IU Simon Cancer Center Indiana University

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Professor, Indiana University School of Nursing
Co-director, Research in Palliative and End-of-Life Communication and Training (RESPECT) Center

Walther funding helps advance supportive oncology

In Indiana, the Walther Cancer Foundation is funding watershed work in supportive oncology, a field of care that provides specialized support for seriously ill cancer patients and their families.

One of the new breed of specialists in this field is Susan Hickman, PhD. A geriatric psychologist by training, she is based at Indiana University School of Nursing where she studies ways to improve the lives of seriously ill cancer patients and their families through the advance care planning process. She is a professor of nursing as well as co-director of the Research in Palliative and End-of-Life Communication and Training (RESPECT) Center on the IUPUI campus.

Hickman is on a mission to educate medical professionals how best to help seriously ill patients and their family members make informed, values-based treatment decisions. She also is committed to raising awareness of and promoting advance care planning tools in Indiana.

“Walther has funded me twice. I am a grateful recipient of their support,” she says. “It is so important to improve advance-care planning for cancer patients and their families.

Studying how patients make treatment decisions

With a three-year grant from the Walther Cancer Foundation (2010 – 2013), Hickman researched the decision-making processes of cancer patients and their families.

“So often, people don’t even know there are treatment decisions to be made. People sort of slide along, and they don’t have conversations about treatment decisions fit with their goals or what the trade-offs are.”

This sort of medical “decision cascade,” where one important decision quickly leads to another, often without a pause, is a source of tremendous anxiety for patients and families. As a result, Hickman says, “Often the families, the survivors, are left feeling that they somehow left their loved one down.”

This funding from Walther helped Hickman develop methods and generate preliminary data that led to funding from the National Institutes of Health to study decision quality.

Training healthcare professionals

A second grant from Walther (2016-2019) is now enabling Hickman to focus both on teaching the essentials of advance care planning to Indiana’s healthcare community and on raising awareness of the issue.

“The training for physicians and other health care professionals is, I don’t want to say non-existent, but it was not a routine part training for most,” Hickman explains. “Advance care planning requires skill. It’s not something that most people can do well without training and practice. And unsurprisingly, in most settings, it does not happen in any sort of systematic, consistent way.”

With help from the Walther Cancer Foundation, Hickman seeks to remedy this. She will be offering training physicians and other medical professionals on best practices to support advance care planning. She is also producing a video to provide patients and families with foundational knowledge about life-sustaining treatment decisions.

A community leader

As well as her work with the RESPECT Center at IUPUI, Hickman has been a leader in the Indiana Patient Preferences Coalition. The IPPC, a group encompassing professionals in health care, medical ethics, law and senior services, was instrumental in ensuring the availability of the Indiana Physician Orders for Scope of Treatment (POST) form. The POST form is used to document the treatment preferences of seriously ill patients as standardized, actionable orders that can be followed throughout the health care system.

Hickman is also the appointed chair of the Indiana Palliative Care and Quality of Life Advisory Council, a legislatively authorized advisory council overseen by the Indiana State Department of Health. The American Cancer Society Cancer Action Network was responsible for championing this legislation both in Indiana and around the country with the goal of improving cancer patients’ quality of life. The Council is dedicated to making policy recommendations that concern palliative care in Indiana.

Honoring choices

Susan Hickman’s work is in line with the core values of the Walther Cancer Foundation.

As a researcher, Hickman is committed to helping seriously ill patients and their families make informed, values-based decisions, and to ensuring those decisions are honored. From her early clinical training, she has witnessed the systemic barriers in healthcare environments, and she has experienced first-hand the suffering of families. Medical professionals are committed and caring people doing their very best, she says, but much work remains to be done.

“We cannot overstate the importance of philanthropic organizations like Walther in their support for moving the medical community forward. We are really fortunate to have the Walther Cancer Foundation in Indiana.

“Ultimately, my goal is for advance-care planning to become the standard of care in our state. And that we have systems and processes in place that support high-quality advanced-care planning for all patients.”