Clinical Research

by Janie Chen

Dr. Susan Enguidanos of the Gerontology department has taken multidisciplinary research to a new level. Though Dr. Enguidanos primarily does research in palliative care, she has intertwined cognitive psychology with social work. Her innovative work has been so groundbreaking that Kaiser Permanente facilities have implemented her model for palliative care around the nation.

Palliative care is an area of healthcare that focuses on relieving and preventing the suffering of patients. It is appropriate for patients at all stages of disease and traditionally undertakes pain and symptom management. Dr. Enguidanos’ new twist takes palliative care deeper and extends it beyond pain management. Instead, she has pioneered the idea of providing care for total pain, including care for psychological and spiritual needs along with physical ones.

This care empowers the elderly by allowing them to take care of their own problems through the use of problem solving. The elderly are taught to use small stages to accomplish their goals; sometimes these step-by-step exercises are reward based.

Though this new model may not seem modern or revolutionary at first, in comparison with the outdated original it has changed the field of palliative care. The traditional model fixed patient issues superficially at best. This model would only tell the patients what to do to fix their problems but what the patient truly desired was never known. The new guide helps them regain control over their problems without becoming dependent on their care managers.

In one case, an overwhelmed elderly man had not bathed for days. According to the old model, the care manager who was assigned to help him would have told the man to take a shower and clean his house. The new model, on the other hand, had the care manager sit down with the man and talk through his problems, asking him exactly why he had not bathed in days. It was found that the man felt isolated socially. Following Dr. Enguidanos’ model, the care manager helped the man figure out how to rejoin the local senior center and reestablish a relationship with his estranged daughter. The new method gave the man a chance to restart his life, whereas the old method would have only given him another burden.

Kaiser Permanente’s multi-site testing of Dr. Enguidanos’ new model of end-of-life care for chronically and terminally ill patients dramatically alters palliative care. The model brings hospice care that is only available to those who agree to relinquish the option of aggressive treatment, into the home and provides extra services like physical and music therapy to enhance the quality of patient life. In addition, this option is offered to people who have a year or less to live instead of the six months that hospice care requires. Patients who choose this option do not have to abandon aggressive treatment; instead, they can receive the benefits of both. This gives them a more holistic type of care.

“Our healthcare system has communication issues, different systems don’t communicate and nothing is holistic which is why our healthcare system is extremely costly and has earned the reputation of being a silos,” said Dr. Enguidanos. “The only place there is any care like this is primary care but specialists don’t communicate with primary care physicians. Palliative care can cut across this silos.”

Dr. Enguidanos’ work has truly changed healthcare for the elderly and those who are in need of end-of-life care. She currently teaches Psychological and Social Aspects of Death and Dying, End-of-Life Care and Continuum of Care: Systems Perspective and has a joint appointment with the USC School of Social Work.

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