Empathy and Expertise in Palliative Care

Dana Johnson, MD, KentuckyOne Health Hematology and Oncology Associates

LEXINGTON Dana Johnson, MD, works at KentuckyOne Health Hematology and Oncology Associates in the palliative care/medical oncology clinic. He grew up in Ashland, Kentucky, and received his undergraduate degree at the University of Kentucky. After his internship at the University of Tennessee, he returned to Lexington for further studies, including an internal medicine residency and medical oncology fellowship. A perpetual student, Johnson is currently studying for a PhD in history at UK. He met his wife, Jill, who was an oncology nurse, in medical school. They have two sons and live in Lexington.

Finding a Niche

Johnson chose to study cancer and palliative care because of the advancements he observed in the fields as he was working toward his degree in the 80s. Oncology and palliative care merged seamlessly and palliative care had surfaced as a viable option for medical oncology patients with the emergence of Medicare coverage and re-imbursement, so it just made sense.

The new physician found an opportunity to apply his studies in his hometown as the medical director of Community Hospice of Ashland, and now treats patients all over Central Kentucky through his work at KentuckyOne Health. Johnson’s patient population is of advanced age and suffering from cancers common to our region, most notably lung, breast, colon, and prostate malignancies. Palliative care provides advanced care for patients who have been treated repeatedly and still experience symptoms, including emotional symptoms, that are both persistent and very difficult to control.

Hospice and palliative care are not necessarily synonymous. Johnson states, “Generally, palliative care assists a broader scope of patients, while hospice exclusively supports terminally ill patients.” Fellow oncologists usually serve as referring physicians for palliative care and hospice services alike.

Hard Decisions and Holistic Care

Palliative care offers treatments that care for the patient as a whole person, not just as a cancer patient. Emotional, social, and lifestyle pressures often take a toll on oncology patients and their caregivers, and effective palliative care addresses some of those needs. “This kind of support is best achieved by talking to patients and seeing what their individualized goals are. We focus on simple modalities, matching the invasiveness of treatments to the patient’s unique goals, and helping them keep doing those activities that matter most to them,” says Johnson.

“Palliative care assists a broader scope of patients, while hospice exclusively supports terminally ill patients.”— Dana Johnson, MD

He cannot deny the holistic quality of palliative care: “Holistic care has to be part of the approach,” states Johnson. “People who come to our clinic are talking about very emotional topics. Life, death, and possibly how they want to spend their last days. When you’re in our place, you can’t just look at pain medicine and ignore the rest…there’s much more emotional care in our field than in most others.” For these reasons, Johnson states that the clinic also has a chaplain available to patients and families.

Challenges of Palliative Care

Unfortunately, practicing this kind of medicine poses emotional challenges to the physicians, too. Johnson witnesses many family struggles within his patient population. For example, some patients want to adjust to more aggressive treatment, even though the family disapproves. Others want to taper off treatments, while family wants to fight harder. “We see discordance between patients and families all the time,” he says.

Johnson practices alongside a social worker who can speak with patient’s family, a palliative care nurse, and a pharmacist. After joining the patient for the initial consult, the group stays to discuss treatment together after the meeting. “When you work as a team, it puts the patient into a very different mindset when you enter the room,” says Johnson. “They feel, and receive, the support of the whole practice.”

Compassionate Guidance and Common Misconceptions

Johnson sees his work with the KentuckyOne Health palliative care team as a privilege. It gives him the opportunity to provide patient’s with options, to educate them, and empower them with tools to build a more enjoyable life. “We find the life decisions that work for them. During crisis times, you have to give people time and space to make critical decisions. We’re pleased to guide individuals into choices that best fit the needs of themselves and their families,” Johnson explains.

Like many practices, palliative care comes with its own share of misconceptions. Johnson names two. “The first is that everyone who comes here ends up in hospice. And, the second is that our patients have given up. The opposite is true. We work diligently to help them feel as good as they can for as long as they can.”

Though an ardent student of history, Johnson gives a brief prediction about the future of palliative care. He has observed the growing presence of cancers, as people live longer lives and thus become vulnerable to more diseases, and envisions a closer merger between palliative care and oncology in coming years. He predicts, “The interface between medical oncology and palliative care will necessitate growth in this area.”