Behavioral Medicine in the Context of Palliative Care: A Conversation with an International Leader in Clinical Research and Patient Care

Kathrin Milbury, PhD, Palliative Care SIG

The field of palliative care seeks to improve the quality of life in patients (adults and children) and their families who are coping with the burden of a life-threatening disease.  Palliative care focuses on alleviating physical, psychosocial, and spiritual distress.  According to the World Health Organization, an estimated 56.8 million people need palliative care each year and this need is expected to grow due to the ageing of populations and increases in noncommunicable diseases. However, only about 14% of people who need palliative care currently receive it.  From both the clinical and the research perspective, palliative care offers tremendous opportunities to reduce human suffering and promote health equity.

A conversation with Eduardo Bruera, MD, highlights these opportunities for behavioral scientists and clinicians. Dr. Bruera is the endowed FT McGraw Chair in the Treatment of Cancer and serves as the Chair of the Department of Palliative, Rehabilitation, & Integrative Medicine at the University of Texas MD Anderson Cancer Center.  As an internationally renowned leader in the field, Dr. Bruera is recognized as an outstanding clinician scientist and a passionate educator and mentor. 

As an expert in the field, what is the role of behavioral medicine in palliative care?

Bruera: By nature, the scope of palliative care is multidimensional. The expression of physical and emotional suffering of the patient has multiple contributors requiring a multidisciplinary approach.  No single discipline is equipped to address the typically complex symptom expression of patients facing a serious illness.  Emotional or relational suffering often contributes to the expression of physical symptoms such as pain, fatigue, and sleep disorders. Psychologists play a crucial role in supporting patients and their families.  I also believe that psychologists play a vital role in supporting the medical team in biomedical management as they may have insights to the patient’s values and family circumstances that influence treatment goals and decision making. Psychologists are better equipped than any other member of the team to understand the patient’s context that shapes care decisions.

How can behavioral scientists address some of the important research gaps in palliative care?

Bruera: The success of palliative medicine depends on the cohesion and coordination of interdisciplinary care teams. For instance, integrating psychologists in pain management is crucial to optimal care delivery. The concept of integration is very important because there are too many silos in health care.  People are operating as independent entities. We need more research to uncover the limitations of outdated hospital and academic structures and identify the strength of integrated interdisciplinary collaborations to enhance outcomes for patients and their families. Questions around the dynamics of the interactions among care providers that create either barriers or facilitators to caring for patients in acute care institutions remain unaddressed.

What career advice would you offer to someone with a background in behavioral medicine who would like to work in a palliative care setting? 

Bruera: First, I would say, working in palliative care is a highly rewarding field because it allows for an opportunity to alleviate a tremendous amount of unnecessary suffering. A lot of suffering in patients with a serious illness is totally unnecessary.  And unnecessary suffering can be reduced by your presence in the field. On the other hand, I would say, be prepared that there will be suffering.  Cancer is not contagious, heart failure is not contagious but suffering can be contagious.  Because healthcare focuses on cure…a battle we are losing as eventually everyone will die…you need to be prepared of the limits of the achievements that we can make.  Second, inserting yourself in a group that works as a team and values work-life balance to prevent burnout is important.

What career advice in general can you offer to anyone in academic medicine?  

Bruera: I have learned over the years that setting goals that are within my own personal control contributes to academic success. The health care environment is complex and includes randomness around success. Certain goals such as becoming a department chair or dean may or may not happen for reasons outside of your control. Goals such as “I want to be an expert clinician,” “I want to conduct research that is meaningful to patients and families,” “I want to educate the future generations” are within your control. In my opinion, focusing on goals that are achievable through your own efforts with limited input by others leads to career satisfaction.