The APA division examines psychological theories and their “relevance for scientific and pragmatic applications,” said Morrissey, adding that most members of the group come from academia. She said her main focus will be to “push the boundaries” and nudge the group toward “scholar activism.”

“I see health as the whole being,” said Morrissey, who will be teaching a course on patient-centered care in Fordham’s master’s program in health administration this spring. “We need to ask how we’re designing research and translating it into the field in a way that gives voice to marginalized people.

Part of the way she is hoping to turn theory into action is through collaborations with fields beyond psychology.

She noted that the recent refugee crisis in the U.S., which has split up families impacted people fleeing violence, represents an opportunity for research that will not only help future refugees, but provide important evidence to back up potential policy changes. The effort also brings the society in conversation with nine other APA divisions, she said, as well as many organizations outside APA such as community advocacy groups.

“The exciting thing about this kind of work is that it expands the network beyond the academic community of psychologists so that we’re working closely with social workers, attorneys, ethicists and other APA colleagues,” said Morrissey.

This isn’t to say that practical applications will usurp the group’s mission to advance theory, she said. Rather, immersion in practice—action in the field—will help develop theory.

One example of theoretical work being advanced by the society focuses on dementia, she said. She noted that many healthy people view the experience of those who have dementia as totally negative, an assumption she believes should be challenged.

“We need to engage in more reflective dialogue to do a better job of understanding the lived experience of people with dementia, such as, are they experiencing any joy?” she said. “They may also have a certain type of agency that we don’t understand. We need to challenge assumptions to understand the diversity of their experience better. Here there are also big implications for policy and advocating for a workforce that is equipped to care for people with dementia.”

Another aspect within dementia research that pushes theoretical boundaries is the practice of using personal experience with loved ones as narrative evidence.

“We’re rejecting rigid boundaries between subject and object,” she said, of the practice. This is in contrast to traditional practice, where researchers in psychology generally keep their subjects at arm’s length, lest the work be tainted by familiarity.

“It’s a type of qualitative position to disclose that I have written about my own mom,” she said, referring to Mary Ann Quaranta, Ph.D., former dean of the Graduate School of Social Service, who lived through serious illness near the very end of her life.

“I lived with both my grandmother and my mother through their experience with later-life changes and illness, and I draw on those perspectives in my own research in gerontology,” she said.

“As a qualitative practice, I disclose my positionality, my own experience and perspective, and that’s not viewed as a burden,” she said, though she acknowledges this approach is contested by some.

“It may yield insights about dimensions of the subject’s world that until now remained elusive.

Months into her battle with Alzheimer’s, Jessica Morales’ mom developed aspiration pneumonia—the most common cause of death for Alzheimer’s patients. Breathing problems and infections led to frequent and frustrating trips to the emergency room. Morales knew her mother was dying. But she also knew she needed more extensive care than could be provided at home. So she brought her to Calvary Hospital in the Bronx, where staff treated her physical symptoms and so much more.

“I knew I needed the support to get through this time with her,” said Morales, FCRH ’97, an actress who grew up on the Lower East Side of Manhattan. ““The care there was so different from the beginning.” Hospital staff turned her mother in her bed every two hours, she said, brushed her hair the way she liked, and played her favorite Mexican music to soothe her. “It was an individualized approach.”

“Every time we have a meeting here, everybody’s hugging,” said Michael J. Brescia, MD, FCRH ’54, Calvary’s executive medical director. It’s a side effect, he said, of the culture of the facility, where alleviating emotional and spiritual suffering is as crucial as treating the physical symptoms of disease. “You have to touch your patients. You have to hold their hands. And it’s got to mean something to you.”

Fordham and Calvary have enjoyed a close relationship for years, forged in part by Brescia’s love for his alma mater. “Fordham gave me the gift of faith,” said Brescia, who says a silent prayer each time he enters a patient’s room. That personal connection led to a professional partnership. Fordham faculty have conducted research at Calvary, and Calvary medical staff have lectured in Fordham programs. An October 20 symposium at the University highlighted that research, fostering a discussion on the complex issues surrounding palliative care.

Mary Beth Morrissey, PhD, FCRH ’79, LAW ’82, GSS ’11, a healthcare attorney and researcher, and the director of Fordham’s Healthcare Management Certificate Program in Public Health, Palliative Care, and Long-Term Care, organized the conference.

“The relationship with Calvary is a very meaningful one for Fordham,” she said, particularly when it comes to research. “Our faculty is working across the whole spectrum of palliative care.” In one study, Fordham psychologist Barry Rosenfeld, PhD, and Fordham psychology graduate students explored meaning-centered talk therapy with Calvary patients as a way to provide a sense of peace at the end of life. “We’re trying to understand that palliative care is both medical and social,” Morrissey said.

Insurance companies have been slow to fund palliative care, and so Morrissey and her colleagues aim to put it in the larger context of healthcare reform and value. “This is really about changing a cultural paradigm,” she said. “I think the problem is, in our Western culture, we have been very reluctant as a society to engage in any discussions about limits on care or how we’re going to allocate resources.”

Fixing a Broken System

Presenting the keynote at the October 20 conference was Philip Pizzo, MD, FCRH ’66, pediatric oncologist and former dean of the Stanford School of Medicine. A nationally respected policy advocate, Pizzo has helped lead major studies on palliative care and end-of-life care for the Institute of Medicine: the groundbreaking Relieving Pain in America, published in 2011, and last year’s Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.

“It’s not whether to choose more or less care, but whether to honor individual preferences,” said Pizzo, a microbiology and immunology professor at Stanford and founding director of the university’s Distinguished Careers Institute. And pain, he points out, is not just an end-of-life issue. An estimated 100 million people in America suffer from chronic pain. A few years ago, he became one of them. “It became very personal,” he said of the chronic neuropathic pain he experienced after an injury. “Suddenly I was completely incapacitated, so I absolutely appreciated how it literally saps the energy and the sense of purpose from anyone.”

At Calvary, Brescia and his staff view depression and psychological pain as one of several types of suffering to focus on when caring for patients. Patients also struggle with spiritual suffering, he said, asking themselves, “Is there a supreme God that loves me and knows what I’m going through?” And Calvary staff are equally cognizant of familial suffering. Morales, who slept on a cot in her mother’s room during her stay at Calvary, received a massage through the Family Care Center, which she called “a little haven.” And when her mom died, a Calvary chaplain was there at Morales’ side.

When it comes to physical suffering, hospital staff fight aggressively, Brescia said. Calvary physicians have worked to find alternate methods of delivering opioids for pain relief, and they’ve perfected techniques like using a gastrostomy tube to alleviate nausea common in end-stage cancer patients.

Cost Versus Value

That kind of comprehensive care is not without its costs. Calvary, a nonprofit, loses millions of dollars a year, much of it made up in fundraising. But the world-renowned physician was never in this work for the money.

Before he got involved in palliative care, Brescia achieved fame in the mid-1960s for the Brescia-Cimino fistula, a surgically created connection between veins and arteries used in hemodialysis patients. People came to the Bronx from all over to be treated for chronic kidney disease, he said, and Calvary was beginning to collect full compensation for dialysis so they could build a new facility.

“But I went to tell my father, a little Italian immigrant,” Brescia said. He explained the invention and said that centers would open around the world in a year’s time, and he’d stand to make quite a bit of money. The older man said, “A year? Why a year?” When Brescia explained that it would take time to set up the lucrative contracts, his father asked, “How many die in a year?” Brescia told him 50,000, and his father’s face dropped. “‘Give it away,’” he told his son in Italian. When Brescia protested, his father said, “‘When you shave in the morning, the faces of the children will appear in the mirror, [children]who should be with their parents. They will not be because my son, who I should be so proud of, has to have five cars, five boats, five houses.” Brescia knew his father was right. “I left his house and [we]published [the research].”

Clinicians began using the procedure and contacting Brescia for his expertise. “Doors just opened,” said Brescia, who is considered a pioneer in modern palliative care. “They wanted to hear about all the renal work. The price of that was that they had to hear about the palliative work,” which he was now doing at Calvary. He said he and his colleagues were able to get many federal laws passed “that enabled us to survive and prosper.”

Collaborating on Care

But getting insurance companies to cover the cost of palliative care is still a challenge, despite the empirical evidence that it lowers hospital readmission rates, said Falguni Sen, PhD. Sen directs the Global Healthcare Innovation Management Center at Fordham, which presented the October 20 panel discussion in conjunction with the Fordham Science Council.

“Palliative care, in my opinion, has been the first group that has really tried to look at healthcare in an integrated way,” he said, noting that the Affordable Care Act has given providers some options through which they can include palliative care. He cited new accountable care organizations that accept a total fee for the care and well-being of Medicare patients rather than a traditional fee-for-service arrangement.

Sen said his center, part of the Gabelli School of Business, aims to build on Fordham’s collaborations with Calvary Hospital to explore programs based on these new provisions. He hopes to expand the University’s certificate program in palliative care—which includes Calvary medical staff as instructors—to offer “more skill-based” programs. The University’s Graduate School of Social Service also offers an increasingly popular palliative care program, which has MSW students completing fieldwork at Calvary. And Sen anticipates Fordham faculty from several disciplines wanting to make a difference in the way care is delivered.

“We’ve got to move out of the purely medical care model on palliative care. It’s not just a question of managing pain through medication,” he said. “Pain is something that is so complicated … and it requires care and consideration on so many levels.”

Listen to Dr. Pizzo discuss palliative care and his work at the Distinguished Careers Institute on WFUV’s Fordham Conversations.

With the support of the Graduate School of Business Administration’s (GBA) Global Healthcare Innovation Management Center, and its director Falguni Sen, Ph.D., the Westchester-based Collaborative for Palliative Care will run an intensive two-weekend certificate program this summer and next fall.

“One of the big issues is communication,” said Mary Beth Morrissey, Ph.D., FCRH ’79, LAW ’82, GSS ’11. “Patients and families don’t understand and are often not informed about their palliative care options that are being embedded in the health care structure.”

As a fellow of the center, Morrissey has been leading roundtable discussions about health care reform. With her background in law, policy, and social science research, Morrissey spearheaded the cross-disciplinary program, which brings together nurses, social workers, psychologists, doctors, business owners, and managers in the same classroom.

The program will introduce students to the various aspects of palliative care, including: a public health approach to health care management, the legal and ethical consensus in end-of-life decision making, meanings of patient suffering from a human science perspective, new systems of care, policies and protocols in palliative medicine, clinical management of pain, advance care planning, models of financing, and the role of ethics committees in conflict negotiation.

Morrissey said that after the latest health care debate there’s a consensus that “we need to change the way we do business.” Early palliative care intervention would help drive down costs by allowing patients and their families to understand their illness trajectories and help them access care that will improve quality of life, instead of relying on marginally beneficial tests and procedures that may prolong suffering and be unlikely to improve patient outcomes.
Because palliative care has not yet become mainstream, it is often shunted to the sidelines as doctors and patients soldier on when they should be talking about best management of the advanced illness.

“People are living longer with chronic illness,” said Morrissey. “We see multiple co-morbidities, like chronic cancer, diabetes, and advanced dementia in the same patient.”

American culture in general has a problem accepting any limits on care, she said. The language of Western individualism, patient rights, and autonomy, has made little space for engaging in conversations about future health care needs, values, and care preferences.

But it’s not just the culture at large that has a problem with human finitude, said Morrissey. Doctors trained to prolong life, such as oncologists, rarely make referrals to palliative care.

Morrissey has led five annual conferences that have provided a platform for mobilizing resources, especially at the local level. She continues to encourage interdisciplinary training and education that bring together law, policy, and social science research to strengthen the health care workforce. The certificate program will build on these initiatives.

“Participants in the certificate program will understand that palliative care is an effective medical and business model, and holds great promise as a social model,” she said.

With the support of the Graduate School of Business Administration’s (GBA) Global Healthcare Innovation Management Center, and its director Falguni Sen, Ph.D., the Westchester-based Collaborative for Palliative Care will run an intensive two-weekend certificate program this summer and next fall.

“One of the big issues is communication,” said Mary Beth Morrissey, Ph.D., FCRH ’79, LAW ’82, GSS ’11. “Patients and families don’t understand and are often not informed about their palliative care options that are being embedded in the health care structure.”

As a fellow of the center, Morrissey has been leading roundtable discussions about health care reform. With her background in law, policy, and social science research, Morrissey spearheaded the cross-disciplinary program, which brings together nurses, social workers, psychologists, doctors, business owners, and managers in the same classroom.

The program will introduce students to the various aspects of palliative care, including: a public health approach to health care management, the legal and ethical consensus in end-of-life decision making, meanings of patient suffering from a human science perspective, new systems of care, policies and protocols in palliative medicine, clinical management of pain, advance care planning, models of financing, and the role of ethics committees in conflict negotiation.

Morrissey said that after the latest health care debate there’s a consensus that “we need to change the way we do business.” Early palliative care intervention would help drive down costs by allowing patients and their families to understand their illness trajectories and help them access care that will improve quality of life, instead of relying on marginally beneficial tests and procedures that may prolong suffering and be unlikely to improve patient outcomes.
Because palliative care has not yet become mainstream, it is often shunted to the sidelines as doctors and patients soldier on when they should be talking about best management of the advanced illness.

“People are living longer with chronic illness,” said Morrissey. “We see multiple co-morbidities, like chronic cancer, diabetes, and advanced dementia in the same patient.”

American culture in general has a problem accepting any limits on care, she said. The language of Western individualism, patient rights, and autonomy, has made little space for engaging in conversations about future health care needs, values, and care preferences.

But it’s not just the culture at large that has a problem with human finitude, said Morrissey. Doctors trained to prolong life, such as oncologists, rarely make referrals to palliative care.

Morrissey has led five annual conferences that have provided a platform for mobilizing resources, especially at the local level. She continues to encourage interdisciplinary training and education that bring together law, policy, and social science research to strengthen the health care workforce. The certificate program will build on these initiatives.

“Participants in the certificate program will understand that palliative care is an effective medical and business model, and holds great promise as a social model,” she said.

— Tom Stoelker