Palliative Care at Mount Sinai

Palliative Care Newsletter | Spring 2022

leaders, and we’re looking to them to help us understand where opportunities lie, where the areas for innovation are, and where the next area for growth is,” says Dr. Kelley. “This also gives us the opportunity to build a peer network of health care professionals who are tomorrow’s leaders. They are growing together and rely on each

Developing Leaders in Palliative Medicine

other as they develop skills and bump into the inevitable challenges along the way.”

Tom Gualtieri-Reed, MBA; Edith Meyerson, DMin, BCC; Amy S. Kelley, MD, MSHS; Katherine Mark, MD; Nisha Rughwani, MD; Stephanie Chow, MD, MPH; Eileen H. Callahan, MD; and Anup Bharani, MD. Not pictured: Ankita Mehta, MD

The success of the program will be measured by short-term and long-term outcomes, including

Palliative care continues to grow as

In January, Dr. Kelley and Tom Gualtieri-

the successful development of leadership

medical advances provide more effective

Reed, MBA, a partner at Spragens &

skills and the beginning stages of program

treatments, allowing patients to live

Gualtieri-Reed, health care strategists,

innovation. Longer term, the goal is to see

longer with serious illness. The Lilian and

launched a 13-month program to provide

retention and advancement of these skilled

Benjamin Hertzberg Palliative Care Institute,

training to faculty who have been

faculty, who will eventually take on bigger

recognized as a national leader in palliative

increasingly asked to take on leadership

leadership roles at Mount Sinai as their

medicine, has pioneered wide-ranging

roles despite limited business, planning,

programs and innovations take deeper root

programs to meet the needs of patients and

or leadership experience. Seven Palliative

in the Brookdale Department and become

families facing serious illness.

Care and Geriatrics faculty members who

prototypes in the field.

were accepted through a competitive

The program has multiple objectives,

application process are participating in the

explained Dr. Kelley. Participating faculty

program. The training consists of one-on-

will gain leadership skills that will, ideally,

one and group sessions on all aspects of

further their careers, while simultaneously

leadership development.

developing expertise that they can share

that very few were tailored to the skills

The trainees are working closely with Emily

with their colleagues and that will directly

needed that are specific to palliative care

Chai, MD; Audrey K. Chun, MD; and Nathan

benefit their patients. “The program has

and geriatrics,” says Amy S. Kelley, MD,

E. Goldstein, MD, all Vice Chairs in the

complementary goals. What we achieve

MSHS, Vice Chair of Health Policy and

Brookdale Department who oversee clinical

in the growth of each individual directly

Faculty Development in the Brookdale

programs across the Mount Sinai Health

feeds into what we can achieve for our

Department of Geriatrics and Palliative

System and who serve as mentors to the

patients,” she says. “We hope that this

Medicine. “We want to build a program that

program participants.

will become a model for other programs

Developing a dynamic team of leaders to bring forward innovations is a focus of the Hertzberg Institute. “When we looked at leadership training programs, both at Mount Sinai and elsewhere, we realized

develops leaders in both the clinical and health care administrative realms.”

B R O O K D A L E

“We see the participants as tomorrow’s

D E P A R T M E N T

O F

G E R I A T R I C S

A N D

around the country.”

P A L L I A T I V E

M E D I C I N E

electronic medical charts, and performing

Studying Quality of Care Under Medicare Advantage Plans

Mount Sinai Improves Palliative Care Training in Kenya The Icahn School of Medicine at Mount Sinai has been a leader in training palliative care practitioners nationwide. The Center to Advance Palliative Care (CAPC) has trained more than 80,000 clinicians since its

These tasks take them away from their families, support systems, hobbies, and passions that normally reduce their stress.

More than 28 million older Americans are enrolled in Medicare

By learning to make time for good self-

Advantage plans, a privatized version of Medicare that is often less expensive and can offer a wider range of benefits than the traditional government-run program.

Claire K. Ankuda, MD, MPH, Assistant Professor of Geriatrics and Palliative Medicine at Mount

New Wellness Curriculum Aims to Improve Well-Being of Palliative Care Fellows

professional fulfillment.

The one-year curriculum, which began in July 2021, is taught both virtually and in person. During a series of 16 sessions throughout their training year, fellows

Sinai, recently published a study Since the onset of the COVID-19 pandemic,

learn about best practices and evidence-

of care for people enrolled in

stress has increased among health care

based interventions shown to prevent

Medicare Advantage plans vs.

professionals nationwide. This is particularly

burnout, a variety of evidence-based

To help close this gap, CAPC launched

traditional Medicare. The cross-

true in certain specialties, such as palliative

wellness practices including meditation

The John A. Hartford Foundation Tipping

sectional study of 2,119 patients

care, where doctors care for patients and

and mindfulness-based stress reduction,

and about one-third of the people with serious illness have no access to palliative care.

Point Challenge, a nationwide competition

found that family and friends of people who died while enrolled

families facing serious illness. In response to

wellness peer coaching, communication

designed to catalyze the spread of skills,

in Medicare Advantage plans reported lower quality of care in

this, many hospitals are focusing attention

skills training, and therapy-based

ideas, and solutions to improve health care

the last month of life compared with family and friends of those

on wellness, which improves the well-being

supervision. The Brookdale Department

delivery for all people living with serious

who died while enrolled in traditional Medicare.

of doctors and ultimately improves the

surveys the fellows to learn about the kinds

patient experience and health outcomes.

of group activities they feel would be most

illness. In 2021, the Academic Model Providing Access to Healthcare (AMPATH), a consortium of North American Medical

Schools, with members including Lindsay A. Dow, MD, Assistant Professor of Geriatrics and Palliative Medicine, and Global Health at Icahn School of Medicine at Mount Sinai, was a gold winner for its training initiative to improve palliative care in western Kenya.

In Kenya, palliative care services are concentrated in urban areas,

“The heart of my research is trying to understand

of Geriatrics and Palliative Medicine at

how [these] plans impact our

component to the curriculum followed

older population.”

by fellows, who are doctors in training for specialization. The curricular emphasis on

American Geriatrics Society, is part of a body of research

Mulholland, MD, Assistant Professor of

that Dr. Ankuda is conducting to understand general health

Geriatrics and Palliative Medicine, and

care use patterns and specifically how Medicare Advantage

Faculty and Graduate Medical Education

plans shape home health and hospice care. She points out

Well-Being Champion at the Icahn School

that, since Black and Hispanic older adults are more likely

of Medicine at Mount Sinai.

The AMPATH initiative began in May 2018 when the team met with local

to be insured by Medicare Advantage plans, these quality

Kenyan clinicians and educators and proposed a curriculum combining

“We launched this curriculum to improve

differences could lead to racial disparities in care.

fellows’ well-being as they care for patients

The palliative care specialists created a training program for Kenyans,

The primary goal of Dr. Ankuda’s research, which frequently

with serious illness, as well as to develop

including nurses, clinical officers, and physicians as well as community

examines various aspects of Medicare, is to inform public

their leadership skills and empower them

health volunteers. In addition to providing medical skills, training

policy. “How can we ensure that the plans are all providing the

to become change agents driving a

will include management, advocacy, and research skills to prepare

best care possible for people with serious illness? How do we

graduates for roles in administration, government, or academia.

measure that, and how do we set up regulations around that?”

care services. “Our goal is to create clinicians and leaders in the field of palliative care,” says Dr. Dow. “We want to ensure access to treatment, not just to control pain, but to enable patients to live a longer and better life.”

classroom learning and clinical rotations across health care settings.

The goal is for graduates of the initiative to sustain the program by increasing awareness, inspiring new trainees, and expanding clinical services in palliative care. Short- and long-term benefits

she says. “The heart of my research is trying to understand how the plans impact our older population.”

and rock climbing, which encourage social connectedness among their peers.

Mount Sinai is incorporating a wellness

wellness is being spearheaded by Christie

with only 3 percent of health care facilities nationwide offering palliative

beneficial, including yoga, pottery, painting,

To address this, the Brookdale Department

The award-winning study, which was recognized by the

are anticipated.

care, physicians are contributing to their

that examined end-of-life quality

founding in 1999. However, the global need for palliative care is growing,

Lindsay A. Dow, MD

clerical work and other administrative tasks.

Lilian and Benjamin Hertzberg Palliative Care Institute Advisory Board Members

Wellness activities, while encouraged, are not mandatory. health care culture that prioritizes clinician wellness,” Dr. Mulholland says. “It all comes back to patient care. We invest in our doctors and other clinicians so they can take care of themselves and, in turn, their patients.”

Mount Sinai is a leader in initiating and implementing best practices regarding wellness. In addition, as members of the largest palliative medicine training program in the United States, nearly all Mount Sinai graduates advance to leadership positions

Dr. Mulholland cites studies showing that

around the country within 10 years. “It’s

more than 96 percent of palliative care

especially important to train our fellows

doctors find meaning in caring for their

in leadership skills and to put wellness

patients and connecting with them and their

programs in place so that when our fellows

families. However, additional tasks beyond

are in those leadership positions, they can

those involving patient interaction can be

then advocate for resources to train future

stressful as doctors spend hours updating

generations of doctors,” says Dr. Mulholland.

Susie West, Chair Emerita Meryl Rosofsky, MD, Co-Chair Saskia Siderow, Co-Chair Deborah Berg Jeannie Blaustein, PhD, DMin

Beth Dannhauser Peggy Danziger Joseph Hertzberg David Mitnick Lois Perelson-Gross, DMin

Daniel Rube Stephen Siderow Jennifer Steingart Zena Wiener

Chaplains Provide Support to Palliative Care Patients and Their Loved Ones When patients are coping with serious illness, they often feel overwhelmed by symptoms, pain, and stress. The chaplains at the Hertzberg Institute provide spiritual guidance as well as psychological and emotional support to help patients and their loved ones find comfort and navigate difficult decisions they may need to make.

“Patients and families who experience

Lance Kaplan, MA; Mindy Chettih, JD, LCSW; Edith Meyerson, DMin, BCC; Max Reynolds, MA, BCC; and Evan Zazula, MAPCC, DMin. Not pictured: Sam Haddix, MFA

serious or complex illness may find

listen as they seek, or be reminded of, their

with unit chaplains across the Mount Sinai

themselves in stressful, challenging, or life-

own inner strength.” The chaplains are an

Health System and offer a deeper level of

altering situations and the role of the chaplain

integral part of the Mount Sinai Palliative Care

attention and spiritual support.

is to assist them in finding connection, hope,

team of doctors, nurses, and social workers

meaning, and comfort,” says Rabbi Edith M.

“As chaplains, we sit with those experiencing

who work together to manage symptoms

Meyerson, DMin, BCC, Director of Pastoral

pain—physical, spiritual, emotional, and

and maximize patients’ quality of life.

psychological—and, when possible, we

Palliative care chaplains meet with patients

facilitate moments of connection and

and their loved ones in person, via Zoom, or

wholeness, which ultimately aid in the

by phone. They work in close collaboration

healing process,” says Rabbi Meyerson.

Counseling and Bereavement Services at the Hertzberg Institute. “Sometimes people need guidance, a hand to hold, or an ear to

Lilian and Benjamin Hertzberg Palliative Care Institute Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place, Box 1070 New York, NY 10029 (212) 241-1446 mountsinai.org/care/palliative-care @MSHSGeriPalCare