LIVE FROM THE 10th EAPC WORLD RESEARCH CONGRESS IN BERN . . .
Highlights of every EAPC Congress are the EAPC Researcher Awards, which recognise and support the work of scientists and clinicians who make an outstanding contribution to palliative care research.
Earlier today, Dr Thomas W LeBlanc, Associate Professor of Medicine at Duke University School of Medicine, North Carolina, USA, received the 2018 EAPC Clinical Impact Award. Here, he talks about his work as medical oncologist, palliative care physician and patient experience researcher.
What is your main research interest?
Dr TW LeBlanc: The primary focus of my research is to generate greater understanding about what patients go through when facing a serious illness, and to develop and test interventions that improve upon their experiences of illness. Since I’m a practising oncologist and leukaemia specialist, my work often focuses on patients with hematologic malignancies, and their caregivers.
Can you tell us a little more about this? In particular, how your research explores the experience of patients and families?
TWL: There’s so much more to medicine than just the biology. I’ve long been interested in what many would call the ‘softer sciences’ for they examine many of the more profound issues that drive patients’ experiences of illness. For example, I often think about how we can help patients and families better understand their medical situation, how we can improve our communication of complex information, and also how we can better support them emotionally as they attempt to cope with difficult news. Similarly, some of my work examines patients’ experiences much more tangibly, around issues of symptom burden, overall quality of life, and psychological distress. These are objectively measurable constructs, yet they are also much less tangible in the clinic than a blood chemistry or a platelet count. Despite this, these factors are just as important to that person, perhaps more so, than the biomedical, at least in terms of how they feel and how they experience their illness each day. Ultimately, this is what my research is all about.
What was the most unexpected finding in your recent research projects?
TWL: What often surprises me the most is what’s said, or not said, to patients and families during a clinical encounter. Listening to audio recordings of these encounters is fascinating, especially when one has the subsequent opportunity to talk with the patients and the clinicians separately about what they were thinking about at the time, and how they experienced that encounter. So much goes unsaid, or just isn’t heard, or perhaps isn’t understood as intended. It has given me a great appreciation for how difficult it is to convey complex information in ways that patients can fully understand and apply to their lives and to do so with empathy and compassion.
A corollary is that I’m also often surprised at how little we really understand about what our patients go through. As someone who prescribes high-dose chemotherapies to patients with acute leukaemias, who has seen and managed the resultant side effects, I thought I had a pretty good grasp on what my patients are facing. But when we applied objective scales to this population, to assess symptoms, quality of life, and distress, and then interviewed many of these patients over time, I learned that things are often much worse than I had thought (and worse than my patients were willing to tell me).
This has made it very clear to me that palliative care and patient experience research are sorely needed in medicine, particularly in cancer care, and that there remain many opportunities to improve upon standard care practices in supporting patients and families through these difficult experiences.
Who or what inspired you to take up work in this area?
TWL: Ultimately, what inspired me to work in palliative care, oncology, and patient experience research was a series of rather awful experiences I had as a medical student and trainee. I repeatedly saw people die in ways they wouldn’t have wanted, on machines, in the hospital, away from home, with diseases that everyone knew weren’t going to get better with aggressive care. I saw conflict, poor communication and sometimes, even arguments, between incredibly hard-working, caring, brilliant clinicians, and similarly loving, caring family members. And though I often asked “why?” I never heard a satisfactory answer. So I set my sights on trying to figure out a way to do something about it.
I’ve also been very fortunate to learn from some incredible people over the years, and they’ve played a central role in inspiring me to do what I do. While I cannot name them all, there have been two particularly influential mentors who have made my early career successes possible. Amy Abernethy, who put palliative care clinical trials on the map in the US, taught me so much about how to do research, how to write, how to mentor, and how to lead. Similarly, James Tulsky has played a very influential and formative role in my career path. Before meeting James, I hadn’t even heard of palliative care. I also hadn’t realized I could actually study what happens in the examination room, and that what people say (and how they say it) can be rigorously studied, or that clinicians can be trained in communicating well (and it actually works!).
These insights transformed me from someone who thought they hated research (because to me that just meant pipetting things in the lab), to a person who proudly wears the badge of ‘researcher’ today.
You have achieved a great deal in a short time. What were some of the unexpected hurdles and what were some of the unexpected benefits you have encountered?
TWL: Career paths in academic medicine are quite circuitous, by definition. My path has been no less winding and perhaps is a bit more tortuous than that of others. What perhaps surprised me the most over the years though is the realization that medicine affords us with a tremendously wide range of opportunities, such that nearly anything is possible. If you have an idea, and you can convince others of its importance (and thus get funding for it!), then you can make it the focus of your work. And if it doesn’t work out, there are so many other opportunities to change direction.
I’ve met many people who’ve had three or four different ‘careers’ in medicine, from education, to research, to administration, and even industry, with marked changes in their paths over time. There are few other jobs where that’s possible. And there are even fewer where one is afforded the privilege of being able to enter into people’s lives during a difficult, emotional time, and to be able to do something that makes a significant difference. It’s so incredibly rewarding to practise medicine, and for me, applied research is just an extension of that. I hadn’t anticipated some of these remarkable benefits and experiences years ago as a premedical student. Now, I can’t imagine doing anything else.
You are actively involved in teaching medical students at Duke. What is the most important message that you would pass on to someone who is just starting out on a career in palliative care?
TWL: There are so many important messages that I try to convey to students and trainees, but perhaps most important of all is this:
Figure out what really bothers you, what you want to change in the world, and what you’d like to fix about medicine, and make that the focus of your life’s work. James said something like this to me many years ago, and it has since resonated with me as some of the best advice I’ve ever received.
What does winning the EAPC Clinical Impact Award mean to you?
TWL: This is really a wonderful honour, and frankly, it’s the type of thing I never expected would be a part of my story. As I reflect upon the path I’ve travelled to get to this point, to me this Award is a sign that I haven’t veered too far off track from something that’s important in the world. It energizes me to continue working hard to improve the lives of people facing serious illness and to increasingly teach and mentor others in doing this kind of work. I’m so very appreciative to the EAPC for this recognition, and am thankful to all those who have helped me along the way and made this possible.
- Read the abstract of Dr Thomas W LeBlanc’s lecture, Integrating palliative care aside curative treatment in hemato-oncological diseases in the EAPC Book of Abstracts for the 10thWorld Research Congress, Palliative Medicine, volume: 32 issue: 1_suppl, page(s): 3-330.
- Contact Dr Thomas LeBlanc by email.
- Twitter: @tomleblancMD
- Follow the EAPC 10th World Research Congress at #EAPC2018.
- Look out for more interviews on the EAPC blog with Dr Lorna Fraser, winner of the 2018 EAPC Post-Doctoral Award, and Ms Anna Collins, winner of the Early Researcher Award.