Dr. Grant Smith is a palliative care physician and Clinical Assistant Professor of Medicine at the Stanford School of Medicine. He is the medical director of the Stanford Palliative Care Center of Excellence (PCCOE) Community Partnerships Team, and he is the lead for quality improvement in advance care planning in the Division of Primary Care and Population Health. Dr. Smith graduated with a Bachelor of Science in psychology from Duke University. 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. As part of the Stanford faculty, he is an attending on the palliative care inpatient service and as a provider in the outpatient palliative care clinic in Palo Alto.
- Hospice and Palliative Medicine
Clinical Assistant Professor, Medicine - Primary Care and Population Health
Serious Illness Communication Program Trainer, Serious Illness Communication Program, Stanford Department of Medicine (2022 - Present)
Advance Care Planning Quality Improvement Lead, Division of Primary Care and Population Health, Stanford School of Medicine (2022 - Present)
Medical Director, Palliative Care Center of Excellence - Community Partnerships Team (2019 - Present)
Boards, Advisory Committees, Professional Organizations
Member, American Academy of Hospice and Palliative Medicine (2013 - Present)
Residency: UCSF Dept of Internal Medicine (2017) CA
Board Certification, American Board of Internal Medicine, Hospice and Palliative Medicine (2022)
Fellowship: UCSF Hospice and Palliative Medicine Fellowship (2019) CA
Board Certification: American Board of Internal Medicine, Internal Medicine (2017)
Medical Education: Harvard Medical School (2014) MA
Education About Specialty Palliative Care Among Non-Healthcare Workers: A Systematic Review.
Journal of pain and symptom management
Despite the expansion of palliative care (PC) services, the public has little knowledge and holds misperceptions about PC, creating barriers to accessing timely specialty PC.To systematically review the evidence regarding the efficacy of educational interventions to improve knowledge and attitudes about PC among non-healthcare workers.We searched five databases (PubMed/MEDLINE, Embase, CIANHL, Web of Science, and Scopus) for studies investigating educational interventions about specialty PC in adults who identified as patients, caregivers, or members of the public. We included studies that were available in English and had a comparator group. We excluded studies that only sampled health professionals or children. We used the Mixed Methods Appraisal Tool to assess quality and risk of bias.Of 12,420 records identified, we screened 5,948 abstracts and assessed 526 full texts for eligibility. 21 articles were extracted for analysis, representing 20 unique educational interventions. Common methodologies included quasi-experimental (9, 45%), randomized controlled trial (4, 20%), and non-randomized trial (2, 10%). Common components of the educational interventions included video presentations (9, 45%), written materials (8, 40%), and lectures (4, 20%). Content included definition (14, 70%) and philosophy (14, 70%) of PC, distinctions between PC and hospice (11, 55%), and eligibility for PC (11, 55%). Fourteen (70%) interventions showed statistically significant positive differences in either knowledge or attitudes about PC.While educational interventions can positively impact knowledge and attitudes about PC among non-healthcare workers, more research is needed to inform the design, delivery, and evaluation of interventions to increase knowledge and attitudes about PC.
View details for DOI 10.1016/j.jpainsymman.2023.09.023
View details for PubMedID 37797678
"The More I Know ... the More I Like It": A Systematic Review Evaluating Public- and Patient-Facing Educational Interventions About Palliative Care
ELSEVIER SCIENCE INC. 2023: E579
View details for Web of Science ID 001006227200128
Improving Public Knowledge and Attitudes About Palliative Care Through Virtual, Community-Based Education
ELSEVIER SCIENCE INC. 2023: E600
View details for Web of Science ID 001006227200165
Virtual Reality for Symptom Management in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Quality Improvement Initiative.
Oncology nursing forum
2022; 49 (3): 233-241
OBJECTIVES: To evaluate the effects of virtual reality (VR) on symptom distress, such as depression, anxiety, and pain, experienced by individuals receiving allogeneic hematopoietic stem cell transplantation.SAMPLE & SETTING: 20 participants aged 19-70 years (median age of 56.5 years) who were hospitalized in an academic setting received as many as two sessions of VR per week for two weeks.METHODS & VARIABLES: Before and after each session, participants completed the revised Edmonton Symptom Assessment Scale (ESAS-r) to evaluate their symptoms. Paired t tests were later conducted.RESULTS: VR sessions showed significant improvement in 8 of the 10 symptoms addressed in ESAS-r.IMPLICATIONS FOR NURSING: VR can improve symptoms in patients following hematopoietic stem cell transplantation in a hospital setting, provide a low-cost intervention to treat symptoms, and support future investigations exploring how VR affects prolonged hospitalizations related to distressing symptoms.
View details for DOI 10.1188/22.ONF.233-241
View details for PubMedID 35446838
Community/Institution Partnerships to Improve Palliative Care Awareness and Advance Care Planning in Diverse Communities
ELSEVIER SCIENCE INC. 2022: 836
View details for Web of Science ID 000812783700121
Development, Implementation, and Outcomes of a Serious Illness Care Community of Practice.
Journal of pain and symptom management
CONTEXT: Communities of Practice (CoP) can help geographically separated individuals who share a joint enterprise, mutual engagement, and a repertoire of tools to gain, maintain, and implement new skills, including serious illness communication.OBJECTIVES: To investigate the health system uptake, implementation and outcomes of the Serious Illness Community of Practice (SICoP).METHODS: Participants included members of the online SICoP, including participants from all 50 states in the United States and 44 countries, interested in implementation of the Serious Illness Care Program. Yearly surveys asked members about their program's composition, completed trainings, number of serious illness conversations, and utilization of the online SICoP tools and resources.RESULTS: Over four years, membership in the SICoP increased from 429 to 1,912, with an estimated 17,785 clinicians trained and 38,945 serious illness conversations conducted. Members have continued to utilize and modify the SICoP resources.CONCLUSIONS: Utilizing a CoP has contributed to improving the health care system implementation and process outcomes of serious illness communication training.KEY MESSAGE: This article describes the implementation and health system outcomes of a Community of Practice developed to support serious illness communication. The results indicate that the membership of the community grew and that the community supported growth in the number of trained clinicians and the number of serious illness conversations conducted.
View details for DOI 10.1016/j.jpainsymman.2021.07.033
View details for PubMedID 34371136
Palliative Care to the People: Partnering with a Patient Experience Department to Raise Awareness of Palliative Care in the Community
ELSEVIER SCIENCE INC. 2021: 647
View details for Web of Science ID 000621206400037
Responding to Community Needs During COVID-19: A Virtual, Interdisciplinary Palliative Care Education Series for the Public
ELSEVIER SCIENCE INC. 2021: 663–64
View details for Web of Science ID 000621206400066
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