Dr. Grant Smith is originally from Knoxville, TN. He graduated with a bachelor of science in psychology from Duke University, where he first developed an interest in palliative care. He received his medical degree from Harvard Medical School. He completed residency in internal medicine at the University of California, San Francisco with a focus in primary care, followed by a chief resident year at the Zuckerberg San Francisco General Hospital. He subsequently completed his palliative care fellowship at the University of California, San Francisco. Outside of work, Dr. Smith lives in San Francisco, and he enjoys running in Golden Gate park, cooking, and visiting the many great restaurants in the area. Dr. Smith is excited to be part of the Stanford faculty, where he provides direct patient care while pursuing his academic and educational interests improving patient-centered care across settings, increasing access to palliative care, and promoting clinician well-being.
- Hospice and Palliative Medicine
Clinical Assistant Professor, Medicine - Primary Care and Population Health
Boards, Advisory Committees, Professional Organizations
Member, American Academy of Hospice and Palliative Medicine (2013 - Present)
Fellowship: UCSF Hospice and Palliative Medicine Fellowship (2019) CA
Board Certification: American Board of Internal Medicine, Internal Medicine (2017)
Residency: UCSF Internal Medicine Residency (2017) CA
Medical Education: Harvard Medical School (2014) MA
Comparing the Palliative Care Needs of Patients Seen by Specialty Palliative Care Teams at Home Versus in Clinic.
Journal of pain and symptom management
CONTEXT: Understanding the unique needs of patients seen in clinic versus at home can help palliative care (PC) teams choose how to maximize available resources.OBJECTIVES: To compare the characteristics and PC needs of patients seen by PC teams in clinic versus at home.METHODS: We analyzed data from the Palliative Care Quality Network between August 2016 and September 2019 and compared demographics, diagnosis, reason for referral, PC needs, functional status, self-reported symptoms, and patient-reported quality of life.RESULTS: Compared to patients receiving PC in clinic, patients receiving PC at home were more likely to be age 80 years or older (OR 7.5, 95% CI 5.0, 10.9, p<0.0001), have lower functional status (mean Palliative Performance Scale (PPS) score 53% vs. 68%, p<0.0001), and were less likely to screen positive for needing pain management (OR 0.31, 95% CI 0.22, 0.42, p<0.0001) or other symptom management (OR 0.61, 95% CI 0.41, 0.90, p=0.01). Patients receiving care at home were more likely to be referred for care planning (goals of care discussions or advance care planning) (OR 11.5, 95% CI 8.3, 16.0 p<0.0001) and patient/family support (OR 5.9, 95% CI 4.2, 8.3, p<0.0001).CONCLUSION: Patients seen by PC teams at home had worse function and were more likely to be referred for care planning, while patients seen in clinic had more PC needs related to pain and symptom management. Despite these differences, both populations have significant PC needs that support routine assessment and require appropriately staffed interdisciplinary teams to address these needs.
View details for DOI 10.1016/j.jpainsymman.2020.11.020
View details for PubMedID 33246071
What If I Get Seriously Ill? A Virtual Workshop for Advance Care Planning During COVID-19.
Journal of pain and symptom management
The coronavirus disease 2019 (COVID-19) has brought public attention to questions regarding the type of care individuals would want to receive in the event of becoming suddenly critically ill. Advance care planning (ACP) is one way to help individuals and families address these questions. However, social distancing, stay-at-home orders, and hospital visitor restrictions have raised new barriers to facilitating these conversations. Here, we describe the implementation and evaluation of a novel, public-facing, 2-part virtual ACP workshop. Participants were recruited through electronic communication, and evaluations were collected through surveys administered after each part of the workshop. We found that utilizing a virtual format allowed us to reach a large, geographically diverse audience. Participants were likely to recommend the workshop to friends and family. There was no change in advance care planning engagement between the post-session surveys between the first and second parts of the workshop.
View details for DOI 10.1016/j.jpainsymman.2020.08.022
View details for PubMedID 32835831
- Who Becomes a High Utilizer? A Case-Control Study of Older Adults in the USA JOURNAL OF GENERAL INTERNAL MEDICINE 2020; 35 (2): 596–98
Flattening the curve of distress: A public-facing webinar for psychoeducation during COVID-19
Patient Experience Journal
2020; 7 (2): 151-155
View details for DOI 10.35680/2372-0247.1497
- Home Is Where the Heart Is JOURNAL OF PALLIATIVE MEDICINE 2020; 23 (1): 144–45
The Role of Palliative Care in Population Management and Accountable Care Organizations
JOURNAL OF PALLIATIVE MEDICINE
2015; 18 (6): 486–94
By 2021, health care spending is projected to grow to 19.6% of the GDP, likely crowding out spending in other areas. The 2010 Affordable Care Act (ACA) attempts to curb health care spending by incentivizing high-value care through the creation of Accountable Care Organizations (ACOs), which assume financial risk for patient outcomes. With this financial risk, health systems creating ACOs will be motivated to pursue innovative care models that maximize the value of care. Palliative care, as an emerging field with a growing evidence base, is positioned to improve value in ACOs by increasing high-quality care and decreasing costs for the sickest patients. ACO leaders may find palliative care input valuable in optimizing high-quality patient-centered care in the accountable care environment; however, palliative care clinicians will need to adopt new models that extrapolate their direct patient care skills to population management strategies. We propose that palliative care specialists take on responsibilities for working with ACO leaders to broaden their mission for systemwide palliative care for appropriate patients by prospectively identifying patients with a high risk of death, high symptom burden, and/or significant psychosocial dysfunction, and developing targeted, "triggered" interventions to enhance patient-centered, goal-consistent, coordinated care. Developing these new population management competencies is a critical role for palliative care teams in the ACO environment.
View details for DOI 10.1089/jpm.2014.0231
View details for Web of Science ID 000354608100004
View details for PubMedID 25723619
View details for PubMedCentralID PMC4519048
Development of the Serious Illness Care Program: a randomised controlled trial of a palliative care communication intervention
2015; 5 (10): e009032
Ensuring that patients receive care that is consistent with their goals and values is a critical component of high-quality care. This article describes the protocol for a cluster randomised controlled trial of a multicomponent, structured communication intervention.Patients with advanced, incurable cancer and life expectancy of <12 months will participate together with their surrogate. Clinicians are enrolled and randomised either to usual care or the intervention. The Serious Illness Care Program is a multicomponent, structured communication intervention designed to identify patients, train clinicians to use a structured guide for advanced care planning discussion with patients, 'trigger' clinicians to have conversations, prepare patients and families for the conversation, and document outcomes of the discussion in a structured format in the electronic medical record. Clinician satisfaction with the intervention, confidence and attitudes will be assessed before and after the intervention. Self-report data will be collected from patients and surrogates approximately every 2 months up to 2 years or until the patient's death; patient medical records will be examined at the close of the study. Analyses will examine the impact of the intervention on the patient receipt of goal-concordant care, and peacefulness at the end of life. Secondary outcomes include patient anxiety, depression, quality of life, therapeutic alliance, quality of communication, and quality of dying and death. Key process measures include frequency, timing and quality of documented conversations.This study was approved by the Dana-Farber Cancer Institute Institutional Review Board. Results will be reported in peer-reviewed publications and conference presentations.Protocol identifier NCT01786811; Pre-results.
View details for DOI 10.1136/bmjopen-2015-009032
View details for Web of Science ID 000365467600096
View details for PubMedID 26443662
View details for PubMedCentralID PMC4606432
Missed Opportunities To Train Medical Students in Generalist Palliative Care during Core Clerkships
JOURNAL OF PALLIATIVE MEDICINE
2014; 17 (12): 1344–47
To improve the quality of care for dying patients, experts have called for all clinicians to be able to provide a generalist level of palliative care. Core clinical clerkships provide an opportunity to incorporate palliative care training to address the lack of required palliative care rotations at most U.S. medical schools.The objective of this study was to identify and quantify missed opportunities to train third-year medical students in generalist palliative care during required core clerkships.This study was a cross-sectional survey of third-year students at a leading U.S. medical school without a required palliative care rotation.Students completed a survey during the last 4 months of the 2012-2013 academic year quantifying and evaluating their experiences caring for dying patients. Attitudes were assessed using a scale from a national survey of students, residents, and faculty.Eighty-eight students responded (response rate [RR]=56%). More than one-quarter (26%) never participated in caring for a patient who died. More than one-half (55%) never delivered significant bad news and 38% never worked with a specialist in palliative medicine. Eighty-four percent of students who cared for a patient who died and 60% of students who delivered significant bad news had one or more of those experiences that were not debriefed.At an institution without a required palliative care rotation, third-year medical students rarely or never care for patients who die during core clerkships, and when they do, their teams do not debrief or reflect on these experiences. Clinical faculty, including palliative care consultants, can address missed opportunities for palliative care training during core clerkships by augmenting and routinely debriefing students' experiences giving bad news and caring for dying patients.
View details for DOI 10.1089/jpm.2014.0107
View details for Web of Science ID 000346336200011
View details for PubMedID 24971609
Growing Up With Sickle Cell Disease: A Pilot Study of a Transition Program for Adolescents With Sickle Cell Disease
JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY
2011; 33 (5): 379–82
We implemented the Duke Sickle Cell Disease (SCD) Transition Program for adolescents with SCD and investigated the knowledge about SCD; concerns and emotions about transitioning; and the initial impact of the Transition Program. Thirty-three adolescents participated in the initial study. Gaps in knowledge included ethnicities affected by SCD and inheritance of SCD. Adolescents were primarily concerned about transferring to a new medical team. There was a mix of both positive and negative emotions that varied over time. Overall, we have identified educational gaps and concerns and emotions about transitioning, which we will address through the Duke SCD Transition Program.
View details for DOI 10.1097/MPH.0b013e318211bb2e
View details for Web of Science ID 000291924700023
View details for PubMedID 21602723