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Bruera (Eduardo), MD, FAAHPM, Oral History Interview: Home

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Welcome to the interview landing page.

 

Scroll down this page to explore this interview in several ways.

An Interview Profile summarizes this individual’s role, specialization, and contributions to MD Anderson.

A Table of Contents shows the range of topics covered in each interview session: each chapter title links to a chapter summary.

Chapter Summaries describe the specific topics treated in each section; each summary links to the corresponding recording so you can listen to the chapter.

Here is a link to the full transcript so you may browse and search. (link)

 

 

Interview Profile

 

 

 

 

Interview Information:

Three sessions:  8 August 2018, 13 August 2018, 05 November 2018

Total approximate duration: 4 hours

Interviewer: Tacey A. Rosolowski, Ph.D.

 

To request the interview subject’s CV and other supporting materials, please contact:

Tacey A. Rosolowski, PhD, trosolowski@mdanderson.org

Javier Garza, MSIS, jjgarza@mdanderson.org

 

About the Interview Subject:

Medical oncologist Eduardo Bruera, MD (b. 1955, Argentina) came to MD Anderson in 1999 to serve as Chair of the Department of Palliative, Rehabilitation, and Integrative Medicine in the Division of Medicine, a role he still serves. During this time, he has also served as Executive Director of the Palliative Research Group.  He has a joint appointment in the University of Texas Graduate School of Biomedical Sciences.  Dr. Bruera specializes in palliative care and symptom management: his department’s research program focuses on the multi-disciplinary treatment and management of burdensome physical symptoms and/or psychological distress from cancer and/or the cancer treatment itself, with services offered to the patient and to the family.  Dr. Bruera has served as a principal or coinvestigator on randomized controlled trials of patients presenting with multi-dimensional problems, as well as various psychosocial, spiritual, and existential issues requiring holistic end-of-life care.  He has extensive experience in conducting single-center and multicenter randomized control trials.  He and his research teams have published research findings in over 550 peer-reviewed articles in the leading journals in oncology and supportive care.  Dr. Bruera has been instrumental in broadening the acceptance of palliative care at MD Anderson and beyond through his work with external committees and organizations.  He has also experimented in innovative ways with providing leadership support for wellness initiatives for his department’s faculty and staff.

 

Major Topics Covered:

Personal background and education

Research: pain management; assessment of patient needs;

History of palliative care and its recognition by mainstream medicine; palliative care as a “fringe discipline”; strategies for promoting acceptance of the field; the importance of institutional structures and support; communicating with mainstream disciplines; developing a clinical service supported by research; relationship of palliative care to other care disciplines; the future of palliative care

Disease-centered patient care versus patient-centered care; MD Anderson’s commitment to these approaches

Leadership practices: building a department; building teams; fostering collaborative leadership;

Burnout in palliative care; strategies to address it

Service to the World Health Organization and to the International Association for Hospice and Palliative Care

Spiritual dimensions of leadership and palliative care

 

About transcription and the transcript

 

This interview had been transcribed according to oral history best practices to preserve the conversational quality of spoken language (rather than editing it to written standards).

The interview subject has been given the opportunity to review the transcript and make changes: any substantial departures from the audio file are indicated with brackets [ ].

In addition, the Archives may have redacted portions of the transcript and audio file in compliance with HIPAA and/or interview subject requests.

The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.


Table of Contents

 

Interview Session One: August 6, 2018

 

Learning to See the Human Side of Medicine
Chapter 01 / Personal Background

 

Turning to the Human Side of Medicine: “An Impeccable Diagnosis is Not Sufficient”
Chapter 02 / Educational Path

 

 

Working “On the Fringe”: Establishing Palliative Care as a New Area of Service
Chapter 03 / Professional Path

 

 

Building Teams by Building Culture and Developing Collaborative Leadership
Chapter 04 / Building the Institution

 

 

“Coming to MD Anderson Was Almost an Obligation”
Chapter 05 / Joining MD Anderson/Coming to Texas

 

 

Establishing Palliative Care at MD Anderson: First Challenges
Chapter 06 / Building the Institution

 

Interview Session One: August 13, 2018

 

 

Starting a Palliative Care Service
Chapter 07 / Building the Institution

 

 

Growing Through Balance in Clinical and Research Activities
Chapter 08 / Building the Institution

 

 

Shifting the Perception of Palliative Care and Related Services
Chapter 09 / Building the Institution

 

 

Palliative and Supportive Care in a Changing Institution
Chapter 10 / Overview

 

 

Creating a Department Culture of Support and Wellness
Chapter 11 / Building the Institution

 

Interview Session Three: November 5, 2018

 

 

Committee Service: An Issue of Leadership and a Voice for Palliative Care
Chapter 12 / Overview

 

 

Building the IAHPC [International Association for Hospice and Palliative Care] and the Challenges of Cross-Cultural Care
Chapter 13 / Overview

 

 

Committee Work, Care Guidelines, and ASCO Acceptance of Palliative Care
Chapter 14 / Overview

 

 

The Future of Palliative Care
Chapter 15 / Overview

 


 

Chapter Summaries

Interview Session One: August 6, 2018 (listen/read)

 

Chapter 00A: 
Interview Identifier (listen/read)


Chapter 01  (Personal Background)
Learning to See the Human Side of Medicine   (listen/read)

Codes

  • Personal Background
  • Character, Values, Beliefs, Talents
  • Personal Background
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences
  • Professional Values, Ethics, Purpose
  • Understanding Cancer, the History of Science, Cancer Research

Dr. Bruera begins this chapter by sketching his family background and experiences growing up in Rosario, Argentina. He talks about the impact of his father’s work as a cardiologist. He explains his father’s interest in both research and, most particularly, in clinical work. His father’s discussions of interactions with patients and ethical issues enabled Dr. Bruera to see the “human side” of medicine very early.

Next, Dr. Bruera explains that cancer was “a big taboo” when he was in his early medical career. He talks about the fear of the disease, prohibitions against speaking about it, and his early commitment to contribute to addressing this challenge.

Next, he sketches his interest in sports in school. He talks about the importance of his interest in soccer, a team sport, and the “communist” attitude he took toward coaching children’s soccer.



Chapter 02  (Educational Path)
Turning to the Human Side of Medicine: “An Impeccable Diagnosis is Not Sufficient”   (listen/read)

Codes

  • Personal Background
  • Faith
  • Character, Values, Beliefs, Talents
  • Personal Background
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences
  • Professional Values, Ethics, Purpose
  • Healing, Hope, and the Promise of Research
  • Human Stories
  • Offering Care, Compassion, Help
  • Professional Practice
  • The Professional at Work

In this chapter, Dr. Bruera begins to sketch his medical education. He begins by explaining his selection of a medical school and the education he received (MD conferred, 1979; Universidad de Rosario, Rosario, Argentina). He also speaks about professors who had a great impact on him and how he keeps their influence in mind through keepsakes in his office. He describes this as an important kind of ritual and symbolism he integrates into daily life.

Next he describes shifts in his interest in medicine. He began, he explains, with a fascination with disease and how it causes processes to break down in the body. However, as his clinical experience deepened, he became more interested in “the person around the problem.” He tells several anecdotes from his oncology training that inspired him to shift his focus (Certificate of Specialist, 1984 or 1982, Medical Oncology, Universidad del Salvador, Buenos Aires, Argentina). He explains that his director cautioned him against focusing on what was a “fringe area” at that time.



Chapter 03  (Professional Path)
Working “On the Fringe”: Establishing Palliative Care as a New Area of Service   (listen/read)

Codes

  • Overview
  • The Researcher
  • Survivors, Survivorship
  • Patients, Treatment, Survivors
  • Discovery and Success
  • Leadership
  • On Leadership
  • Mentoring
  • On Mentoring
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences
  • Professional Values, Ethics, Purpose
  • The Researcher
  • Professional Practice
  • The Professional at Work

In this chapter, Dr. Bruera talks about his work at the Cross Cancer Institute in Edmonton, Canada. He talks about Dr. Neil MacDonald, the Institute Director, who brought him in on a fellowship to begin to establish palliative care.1 He explains that Dr. MacDonald wanted to put patient experience at the center of the Institute’s services. He then describes the situation on the ground with attention to patient experience and how, through surveys and research, he and a team began to establish evidence based approaches for addressing pain and other dimensions of the cancer experience. He also talks about the pushback against these efforts and how publications documenting evidence were effective in building acceptance. Next, Dr. Bruera discusses why it has taken so long to develop the “fringe area” of palliative care and to build acceptance for it.

He then discusses his team’s most significant accomplishments during his 15 years at the Cross Cancer Institute. He talks about the development of the Edmonton Injector for delivery of pain medication, the discovery of how effective it is to shift a patient’s pain medications, the discovering of methadone’s effectiveness as a pain medication. He also talks about the value of discovering that team work is the best way to deliver care.



Chapter 04  (Building the Institution)
Building Teams by Building Culture and Developing Collaborative Leadership   (listen/read)

Codes

  • Overview
  • Leadership
  • On Leadership
  • Professional Practice
  • The Professional at Work
  • MD Anderson Culture
  • Working Environment
  • Collaborations
  • Professional Values, Ethics, Purpose
  • The Researcher

In this chapter, Dr. Bruera talks about the lessons he learned about building teams at the Cross Cancer Institute, a model he brought to MD Anderson. He begins by describing the environment needed for a functioning team (a safe place where everyone has a voice and works for consensus) and uses the metaphor of a “symphonic concert” to characterize the working relationship that results.

Dr. Bruera then makes the connection to teams he has set up in the department at MD Anderson, saying that “we depend on people referring patients to us” and this kind of team ensures the quality of care that brings in new patients. He notes that the department makes operational changes eight to ten times per year, assessing the results. He describes how the department plans and manages these change processes and gives several examples, including a “failure” that required the department to return to a former procedure.

Next, Dr. Bruera talks about the stresses of palliative care and the support the department has created to address this. He shows two informative handbooks on self-care distributed to all department members.

Dr. Bruera then talks about his view that burnout and stress are linked to the “superstar model” of how resources and prestige are assigned in departments. He says that too much of medicine is geared toward supporting the individual. He talks about how Palliative Care balances expectations among the faculty to establish a more equitable and less ego-centered culture more geared to team work. He discusses how he has shaped his own persona as a leader to role-model this mentality.



Chapter 05  (Joining MD Anderson/Coming to Texas)
“Coming to MD Anderson Was Almost an Obligation”   (listen/read)

Codes

  • MD Anderson Culture
  • Leadership
  • On Leadership
  • Professional Practice
  • The Professional at Work
  • MD Anderson Culture
  • Working Environment
  • Collaborations
  • Professional Values, Ethics, Purpose
  • The History of Health Care, Patient Care
  • Multi-disciplinary Approaches
  • Multi-disciplinary Approaches
  • MD Anderson Impact

 

In this chapter, Dr. Bruera discusses how and why he left the Cross Cancer Institute to come to MD Anderson in 1999. He notes that twenty years ago there was not much understanding the United States about palliative care. He received a call from Andrew von Eschenbach inquiring whether he would bring the knowledge he had developed at Cross Institute to MD Anderson. Dr. Bruera describes his interactions with people at MD Anderson, the types of anxieties they expressed about bringing in this new perspective, and what he found exciting about the opportunity. Dr. Bruera notes that, given MD Anderson’s reputation, if he could establish palliative care, he would be able to have an impact on other institutions as well. As a result, he felt that it was “almost an obligation” to take the position at MD Anderson.



Chapter 06  (Building the Institution)
Establishing Palliative Care at MD Anderson: First Challenges   (listen/read)

Codes

  • Overview
  • Institutional Politics
  • MD Anderson Culture
  • Leadership
  • On Leadership
  • Professional Practice
  • The Professional at Work
  • MD Anderson Culture
  • Working Environment
  • The Researcher

In this chapter, Dr. Bruera sketches what services existed at MD Anderson when he arrived in 1999. He notes that his mandate from Dr. John Mendelsohn [oral history interview] and Andrew von Eschenbach was to recreate what he had accomplished at Cross Cancer Institute on a “huge scale,” including a research component as well as a clinical service. He explains that his own personal goal was to establish an intensive inpatient unit for care of suffering as well as an outpatient clinic for supportive care, a combination that was virtually non-existent in the United States at that time.

Next, Dr. Bruera discusses how some of his expectations for beginning this new enterprise were immediately compromised because of Andrew von Eschenbach left the institution and there were other leadership changes that eliminated the sources of administrative support he had expected.

Interview Session Two: August 13, 2018 (listen/read)

 

Chapter 00B: 
Interview Identifier (listen/read)



Chapter 07  (Building the Institution)
Starting a Palliative Care Service   (listen/read)

Codes

  • Institutional Politics
  • MD Anderson Culture
  • Leadership
  • On Leadership
  • Professional Practice
  • The Professional at Work
  • MD Anderson Culture
  • Working Environment
  • The Researcher

In this chapter, Dr. Bruera begins the story of how he set up an entirely new palliative care service upon arriving at MD Anderson. He begins by reviewing some of the context discussed at the end of the last session. He anticipated support from Dr. John Mendelsohn and Dr. David Callendar, but administrative shifts brought in new individuals for him to report to. He describes how this shifted perception of this new initiative to bring in palliative care from “the executive leadership wants it” to “this newcomer, .

Dr. Bruera wants it.” He describes a conversation with John Mendelsohn that resulted in transferring the Palliative Care Department to the Division of Cancer Medicine under Dr. Waun Ki Hong [oral history interview]. Dr. Bruera then describes how he began to operate in this situation and the importance of a very positive external review of the program conducted in 2003 0r 2004, which enabled Dr. Bruera to go to Dr. Hong with concrete evidence of success. Dr. Hong authorized additional resources to build the program.

Next, Dr. Bruera talks about his strategies for assessing the institution’s need for palliative care and support services. He explains why he avoided giving presentations to introduce services.



Chapter 08  (Building the Institution)
Growing Through Balance in Clinical and Research Activities   (listen/read)

Codes

  • Leadership
  • On Leadership
  • The Researcher
  • Institutional Politics
  • MD Anderson Culture
  • On Research and Researchers
  • Professional Values, Ethics, Purpose
  • Fundraising, Philanthropy, Donations, Volunteers
  • Professional Practice
  • The Professional at Work
  • MD Anderson Culture
  • Working Environment
  • Collaborations
  • Multi-disciplinary Approaches

In this chapter, Dr. Bruera talks about the challenges his faculty face balancing research efforts with substantial clinical responsibilities. He notes that developing research was essential to building the credibility of palliative care, but with few faculty, it was difficult to organize adequate time to conduct studies. Dr. Bruera explains a creative approach he took, establishing international partnerships to gather data. These studies then served as the foundation for two of the department’s 3 RO-1 grants.

Next, he explains the department’s growth pattern, noting that as a “fringe” department, he was never provided funds and resources in anticipation of growth. However, he notes, the department demonstrated it could sustain itself, which led to additional resources. Dr. Bruera then discusses strategies the department instituted so faculty, fellows, and staff could support each other in this stressful environment. He notes that his department is one of the most successful and research-productive in the country. He comments on Dr. Waun Ki Hong, Division head, as a fair leader. .

Dr. Bruera also sketches the egalitarian culture he has established in the department and shares his view that clinical work is an essential counterpart to conducting research in the field of palliative care.



Chapter 09  (Building the Institution)
Shifting the Perception of Palliative Care and Related Services   (listen/read)

Codes

  • Overview
  • Leadership
  • On Leadership
  • MD Anderson Culture
  • The Researcher
  • Professional Practice
  • The Professional at Work
  • Working Environment
  • Collaborations
  • Multi-disciplinary Approaches
  • Survivors, Survivorship
  • Patients, Treatment, Survivors
  • Institutional Mission and Values

Dr. Bruera note that by 2008 and 2009, after a decade, the institution was more comfortable with palliative care. However, because the department had a perception problem, being known as a kind of “pre-hospice” with the result that clinicians were sending them patients too late in treatment. Dr. Bruera explains a survey the department conducted to assess the impact of the names “palliative care” versus “supportive care.” Fewer than 30% said they would feel comfortable sending patients who were early in their treatment process to palliative care. He explains that that he was able to obtain official approval to change the name of the patient center and the mobile teams, and within six months the services had grown by 41%.

Next, Dr. Bruera talks about the wide range of patient issues that supportive care addresses. Dr. Bruera also explains that the Department’s growth in business came exclusively from word of mouth referrals of patients and their success was totally unplanned by the institution. He notes that over the past eight years, the supportive care program has been the fastest growing program at MD Anderson, despite the resources that the institution has devoted to growing other areas.



Chapter 10  (Overview)
Palliative and Supportive Care in a Changing Institution   (listen/read)

Codes

  • Leadership
  • On Leadership
  • Overview
  • MD Anderson Culture
  • The Researcher
  • Professional Practice
  • The Professional at Work
  • MD Anderson Culture
  • Working Environment
  • Collaborations
  • Professional Values, Ethics, Purpose
  • Growth and/or Change
  • Institutional Politics
  • Institutional Mission and Values

In this chapter, Dr. Bruera explores how attitudes toward palliative care reflect larger institutional priorities and focus on cancer. He begins by setting the institution’s lack of support for palliative care despite its success, in context of what this says about institutions, the educational backgrounds of leadership, and the traditional disease-focus of cancer centers and other medical practices. He notes that Houston lags behind other cities in shifting this focus. .

Dr. Bruera admits he is disappointed that a person-focus has not “exploded” over the course of his career at MD Anderson and that the institution has remained very disease focused. However he is hopeful, given some statements by new president, Peter Pisters, that this may be about to change and that Dr. Pisters may be shifting the focus away from cancer and the history of cancer to the person who has cancer.

Next, Dr. Bruera responds to a question about institutional changes under fourth president, Ronald DePinho and how they effected the view of clinical practice. Dr. Bruera responds that he saw no real change under Dr. DePinho, as the institution even under John Mendelsohn was very disease focused rather than person focused. He notes again that he has seen a change over the past 6 months, under Peter Pisters, in that palliative care is viewed as more mainstream and essential to treatment. He notes that Palliative Care has saved the institution millions in costs. He notes the work of Ben Nelson in using positive financial data to generate a more up to date view that palliative care and support services are not simply “touchy feely” but useful for a vitally functioning institution.

 


Chapter 11  (Building the Institution)
Creating a Department Culture of Support and Wellness   (listen/read)

Codes

  • Leadership
  • On Leadership
  • Overview
  • MD Anderson Culture
  • Professional Practice
  • The Professional at Work
  • MD Anderson Culture
  • Working Environment
  • Collaborations
  • Professional Values, Ethics, Purpose
  • The Researcher
  • Ethics

In this chapter, Dr. Bruera talks about the practices he has instituted to support faculty, fellows, and staff as the department has growth through very stressful times with challenging workloads. These include creating 100% transparency in decision-making about operations, workflow, and hiring. Dr. Bruera specifies that this is to provide department members with a sense of autonomy and control over their work environment. He also explains his own open-door policy, his views of serving as a role model for the rest of the department, and the use of anonymous surveys to assess the results of decisions and his own performance. He also discusses how the department has assembled a good team over the years, citing the fact that all the faculty have been fellows and trained through a rigorous monthly review process to perform according to the department’s standards for excellence and emotional intelligence. Dr. Bruera shares an anecdote about a VIP patient and how he had full confidence that anyone on call on the supportive care service could provide the appropriate standard of care.

Next, Dr. Bruera talks about the high rates of burnout in palliative care. He also explains how the department has created a culture the values self-care and support among faculty and staff. He explains the department’s self-care handbooks, how they were created and how the department is not reviewing them to make them even more effective. He notes that instituting this kind of self care is good ethical practice for the institution.

In this chapter, Dr. Bruera talks about the practices he has instituted to support faculty, fellows, and staff as the department has growth through very stressful times with challenging workloads. These include creating 100% transparency in decision-making about operations, workflow, and hiring. Dr. Bruera specifies that this is to provide department members with a sense of autonomy and control over their work environment. He also explains his own open-door policy, his views of serving as a role model for the rest of the department, and the use of anonymous surveys to assess the results of decisions and his own performance. He also discusses how the department has assembled a good team over the years, citing the fact that all the faculty have been fellows and trained through a rigorous monthly review process to perform according to the department’s standards for excellence and emotional intelligence. Dr. Bruera shares an anecdote about a VIP patient and how he had full confidence that anyone on call on the supportive care service could provide the appropriate standard of care.

Next, Dr. Bruera talks about the high rates of burnout in palliative care. He also explains how the department has created a culture the values self-care and support among faculty and staff. He explains the department’s self-care handbooks, how they were created and how the department is not reviewing them to make them even more effective. He notes that instituting this kind of self care is good ethical practice for the institution.

 

 

Interview Session Three: November 5, 2018 (listen/read)

 

Chapter 00C
Interview Identifier (listen/read)


Chapter 12  (Overview)
Committee Service: An Issue of Leadership and a Voice for Palliative Care   (listen/read)

Codes

  • Leadership
  • On Leadership
  • Obstacles, Challenges
  • Research
  • Overview
  • Overview
  • Research
  • The Researcher
  • Building/Transforming the Institution

In this chapter, Dr. Bruera sketches his service on institutional committees. He notes some significant lessons he has learned from work as a board member of the MD Anderson Network Association: that organizations that seek to improve their operating systems value the opportunity to work with a highly credible state, not-for-profit institution like MD Anderson.

Next, Dr. Bruera discusses the significance of having palliative care represented on high-level committees and he talks about strategies he has used to build credibility with other committee members whose values and languages for discussing institutional issues are very different. Dr. Bruera stresses the strategy of discussing palliative care with data rather than soft rhetoric about the value of palliative care. He gives examples of what “irritates” administrators about introducing palliative care into the discussion of institutional processes, noting that palliative care’s patient centered approach threatens an administrator’s perception of his/her “area of control.” Another challenge, Dr. Bruera observes, is that there are no models in other institutions of well-established palliative care practices that administrators can look to.



Chapter 13  (Overview)
Building the IAHPC [International Association for Hospice and Palliative Care] and the Challenges of Cross-Cultural Care   (listen/read)

Codes

  • Leadership
  • On Leadership
  • Beyond the Institution
  • Activities Outside Institution
  • Professional Practice
  • The Professional at Work
  • Overview
  • Overview
  • Building/Transforming the Institution
  • The Researcher
  • Cultural/Social Influences
  • Global Issues –Cancer, Health, Medicine
  • Women and Diverse Populations
  • Ethics

In this chapter, Dr. Bruera talks about his work developing the IAHPC [International Association for Hospice and Palliative Care]. He explains that around 2000 he brought the headquarters of this organization to Houston to better manage its evolution and its ability to promote hospice and palliative care globally. He sketches some of the work done to foster regional organization of these care services.

Next, Dr. Bruera discusses the very significant issues that arise when adapting patient centered care to other cultures with different senses of family and social organization, meaning, and spirituality. He gives two main examples.

The first covers differences in practices about disclosing a cancer diagnosis to patients. He notes that in the West, the original practice was not to disclose a diagnosis to a patient/family because of fears surrounding the disease, a practice that changed with shifts in medical ethics.

The second example focuses on challenges in cultures where the family serves as the patient’s advocate and sometimes comes to meet with the care team before the oncologists see the patient. He discusses challenges for Western physicians working in those contexts as well as clinicians from the culture who are educated in Western medicine, but need to adapt back to practicing in their own cultures.



Chapter 14  (Overview)
Committee Work, Care Guidelines, and ASCO Acceptance of Palliative Care   (listen/read)

Codes

  • Overview
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Ethics
  • Offering Care, Compassion, Help
  • Survivors, Survivorship
  • Patients, Treatment, Survivors

Dr. Bruera begins this chapter by talking about his involvement in the WHO’s Cancer Pain Management Committee. He describes the challenges and limitations of working with an intergovernmental organization, then talks about the committee’s work in developing guidelines for both cancer pain management and palliative care, the latter expanding the scope of guidelines to other diseases. Dr. Bruera notes that palliative care was “born out of” cancer suffering, and the expansion of the guidelines underscores a focus on “personhood care” rather than disease based care. He then discusses work on the EAPC [European Palliative Care Committee]. Dr. Bruera then discusses the importance of the Palliative Care Task Force convened by the American Society of Clinical Oncology [ASCO]. He notes that acceptance by ASCO around 2012 marked an important moment in the mainstreaming of palliative care. CLIP He makes some final comments on the fact that palliative care is not exciting to organized medicine, which is fixated on cure.



Chapter 15  (Overview)
The Future of Palliative Care   (listen/read)

Codes

  • Definitions, Explanations, Translations
  • Overview
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Offering Care, Compassion, Help
  • Survivors, Survivorship
  • Patients, Treatment, Survivors
  • Human Stories
  • Post Retirement Activities
  • Multi-disciplinary Approaches
  • Personal Background

Dr. Bruera first talks about his dream for the evolution of palliative care. He says he would like to large, centralized and multidisciplinary supportive care services available to all patients at institutions, with care programs tailor made for each individual. He explains why the idea of multi-disciplinary supportive care is controversial for traditionally-trained clinicians. He acknowledges that medicine is far from reaching this dream.

Next, Dr. Bruera notes how proud he is of the many individuals he has mentored in the Department. He then talks about the challenges he sees as the field moves forward. First he talks about the danger of palliative care attempting to “be everything to everyone.” He explains the importance of staying focused on suffering brought about by cancer and other diseases. Next he talks about the challenge of convincing organized medicine and the healthcare system to embrace palliative care.

Next, Dr. Bruera explains how this process is connected to administrative structures in organizations. He also offers his evolutionary schema of how palliative care is accepted after processing through several stages he bases on Elizabeth Kubler-Ross’s phases of grief: denial; palli-phobia; palli-lalia (nonsense talk with no action); palli-active. He notes that most of the nation is in the stage of “palli-lalia”. .

Dr. Bruera concludes the interview by saying he is optimistic about the future of palliative care and its acceptance.