University of Iowa Supportive and Palliative Care Program

Supportive and
Palliative Care
Program

2 SUPPORTIVE AND PALLIATIVE CARE

Supportive and Palliative Care Program Overview

The University of Iowa Hospitals & Clinics’ Supportive and Palliative Care Program reports
administratively to the Chief Medical Officer of the University of Iowa Hospitals & Clinics. The Program
is based within the Division of General Internal Medicine, in the Department of Medicine of the
University of Iowa Carver College of Medicine. In both inpatient and outpatient settings, the Supportive
and Palliative Care team works with the patient’s primary service to manage pain and symptoms,
provide support in handling emotional stress, and offer spiritual support. The Supportive and Palliative
Care Program provides an enriching experience for our faculty by actively promoting participation in
teaching opportunities, research initiatives, and quality improvement projects. Since its creation in
1999, the Supportive and Palliative Care Program has grown substantially and is now staffed by six
physicians and four nurse practitioners. Three of the physicians are dual-board certified in geriatric
medicine and palliative medicine and two of the nurse practitioners are Adult-Gerontology Nurse
Practitioner (AGNP) certified. The inpatient palliative care service has more than 4,000 encounters
per year. Our patients and families are well supported by an interdisciplinary team consisting of the
following disciplines: physicians, nurse practitioners, supportive care nurses, pharmacists, clinical
psychologist, music therapist, chaplains, social worker and volunteers.

The Supportive and Palliative Care Program also has significant philanthropic support and is working
with University of Iowa Healthcare leadership on plans to create a multidisciplinary Supportive and
Palliative Care Institute.  The Institute’s mission would include responding to the call of the Iowa
legislature and the Iowa Department of Public Health for a statewide resource to assist in building
palliative capacity and standardizing palliative practice across our rural state.

University of Iowa Health Care is consistently ranked among the best locations in the country to train,
work, and receive care by Forbes, U. S. News & World Report, and many other respected outlets. UI
Health Care is affiliated with the University of Iowa and overseen by the Board of Regents, State of Iowa.
UI Health Care is a public teaching hospital and level 1 trauma center located in a midwestern Big Ten
college town in Iowa City, Iowa, surrounded by a population of nearly 80,000. UI Health Care annually
admits more than 36,000 patients for inpatient hospital care. In addition, in fiscal year 2017, University
of Iowa Hospitals & Clinics received nearly 60,000 emergency department visits. One in seven adults in
Iowa rely on Medicaid for health care coverage (Iowa Department of Human Services). Iowa’s nearly 1.3
million rural residents make up over 40% of the state’s population (U.S. Census Bureau). UI Health Care
is the hub of a consortium of ten Iowa non-profit critical access hospitals and strives to enhance access
and provision of quality health care services in rural and underserved communities. UI Health Care is
bound by its mission to serve as a tertiary care center and safety net for all of Iowa’s rural, underserved
and Medicaid populations.

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Supportive and Palliative Care Team

Licensed Independent Professionals

Physicians and Advanced Registered Nurse Practitioners
o Provide Inpatient and Outpatient consults
o Educate rotating learners
o Serve as educational and consultative resources to UIHC staff
o Assist with developing and revising standards of care for Palliative Care patient population

Pharmacists

o Provide consultation on complex symptom management
o Facilitate distribution of medication information
o Assist with medication reconciliation
o Provide didactic education for the Palliative Care team
o Assist with developing and implementing policies and procedures for safe and effective

medication therapy

Supportive Care Nurses

o Establish primary goals of care and facilitate advance care planning
o Explore symptoms and suffering
o Support patients and families through advocacy
o Integrate nursing and palliative care research into clinical practice

Social Work

o Support individuals and families in prioritizing their psychosocial well-being
o Assist patients and families during the most vulnerable and stressful times
o Emphasize the importance of treating the whole person to enhance quality of life

Spiritual Services

o Provide spiritual support and encouragement to patients, families and staff
o Assist patients and their families in coping with serious illness and emotionally difficult times
o Support patients and families when facing mortality, the dying process, and bereavement

Music Therapy

o Provide grief support through music to both patient and family
o Address pain and anxiety through music-assisted relaxation techniques
o Collaborate with interdisciplinary team members to provide psychosocial support to patients

and families

Clinical Psychology Services

Licensed clinical psychologist
o Help optimize mood and behavioral care via assessment and empirically supported
interventions

Volunteers

o Provide a supportive relationship with patients and families who are experiencing a serious
illness

o Provide individual attention to Palliative Care patients and their families

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Outpatient and Inpatient Palliative Care Consult Services

Outpatient consult service is staffed Monday through Friday by either a
physician or advanced practice provider as well as a pharmacist.

Four inpatient teams are staffed by physicians and advanced practice
providers with additional support from a team of medical students, residents,
and fellows. Three teams are staffed continuously, with three providers during
the day, one provider overnight, and one provider on weekends. One team is
staffed by a physician or advanced practice provider uniquely paired with our
supportive care nurses.

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Hospice and Palliative Medicine Fellowship

Eligibility

This is a one-year, ACGME-accredited program open to physicians in multiple specialties who have a
desire to develop skills related to caring for patients coping with serious illnesses.

Fellows

We recruit two fellows each year for the program. The program’s principal goal is to provide trainees
with clinical knowledge and judgement, professional and interpersonal skills, and the abilities necessary
to become a leader in hospice and palliative medicine.

Opportunities

Opportunities- Fellows receive the opportunity to train with multi-disciplinary teams, work with diverse
patient populations and families, and build skills in the comprehensive care of patients in inpatient,
outpatient, and home settings.

Teaching

Palliative Care and Pain Management PGY-2 Pharmacy Residency

The goal of the program is to produce pharmacy specialists to serve as integral members of any
interprofessional team engaging in palliative care, pain management or hospice care.

Learner Rotations

The interdisciplinary palliative care team serves as a teaching site for an average of 60-70
multidisciplinary learners per year. Learners come from many different specialties: anesthesia,
hematology and medical oncology, critical care, family medicine, internal medicine, emergency
medicine, and pharmacy. Learners include fellows, residents, medical students, pharmacy students,
physician assistant students, nurse practitioner students, and students from many other disciplines.

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Philanthropy

The work of our partners at the University of Iowa Center for
Advancement helps connect former trainees, grateful patients
and their families, and the community in supporting palliative
care through philanthropy. Private gifts have created new faculty
and staff positions, such as a professorship within the College of
Pharmacy, supportive care nursing, music therapy, and helps further
the education of our staff. Philanthropy has expanded curriculum
offered to pharmacy, medical and nursing students, and supports the
Hospice and Palliative Care Fellowship program. The generosity of
our community helps the Supportive and Palliative Care Program’s
mission of helping patients and families reduce pain and suffering in
the face of illness.

Scholarship (Grant Funding)

Geriatrics Academic Career Award (GACA)

Health Resources and Services Administration
September 1, 2019 - June 30, 2023
$300,000
PI: Yuya Hagiwara, MD, MACM

Oncology Associated Stress & Individualized
Support: AYA Feasibility Study

American Cancer Society
January 1, 2020 – December 31, 2020
$30,000
Co-PI: Stephanie Gilbertson-White, PhD, APRN-BC (with Aaron
Seaman, PhD)

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Publications

Peer-reviewed papers and journal articles

Atayee RS, Lockman K, Brock C, Abazia DT, Brooks TL, Pawasauskas J, Edmonds KP, Herndon CM.
Multicentered study evaluating pharmacy students’ perception of palliative care and clinical
reasoning using script concordance testing. American Journal of Hospice and Palliative
Medicine. 2018; 35(11): 1394-1401. https://www.ncbi.nlm.nih.gov/pubmed/29690782

Gilbertson-White S, Perkhounkova Y, Saeidzadeh S, Hein M, Dahl R, Simons-Burnett A. Understanding
Symptom Burden in Patients with Advanced Cancer Living in Rural Areas, Oncology Nursing
Forum. 2019 Jul 1;46(4):428-441. https://dx.doi.org/10.1188%2F19.ONF.428-441 . PMIDD:
31225835. PMCID: PMC6642634.

Gilbertson-White S, Shahnazi A, Cherwin C. Are Perceived Stress and Cytokine Genotypes Clinically
Feasible as Predictors of Psychoneuroimmune Symptoms in Advanced Cancer? The Permanente
Journal. 2019;23. https://dx.doi.org/10.7812%2FTPP%2F18-120 . Epub 2019 Jul 8. PMID:
31314714. PMCID: PMC6636494.

Gilbertson-White S, Yeung CW, Saeidzadeh S, Tykol, Vikas P, Cannon A. Engaging Stakeholders in the
Development of an eHealth Intervention for Cancer Symptom Management for Rural Residents,
Journal of Rural Health. 2019 Mar;35(2):189-198. https://doi.org/10.1111/jrh.12297 . PMID:
29696696.

Gilbertson-White S, Yeung C, Wickersham KE. “Just Living with Them”: Symptom Management
Experiences of Rural Residents with Advanced Cancer, Oncology Nursing Forum. 2019 Sep
1;46(5):531-542. https://doi.org/10.1188/19.onf.531-542 .531-542. PMID: 31424451.

Glisch C, Ray JB. Things we do for no reason: Prescribing Tramadol for Pain. J Hosp Med (in press)

Glisch C, Saeidzadeh S, Snyders T, Gilbertson-White S, Hagiwara Y, Lyckholm L. Immune Checkpoint
Inhibitor Use Near the End of Life: A Single-Center Retrospective Study., Journal of palliative
medicine. 2019 November 8. PMID:31702481. https://doi.org/10.1089/jpm.2019.0383

Hagan TL, Gilbertson-White S, Cohen SM, Temel JS, Greer JA, Donovan HS. Symptom Burden and
Self-Advocacy: Exploring the Relationship Among Female Cancer Survivors, Clinical Journal of
Oncology Nursing. 2018 Feb 1;22(1):E23-E30. https://doi.org/10.1188/18.CJON.E23-E30 . PMID:
29350706. PMCID: PMC5841467.

Hagiwara Y, Healy J, Lee S, Ross J, Fischer D, Sanchez-Reilly S. Development and Validation of a
Family Meeting Assessment Tool (FMAT), Journal of Pain and Symptom Management. 2018
January;55(1):89-93. PMID:28843457. https://doi.org/10.1016/j.jpainsymman.2017.07.048

Harmoney K, Mobley EM, Gilbertson-White S, Brogden NK, Benson RJ. Differences in Advance Care
Planning and Circumstances of Death for Pediatric Patients Who Do and Do Not Receive Palliative Care
Consults: A Single-Centrer Retrospective Review of All Pediatric Deaths from 20212 to 2016, Journal of
Palliative Medicine. 2019 Dec;22(12):1506-1514. https://doi.org/10.1089/jpm.2019.0111 . Epub 2019
Jun 21

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Hagiwara Y, Pagan-Ferrer J, Sanchez-Reilly S. Impact of an early-exposure geriatrics curriculum in an
accelerated baccalaureate-MD program, Gerontology & Geriatrics Education. 2018 Apr 23:1-6.
https://doi.org/10.1080/02701960.2018.1464919 . PMID: 29683782.

Khan A, Ali F, Iyengar V, Hagiwara Y, Periyakoi VJ, Patel N, & Malone M. (2018). Cardiovascular
iatrogenicity in older adults. In Iatrogenicity: Causes and Consequences of Iatrogenesis in
Cardiovascular Medicine (pp. 205-217). Rutgers University Press.

Lockman K, Broderick A, Geiger-Hayes J, Uritsky T, von Gunten C. Going from casual dating to a long-
term commitment: Adding a pharmacist to your team (TH363). Journal of Pain and Symptom
Management. 2018; 55(2):585. https://doi.org/10.1016/j.jpainsymman.2017.12.054

McPherson ML, Walker KA, Davis MP, Bruera E, Reddy A, Paice J, Malotte K, Lockman DK, Wellman
C, Salpeter S, Bemben NM, Ray JB, Lapointe BJ, and Chou R. Safe and appropriate use
of methadone in hospice and palliative care: expert consensus white paper. Journal
of Pain and Symptom Management. 2019; 57(3): 635-645. https://doi.org/10.1016/j.
jpainsymman.2018.12.001

Nakad L, Booker S, Gilbertson-White S, Shaw C, Chi N, Heer K. Pain and Multimorbidity in Late Life,
Epidemiology of Aging. 2020 January 23,7:1-8. https://doi.org/10.1007/s40471-020-00225-6 .

Patel P, Lockman K, Broglio K, Calton B, Kullgren J. Hitting the sweet spot: practical tips for navigating
the opioid crisis in outpatient palliative care (FR405). Journal of Pain and Symptom Management.
2018; 55(2):596. https://doi.org/10.1016/j.jpainsymman.2017.12.085

Roeland EJ, Lindley LC, Gilbertson-White S, Saeidzadeh S, Currie ER, Friedman S, akitas M, Mack JW.
End-of-life care among adolescent and young adults patients with cancer living in poverty,
Cancer. 2020 Feb 15;126(4):886-893. https://doi.org/10.1002/cncr.32609 .Epub 2019 Nov 14.
PMID 31724747. PMCID: PMC6992488.

Schulman-Green D, Brody A, Gilbertson-White S, Whittemore R, McCorkle R. Supporting self-
management in palliative care throughout the cancer care trajectory. Current Opinion
in Supportive and Palliative Care. 2018 Sep;12(3):299-307. https://doi.org/10.1097/
SPC.0000000000000373 . PMID: 3006215.

Sunilkumar MM and Lockman K. Practical pharmacology of methadone: A long-acting opioid.
Indian Journal of Palliative Care. 2018; 24(5):10-14. http://www.jpalliativecare.com/text.
asp?2018/24/5/10/223327

Uritsky TJ, Atayee RS, Herndon CM, Lockman K, McPherson ML, Jones CA. Ten tips palliative care
pharmacists want the palliative care team to know when caring for patients. Journal of Palliative
Medicine. 2018; 21(7):1017-23. https://doi.org/10.1089/jpm.2018.0187

Wu J, Gilbertson-White S, Broderick A. College Palliative Care Volunteers: Too Early to Feed the Pipeline
for Palliative Care Clinicians? Journal of Palliative Medicine. 2019 Dec;22(12):1589-1593. https://
doi.org/10.1089/jpm.2018.0662 . Epub 2019 May 9. PMID: 31070488. PMCID: PMC6998045.

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Abstracts (since 2018)

Albashayreh, Alaa; Gilbertson-White, Stephanie; Shamieh, Omar; Al-Omari, Ma’an et al.Seriously Ill Patient
Perspectives of and Attitudes Toward Discussing Goals of Care and Treatment Preferences: A
Qualitative Study in a Middle Eastern Country (S781). Journal of Pain and Symptom Management,
Volume 59, Issue 2, 575 – 576

Fisher LJ, Lockman K, Ray JB. Evaluation of naloxone co-prescribing in ambulatory patients receiving
palliative care. Presented at the American College of Clinical Pharmacy Global Conference on Clinical
Pharmacy, Seattle, WA, October 21, 2018.

Fisher L, Ray JB, Lockman K. What’s the risk? Naloxone co-prescribing in an outpatient palliative care clinic.
(FR440C). Journal of Pain and Symptom Management. 2019; 57(2):419.

Gilbertson-White, Stephanie; Srivastava, SanveshLi, Yunyi; Laures, Elyse; Saeidzadeh, Seyedehtanaz; Yeung,
Chi; Chae, Sena et al. Multimorbidity and Cancer: Using Electronic Health Record (EHR) Data to
Cluster Patients in Multimorbidity Phenotypes (S787). Journal of Pain and Symptom Management,
Volume 59, Issue 2, 579

Glisch C, Ray JB. Vitamin K: Implementing Ketamine as an Adjunctive Analgesic in a Burn Unit Palliative Care
Consult. Presented at Annual Assembly of American Academy of Hospice and Palliative Medicine,
Orlando, FL, March 13, 2019.

Glisch, Chad; Lyckholm, Laurel J; Ray, James B; Hagiwara, Yuya et al. Panacea or Pandora’s Box? Immune
Checkpoint Inhibitors and Palliative Care (TH314). Journal of Pain and Symptom Management,
Volume 59, Issue 2, 413

Lockman K, Broderick A, Geiger-Hayes J, Uritsky T, von Gunten C. Going from casual dating to a long-
term commitment: Adding a pharmacist to your team (TH363). Journal of Pain and Symptom
Management. 2018; 55(2):585.

Lockman, Kashelle; Hagiwara, Yuya; Kooi, Katey; Ries, Katie; Struve, Ann et al. Working Smarter Not
Harder: A Quality Improvement Project to Improve an Interdisciplinary Palliative Care Rotation
(QI642) Journal of Pain and Symptom Management, Volume 59, Issue 2, 522 - 523

Lockman K, Patel P, Broglio K, Kullgren J, Calton B. The opioid crisis and palliative care: tools and strategies
to help turn the tide (P12). Journal of Pain and Symptom Management. 2018; 55(2):552-3.

Miller, Daniel; Vakkalanka, J; Priyanka Swanson, Morgan; Nugent, Andrew; Thomsen, Timothy; Hagiwara,
Yuya et al. Impact of Combining a Code Status Order with Admission Orders for Patients Admitted
Through the Emergency Department. (TH341D) Journal of Pain and Symptom Management, Volume
59, Issue 2, 431 – 432

Pagan-Ferrer, Juan; Swenson, Andrea; Gilbertson-White, Stephanie; Hagiwara, Yuya et al. Integrating
Primary Palliative Care into Early Neurology Resident Education (S735) Journal of Pain and Symptom
Management, Volume 59, Issue 2, 548 – 549

Patel P, Lockman K, Broglio K, Calton B, Kullgren J. Hitting the sweet spot: practical tips for navigating the
opioid crisis in outpatient palliative care (FR405). Journal of Pain and Symptom Management. 2018;
55(2):596.

Weinberg, Richard L; El Zein, Lama; Pagan-Ferrer, Juan; Clevenger, Lauren et al. Breathing, Thinking,
Functioning: Controlling the Dyspnea-Anxiety Cycle (FR435) Journal of Pain and Symptom
Management, Volume 59, Issue 2, 464

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Contact Information

Supportive and Palliative Care Program
University of Iowa Hospitals & Clinics

Phone: 319-467-5426

https://medicine.uiowa.edu/internalmedicine/supportive-and-palliative-care

Other Contacts:

Richard M. Hoffman, MD, MPH Kristin Goedken, MBA
Director, Division of General Internal Medicine Administrator, Division of General Internal
[email protected] Medicine
[email protected]
Timothy A. Thomsen, MD
Director, Adult Supportive and Palliative Care Greg Hamilton, JD
Program Administrative Director, Adult Hospitalist
[email protected] Program and Adult Supportive and Palliative
Care Program
Yuya Hagiwara, MD, MACM [email protected]
Program Director, Hospice and Palliative Medicine
Fellowship Evelyn Kinne, MHA
[email protected] Recruitment Coordinator, Division of General
Internal Medicine
[email protected]

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319-335-0705 (voice), 319-335-0697 (TDD), [email protected].

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