Oncology Palliative Care at Penn Nursing

TON - May 2018, Vol 11, No 2

The University of Pennsylvania School of Nursing, Philadelphia, also known as Penn Nursing, has been ranked as the number 1 school of nursing in the world for the third consecutive year by Quacquarelli Symonds.

This ranking is based on academic reputation, research impact, and employer reputation. Of all the nursing schools in the United States, Penn Nursing offers the most top-rated master’s programs, advancing the entire profession from practice to policy. Penn Nursing offers undergraduate, transfer, accelerated, master’s, and doctoral programs.

Oncology Palliative Care at Penn Nursing Cancer

The Oncology Nurse-APN/PA (TON) spoke with Salimah H. Meghani, PhD, MBE, RN, FAAN, a faculty member at Penn Nursing, about her various roles and thoughts on what is exciting in the field of palliative care. Dr Meghani is an Associate Professor and Term Chair of Palliative Care; Associate Director of the NewCourtland Center for Transitions and Health; and Chair of the Graduate Group in Nursing; University of Pennsylvania School of Nursing, Philadelphia.

 

TON: What is your job description at Penn Nursing?

Dr Meghani: As a tenured Associate Professor, I contribute to the tripartite mission of the University, which is to generate knowledge through research; teach and mentor the next generation of nurses and nurse scientists; and offer professional services at the local, community, and national levels.

Funded by the generous support of Marla Wasserman and family, the Term Chair of Palliative Care is a recognition for productivity in the field of palliative care. The Term Chair is funded to sustain productivity and develop novel approaches to improving the field of palliative care.

Using these funds, I am developing an intervention to improve the uptake of early palliative care communication between the clinician, the patient, and the family.

Palliative care communication frequently occurs too late. The conversation about prognosis should happen much earlier, because it has financial, caregiving, and treatment implications. Burdens to patients and their families and overtreatment can be prevented if clinicians engage the patient and family about prognosis early on. My research focuses on why there are delays in communication about prognosis and what can be done about it.

My role as Chair of the Graduate Group in Nursing is mainly one of administrative leadership. The Graduate Group in Nursing is a faculty governance group responsible for the overall direction of curriculum development, admission, and progression of the PhD studies.

TON: What are the biggest challenges related to your job?

Dr Meghani: I have many wonderful opportunities within the organization, and, of course, those opportunities come with demands. The most important challenge is not to get too bogged down in details so that "you can’t see the forest for the trees." Balancing my roles in academia, research, teaching and mentoring, and service is the biggest challenge.

TON: What are some of the rewards of your job?

Dr Meghani: I find teaching and men­toring students the most gratifying aspect of my job. I am a palliative care researcher and teach 2 core courses at Penn Nursing’s Palliative Care Minor. I also mentor 4 PhD students, 2 postdoctoral students, and a number of undergraduate students. Teaching and mentoring can bear fruit and change clinical practice more quickly. In the current paradigm of research translation, it can take up to 20 years from conduct of research to translation of the findings into clinical practice.

When my students begin my class, their knowledge of palliative care challenges is rather limited. But over the course of the semester, their perspectives transform palpably and they look at dying in America in a new way. They expand their vision of what they can do to improve the care of dying patients and change policies and practices. I hope to give them a sense that each nurse has a role to play in changing and improving palliative care, because only 1% of all nurses have PhDs.

TON: What do you find most exciting in the field of oncology right now?

Dr Meghani: In general, I am excited about the promise of precision science in individualizing patient care. We have been discussing patient-centered care for a long time, but most therapies are based on “average care,” according to existing research literature. The current paradigm of average care is changing. In addition, with projects such as Joe Biden’s Moonshot and big data efforts, we have newer ways of understanding and thinking about individualizing care for patients with cancer.

Although individualized care takes into account genetics and biology, behavioral, psychosocial, and ecologic factors are just as important to consider. You can have a perfect drug, but it will not be beneficial if patients do not adhere to treatment for these other factors.

I am concerned that some efforts in the field of precision science focus solely on genetics and biology. We need to be reminded that psychosocial, behavioral, and environmental factors are equally important to be considered when individualizing patient care.

TON: Does this involve aspects of a patient’s culture?

Dr Meghani: One cannot make assumptions based on people’s culture. There is vast heterogeneity “within” every culture. In effect, there is more heterogeneity within a culture than between cultures because every individual is different in how they respond to situations. The motivations for going to a gym or taking a drug differ among people and may or may not have anything to do with their culture.

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