Welcome to My Newsletter: ”And What Else…?“

Greetings! Many of you know me but some of you don’t. For those who don’t, I am Janet Abrahm, MD. I spent the first half of my medical career in hematology and oncology. For the last 25 years, I’ve helped develop the field of palliative care and worked to integrate it into the care of patients with cancer. Many palliative care clinicians consult with oncology teams, but most community oncologists do not have access to palliative care partners. To change this reality, I’m launching my website, JanetAbrahm.com, and this newsletter.

The topics I will cover in upcoming newsletters fall under the typical palliative care question, “And what else?” Things I describe as “on the periphery of oncology training but at the heart of your current clinical challenges.“

My plan is to send newsletters monthly, discussing a topic that has recently emerged in research, one you have asked for in your emails to janet_abrahm@dfci.harvard.edu , or that is discussed in more detail in the Resource section of my website. If you visit the website and click on the Resource tab, you can find four primary subject areas. Here’s a brief introduction to what you’ll see.

Pain and Symptom Management is at the core of care for patients with cancer. Without it, it is difficult to explore any other areas of distress, psychological, spiritual/existential, or emotional. On my website in the Pain and Symptom Management section, you’ll find links to articles, books, podcasts, presentations, videos, and websites that provide information on cannabis, delirium, GI issues, pain in general, methadone, integrative medicine, psychedelic assisted therapy, palliative sedation, and spinal cord compression.

Communications with Patients and Families. Many of us, even palliative care clinicians, can use ongoing training in communicating with patients with cancer and their families. In some of the future newsletters, therefore, you’ll find techniques for breaking bad news (“really bad” news), and how to assess what is going on when patients or families’ questions seem difficult to understand or untangle. You’ll see how to recognize existential suffering as well as your own moral distress. I’ll also include updates that I find interesting and think might be helpful to you. For example, a recent study confirmed the finding that simply sitting down while you talk with the patient improves their scores for communication during the visit and satisfaction with it, without prolonging the time spent there (Iyer et al BMJ 2023:383:e076309).

Special Topics. The more we explore diversity, equity, and inclusion, the more we appreciate the richness of cultures and beliefs held by our patients and their families. Concerns of these communities differ in ways that may impact their cancer care. Some of these Special Topics are their chosen language, health literacy, sexual orientation and gender identity. We provide resources for working with interpreters, who can help you bridge the gap between cultures when you’re discussing the risks and benefits of the next treatment. We also review how to discuss tough issues like sexuality, spiritual concerns such as hope and the impact of religious teachings on the choices your patients and families make about their cancer care, and working with the LGBTQ+ patients with cancer. We currently have on the website and will share in upcoming newsletters videos of conversations with a spiritual leader, a leader in the trans healthcare community, and a LGBTQ+ palliative care physician. I find their insights exceptionally compelling. These resources will help enhance your therapeutic relationships while earning trust.

End of Life and Bereavement. In this difficult area, we offer clues to help patients and their families understand their grief, ways you and your staff can support them in that grief, as well as specific ways to enhance the possibility that their dying will be a comfortable one. We also recognize your own grief as a clinician and directly address clinician burnout — how you can tell if you’re on the way, if you’re there, and what you can do about it. My goal is to update the website consistently with new research and topics you have asked me to include, so please offer feedback!

I do have two asks of you:

1. Let me know if there is a challenging topic you would like me to address in an upcoming newsletter, and
2. Share this newsletter far and wide with anyone you know who might benefit from it, especially community oncologists!

Again, welcome! I am excited to begin our monthly communication. In the meanwhile, please check out my website, www.janetabrahm.com and let me know what is on your mind.

Best,
Janet Abrahm, M.D.

Posted on: November 12, 2024