brighsm and Women's Hospital, Harvard Medical School · Psychiatry And Medicine

MD

About

272
Publications
61,229
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24,208
Citations
Citations since 2016
55 Research Items
13171 Citations
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Publications

Publications (272)
Article
Full-text available
Background Visits to the emergency department (ED) are inflection points in patients’ illness trajectories and are an underutilized setting to engage seriously ill patients in conversations about their goals of care. We developed an intervention (ED GOAL) that primes seriously ill patients to discuss their goals of care with their outpatient clinic...
Article
Objectives Serious illness conversations (SICs) can improve the experience and well-being of patients with advanced cancer. A structured Serious Illness Conversation Guide (SICG) has been shown to improve oncology patient outcomes but was developed and tested in a predominantly White population. To help address disparities in advanced cancer care,...
Article
Background: During acute health decompensations for seriously ill patients, emergency clinicians often determine the intensity end-of-life care. Little is known about how emergency clinicians conduct these conversations, especially among those who have received serious illness communication training. Aim: To determine the self-reported practice...
Preprint
Full-text available
Background: Visits to the emergency department (ED) are inflection points in patients' illness trajectories and are an underutilized setting to engage seriously ill patients in conversations about their goals of care. We developed an intervention (ED GOAL) that primes seriously ill patients to discuss their goals of care with their outpatient clini...
Article
Palliative care has been shown to help patients live well with serious illness, but the specific psychological factors that contribute to this benefit remain investigational. Although support of patient coping has emerged as a likely factor, it is unclear how palliative care helps patients to cope with serious illness. The therapeutic relationship...
Chapter
Conversations about palliative care pose multiple challenges for patients, families, and clinicians. This chapter emphasizes the critical role of relationships in communication, highlights common practical challenges that arise in communication about palliative care issues, and proposes specific strategies for addressing them. Examples of language...
Article
Background: For adolescents and young adults (AYAs), the diagnosis of cancer can impede social development, especially with respect to education, employment, and financial independence. However, there are limited quantitative data on the extent and trajectory of life disruptions during cancer treatment for AYA patients. Methods: This was a longi...
Article
Full-text available
Background: Serious illness conversations are part of advance care planning (ACP) and focus on prognosis, values, and goals in patients who are seriously ill. To be maximally effective, such conversations must be documented accurately and be easily accessible. Objectives: The two coprimary objectives of the study were to assess concordance between...
Article
Background: Advance care planning (ACP) conversations are an important intervention to provide care consistent with patient goals near the end of life. The emergency department (ED) could serve as an important time and location for these conversations. Objectives: To determine the feasibility of an ED-based, brief negotiated interview (BNI) to sti...
Article
Full-text available
Context Many consider goal-concordant care (GCC) to be the most important of advance care planning and palliative care. Researchers face significant challenges in attempting to measure this outcome. We conducted a randomized controlled trial to assess the effects of a system-level intervention to improve serious illness communication on goal-concor...
Preprint
Background At a population level, conversations between clinicians and seriously ill patients exploring patients’ goals and values can drive high-value healthcare, improving patient outcomes and reducing spending. Methods We examined the impact of a quality improvement intervention to drive better communication on total medical expenses in a high-...
Article
Background: Adolescent and young adult (AYA) cancer survivors have high risks of late effects. Little is known about the late-effect information needs of AYAs early in treatment or their role in treatment decision making. This study evaluated the importance, quality, and implications of information about late effects in AYAs recently diagnosed wit...
Article
Adolescent and young adult (AYA) cancer patients enroll in therapeutic clinical trials at low rates. Prior study has focused on trial availability; this research attempts to elucidate the role of communication in individual decision-making. We surveyed 193 AYA patients and reviewed medical records of informed consent discussions. Twenty percent (38...
Article
Background: Bereavement programs provide institutions with an avenue for obtaining feedback from family members about their experiences during a patient's illness and end-of-life (EOL) period that can be used to improve both patient care and the care of bereaved individuals. Objective: We examined family members' experiences about the clinical car...
Article
Objectives: Identifying family members at-risk of poor bereavement outcomes poses a challenge for clinicians, resulting in inconsistent bereavement follow-up. The current quality improvement study tests a method for identification of at-risk family members, and describes follow-up they received from the bereavement service at Dana-Farber Cancer Ins...
Article
Objective: Adolescents and young adults (AYAs) with cancer have high rates of psychological distress and unmet support needs. Peace of mind is an important construct among older cancer patients and parents of children with cancer but has not been explored in AYAs. We sought to evaluate the extent to which AYAs with cancer experience peace of mind...
Article
Background: Communication between clinicians and patients fundamentally shapes the experience of serious illness. There is increasing recognition that health systems should routinely implement structures and processes to assure high-quality serious illness communication (SIC) and measure the effectiveness of their efforts on key outcomes. The absen...
Article
Background: Although the majority of adolescent and young adult (AYA) patients with cancer desire prognostic information, to the authors' knowledge little is known regarding how preferences for prognostic communication change over time. Methods: The current study was a longitudinal, prospective, questionnaire-based cohort study of 136 AYA patien...
Article
Full-text available
Importance The accuracy of mortality assessment by emergency clinicians is unknown and may affect subsequent medical decision-making. Objective To determine the association of the question, “Would you be surprised if your patient died in the next one month?” (known as the surprise question) asked of emergency clinicians with actual 1-month mortali...
Article
Background: Adolescents and young adults (AYAs) experience cancer while balancing emerging identity and life goals. We investigated AYAs' priorities during cancer, including psychosocial concerns, cure-directed therapy, and potential late effects. Methods: We surveyed 203 cancer patients aged 15-29 treated at Dana-Farber Cancer Institute, Boston...
Article
Full-text available
Background Communication about priorities and goals improves the value of care for patients with serious illnesses. Resource constraints necessitate targeting interventions to patients who need them most. Objective To evaluate the effectiveness of a clinician screening tool to identify patients for a communication intervention. Design Prospective...
Article
Background: Adolescents and young adults (AYAs) with cancer generally want to engage in decision-making but are not always able to do so. We evaluated cancer treatment decision-making among AYAs, including decisional engagement and regret. Methods: We surveyed 203 AYA patients with cancer aged 15 to 29 (response rate 74%) treated at a large acad...
Article
Importance High-quality conversations between clinicians and seriously ill patients about values and goals are associated with improved outcomes but occur infrequently. Objective To examine feasibility, acceptability, and effect of a communication quality-improvement intervention (Serious Illness Care Program) on patient outcomes. Design, Setting...
Article
Importance: Earlier clinician-patient conversations about patients' values, goals, and preferences in serious illness (ie, serious illness conversations) are associated with better outcomes but occur inconsistently in cancer care. Objective: To evaluate the efficacy of a communication quality-improvement intervention in improving the occurrence,...
Article
Full-text available
BACKGROUND: Conversations with seriously ill patients about their values and goals have been associated with reduced distress, a better quality of life, and goal-concordant care near the end of life. Yet, little is known about how such conversations are conducted. OBJECTIVE: To characterize the content of serious illness conversations and identify...
Article
Full-text available
During the last 6 months of life, 75% of older adults with preexisting serious illness, such as advanced heart failure, lung disease, and cancer, visit the emergency department (ED). ED visits often mark an inflection point in these patients’ illness trajectories, signaling a more rapid rate of decline. Although most patients are there seeking care...
Article
Background: Most seriously ill older adults visit the emergency department (ED) near the end of life, yet no feasible method exists to empower them to formulate their care goals in this setting. Objective: To develop an intervention to empower seriously ill older adults to formulate their future care goals in the ED. Design: Prospective interv...
Article
Context: Emergency Department (ED) visits provide opportunities to empower patients to discuss advance care planning (ACP) with their outpatient clinicians, but systematically developed, feasible interventions do not currently exist. Brief negotiated interview (BNI) interventions, which allow ED clinicians to efficiently motivate patients, have po...
Article
Objective We aimed to explore multiple perspectives regarding barriers to and facilitators of advance care planning (ACP) among African Americans to identify similarities or differences that might have clinical implications. Method Qualitative study with health disparities experts ( n = 5), community members ( n = 9), and seriously ill African Ame...
Article
Purpose Communication about prognosis affects decisions patients and family members make about cancer care, and most patients say they want to know about their chances of cure. We sought to evaluate experiences with prognosis communication among adolescents and young adults (AYAs) with cancer. Patients and Methods We surveyed 203 AYAs with cancer...
Article
Background: Few studies have focused on racial and ethnic differences in advance care planning other than advance directives among population-based samples of adults across the lifespan. Methods: Using data from a statewide random-digit dial telephone survey of adults 18 years or older (n = 1851), we investigated racial and ethnic differences in...
Article
Background: Families' communication needs during the early cancer treatment period (ECTP) may not be optimally met by current practices. We sought to identify potential communication gaps and to ameliorate these by developing a novel in-depth conversation between families and their pediatric oncologists, the "Day 100 Talk" (D100), during the ECTP....
Article
Objective: To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). Background: Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, a...
Article
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Background: Early, high-quality serious illness (SI) conversations are critical for patients with glioblastoma (GBM) but are often mistimed or mishandled. Objective: To describe the prevalence, timing, and quality of documented SI conversations and evaluate their focus on patient goals/priorities. Design/participants: Thirty-three patients wit...
Article
Background: Identification of older adults with serious illness (life expectancy less than one year) who may benefit from serious illness conversations or other palliative care interventions in the emergency department (ED) is difficult. Objectives: To assess the performance of the "surprise question (SQ)" asked of emergency physicians to predic...
Article
The NCCN Guidelines for Palliative Care provide interdisciplinary recommendations on palliative care for patients with cancer. These NCCN Guidelines Insights summarize and provide context for the updated guidelines recommendations regarding hospice and end-of-life (EOL) care. Updates for 2017 include revisions to and restructuring of the algorithms...
Article
In 2014 the World Health Organization called for palliative care to be integrated as an essential element of the health care continuum. Yet in 2017 US palliative care services are found largely in hospitals, and hospice care, which is delivered primarily in the home, is limited to people who are dying soon. The majority of Americans with a serious...
Article
Full-text available
Improving communication about goals and values for patients with advancing serious illness nearing the end of life is a key opportunity to improve the value of care. The Serious Illness Care Program, implemented at primary care clinics affiliated with Brigham and Women's Hospital in Boston, Massachusetts, is a multicomponent intervention designed t...
Article
Rationale: The chronically critically ill have survived acute critical illness but require prolonged mechanical ventilation. These patients are frequently transferred from acute care to long-term acute care hospitals (LTACHs) for prolonged recovery, yet many suffer setbacks requiring readmission to acute care. The patient's relatively improved con...
Article
Full-text available
Dialysis-dependent ESRD is a serious illness with high disease burden, morbidity, and mortality. Mortality in the first year on dialysis for individuals over age 75 years old approaches 40%, and even those with better prognoses face multiple hospitalizations and declining functional status. In the last month of life, patients on dialysis over age 6...
Article
49 Background: Conversations about serious illness care goals are often inadequate and fail to address key elements of high-quality discussions. Methods: As part of a cluster-randomized trial of a multi-component communication intervention, we conducted a retrospective chart review of 147 deceased oncology patients to assess frequency and timing of...
Article
Full-text available
This study assesses the potential of the “surprise” question to identify patients who might benefit from palliative care. Palliative care improves the value of care for seriously ill patients, but resource constraints necessitate targeting palliative care interventions to patients who need them most.¹ The “surprise” question (SQ)—“Would you be surp...
Article
Background: Seriously ill older adults in the emergency department (ED) may benefit from palliative care referral, yet little is known about how to identify these patients. Objectives: To assess the performance and determine the acceptability of a content-validated palliative care screening tool. Design: We surveyed Emergency Medicine (EM) att...
Article
Objective: Chronically critically ill patients have recurrent infections, organ dysfunction, and at least half die within 1 year. They are frequently cared for in long-term acute care hospitals, yet little is known about their experience in this setting. Our objective was to explore the understanding and expectations and goals of these patients an...
Article
As the field of Pediatric Palliative Care continues to develop, it is important to consider the scope of practice and the utility of collaboration with other specialties, including child and adolescent psychiatry. The integration of psychiatry and palliative medicine has been explored in adult practice, but has not yet been elaborated in pediatrics...
Article
Full-text available
Importance: The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satis...
Article
In Reply We agree with Dr Galishoff that the question of how physicians should be involved in the end of a human life is of great importance to the medical profession and to the ethical discourse about the rights of patients and responsibilities of physicians. There are strong moral principles and deeply felt arguments on both sides of this questio...
Article
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Background: Clinical decisions for seriously ill older patients with surgical emergencies are highly complex. Measuring the benefits of burdensome treatments in this context is fraught with uncertainty. Little is known about how surgeons formulate treatment decisions to avoid nonbeneficial surgery, or engage in preoperative conversations about end...
Article
Background: African Americans (AA) are more likely to receive worse end-of-life (EOL) care and are less likely to participate in advance care planning (ACP) than white Americans. Objective: Our goal was to understand factors impacting ACP among AA and explore their interactions, in order to guide further research and intervention development. M...
Article
Communication is central to pediatric oncology care. Pediatric oncologists disclose life-threatening diagnoses, explain complicated treatment options, and endeavor to give honest prognoses, to maintain hope, to describe treatment complications, and to support families in difficult circumstances ranging from loss of function and fertility to treatme...
Article
This Viewpoint discusses why physician-assisted death should be considered important enough to be made legally available in all US states.Is physician-assisted death ever justifiable?—Yes.Both the lived experience of a person with a serious illness as well as commonly recognized ethical principles provide guidance in answering this question. A woma...
Article
Full-text available
The NCCN Guidelines for Palliative Care provide interdisciplinary recommendations on palliative care for patients with cancer. The NCCN Guidelines are intended to provide guidance to the primary oncology team on the integration of palliative care into oncology. The NCCN Palliative Care Panel's recommendations seek to ensure that each patient experi...
Article
Full-text available
Objective: To address the need for improved communication practices to facilitate goal-concordant care in seriously ill, older patients with surgical emergencies. Summary background data: Improved communication is increasingly recognized as a central element in providing goal-concordant care and reducing health care utilization and costs among s...
Article
Objectives: Evaluate clinician adoption and acceptability of the training program and the Serious Illness Conversation Guide; determine the frequency, timing, and quality of goals of care documentation before death. Methods: Cluster-randomized trial including oncology clinicians and their patients. Intervention: clinician identification of hig...
Article
Methods: We conducted a series of focus groups with panels of clinicians and researchers, African-American church members, and seriously ill patients and their caregivers to assess barriers to ACP and preferences concerning modifications to the guide. We used template analysis to code themes at the individual, interpersonal and systems levels. Re...
Article
Methods: From July 2012 to October 2014, oncology clinicians at Dana-Farber Cancer Institute were invited to enroll in a randomized controlled trial on the impact of a structured intervention to improve conversations about end-of-life goals -- the Serious Illness Care Program. The SQ was asked about each patient seen by the enrolled clinician. We...
Article
Methods: A cluster-randomized controlled trial with oncology patients at high risk of death, identified by the surprise question. The intervention included a structured, patient-centered discussion about values and priorities conducted by trained oncology clinicians using the Serious Illness Conversation Guide. Patient anxiety (GAD-7) was measured...
Article
Full-text available
Introduction Ensuring that patients receive care that is consistent with their goals and values is a critical component of high-quality care. This article describes the protocol for a cluster randomised controlled trial of a multicomponent, structured communication intervention. Methods and analysis Patients with advanced, incurable cancer and life...
Article
Our aim is to understand experiences with treatment decision-making among young adults with cancer. We studied patients with lung cancer or colorectal cancer in the Cancer Care Outcomes Research and Surveillance Consortium, a prospective cohort study. We identified 148 young adult patients aged 21-40 years who completed baseline interview questions...
Article
Although bereavement programs are a common element of palliative medicine and hospice programs, few health care institutions currently offer universal bereavement services to all their patients. The elevated risk of serious physical and mental health problems among the bereaved is a strong argument for the development of universal institution-based...
Article
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By 2021, health care spending is projected to grow to 19.6% of the GDP, likely crowding out spending in other areas. The 2010 Affordable Care Act (ACA) attempts to curb health care spending by incentivizing high-value care through the creation of Accountable Care Organizations (ACOs), which assume financial risk for patient outcomes. With this fina...
Article
The question "What is truth?" is one of the oldest questions in philosophy. Truth within the field of medicine has gained relevance because of its fundamental relationship to the principle of patient autonomy. In order to fully participate in their medical care, patients must be told the truth - even in the most difficult of situations. Palliative...
Article
Full-text available
In 2006, hospice and palliative medicine (HPM) became an officially recognized subspecialty. This designation helped initiate the Accreditation Council of Graduate Medical Education Outcomes Project in HPM. As part of this process, a group of expert clinician-educators in HPM defined the initial competency-based outcomes for HPM fellows (General HP...
Article
Importance More patients with cancer use hospice currently than ever before, but there are indications that care intensity outside of hospice is increasing, and length of hospice stay decreasing. Uncertainties regarding how hospice affects health care utilization and costs have hampered efforts to promote it.Objective To compare utilization and c...
Article
84 Background: For seriously ill patients to plan for the end of life, they need to discuss with their clinicians their prognosis, values, and goals, yet such conversations often begin very late in the course of illness. To promote early advance care planning (ACP) in oncology, facilitators and barriers to these conversations need to be identified....
Article
12 Background: Conversations between patients and clinicians about end-of-life care allow patients to prepare and plan for the end of life and are associated with improved outcomes. Objective: To determine the impact of a structured, seven-item conversation guide on anxiety and depression in patients with an estimated prognosis under a year. Method...
Article
Full-text available
An understanding of patients' care goals in the context of a serious illness is an essential element of high-quality care, allowing clinicians to align the care provided with what is most important to the patient. Early discussions about goals of care are associated with better quality of life, reduced use of nonbeneficial medical care near death,...
Article
Full-text available
This trial assessed the feasibility, acceptability, tolerability, and efficacy of an Internet-based therapist-assisted cognitive-behavioral indicated prevention intervention for prolonged grief disorder (PGD) called Healthy Experiences After Loss (HEAL). Eighty-four bereaved individuals at risk for PGD were randomized to either an immediate treatme...