Fabian Johnston, MD, MHS
Johns Hopkins School of Medicine
RISE Cohort 6
As a surgical oncologist who focuses on gastrointestinal and hepatobiliary malignancies I am allowed a look behind the veil of oncology care. I get to see the very highest highs and the lowest pits of despair patients and their families face as they travel the road that is paved with a cancer diagnosis. While traveling this path with patients I encountered the positive effect palliative and end of life care can have on these patients if utilized in a timely and manner. Unfortunately, I also saw the barriers to use put forth by patients and families, physicians and society to the use of adequate end of life care. For minority populations this use is even worse creating a disparity within a disparity.
As I grew in my career I felt a heavy burden to create change for these patients and their families. I felt that it was just the right thing to do yet not enough people were doing it. This could be looked at through the guise of quality and safety, disparities, implementation or policy work, but at the base I felt humanisticially patients with cancer shouldn’t die in pain, with their symptoms unmanaged and without adequate mental and familial support. In my opinion cancer is the most cognitively difficult diagnosis to have. As such a holistic approach is needed and I felt that better means to overcome barriers to use were needed. Similar to disparities work much of our current research in the field is focused on the baseline in disparities it is showing the existence of the phenomenon and in palliative care research it is proving its effective. My work aims to focus on the baps in research namely best tools for implementation (tools no good if you don’t use it), measurement of patients, providers, and health system variables and development and testing of interventions in prospective and longitudinal fashion. In brief, there is a desperate need for higher quality, more affordable, patient-centered care for severely ill and dying patients. Palliative care (PC) is known to reduce physical and psychological symptoms, improve quality of life and overall survival in patients with advance malignancies. Ultimately, I hope to expand this work to larger population and integrate my findings into the larger healthcare landscape.