Keri Brenner, MD, MPA is a palliative care physician and a psychiatrist. Her clinical work includes inpatient palliative care consults and psychotherapy for palliative care patients at Stanford. Dr. Brenner’s scholarly interests and research focus on psychodynamic and existential issues in patients with serious illness. Dr. Brenner completed her medical degree at Yale School of Medicine, where she received honors for her thesis on the phenomenology of suffering with terminal illness. She also has a Master in Public Administration from Harvard’s Kennedy School. Dr. Brenner trained in adult psychiatry residency at Massachusetts General Hospital / McLean and palliative care fellowship at Harvard.
- Palliative Medicine
- Hospice and Palliative Medicine
Clinical Assistant Professor, Medicine - Primary Care and Population Health
Board Certification: American Board of Psychiatry and Neurology, Hospice and Palliative Medicine (2016)
Fellowship: Massachusetts General Hospital Palliative Care Fellowship (2016) MA
Board Certification: American Board of Psychiatry and Neurology, Psychiatry (2015)
Residency: MGH McLean Adult Psychiatry Residency (2015) MA
Internship: Massachusetts General Hospital Internal Medicine Residency (2012) MA
Medical Education: Yale School of Medicine (2011) CT
Exploring the Psychological Aspects of Palliative Care: Lessons Learned from an Interdisciplinary Seminar of Experts.
Journal of palliative medicine
2021; 24 (9): 1274-1279
Palliative care has been shown to help patients live well with serious illness, but the specific psychological factors that contribute to this benefit remain investigational. Although support of patient coping has emerged as a likely factor, it is unclear how palliative care helps patients to cope with serious illness. The therapeutic relationship has been proposed as a key element in beneficial patient outcomes, possibly undergirding effective patient and family coping. Understanding the distress of our patients with psychological depth requires the input of varied clinicians and thinkers. The complex conceptual model we developed draws upon the contributions of medicine, nursing, psychology, spiritual care, and social work disciplines. To elucidate these issues, we convened an interdisciplinary seminar of content experts to explore the psychological components of palliative care practice. "Healing Beyond the Cure: Exploring the Psychodynamic Aspects of Palliative Care" was held in May 2019 at Harvard University's Radcliffe Institute for Advanced Study. Over two days, the working group explored these essential elements of successful palliative care encounters through lecture and open discussion. This special report describes the key psychological aspects of palliative care that we believe underlie optimal adaptive coping in palliative care patients. We also outline key areas for further development in palliative care research, education, and clinical practice. The discussion held at this meeting became the basis for a planned series of articles on the psychological elements of palliative care that will be published in the Journal of Palliative Medicine on a monthly basis during the fall and winter of 2021-2022.
View details for DOI 10.1089/jpm.2021.0224
View details for PubMedID 34469229
Defining Clinical Attunement: A Ubiquitous But Undertheorized Aspect of Palliative Care.
Journal of palliative medicine
Attunement, the process of understanding and responding to another's spoken and unspoken needs, is a fundamental concept of human development and the basis of meaningful relationships. To specialize the concept of attunement for palliative care, this article introduces clinical attunement. This term accounts for how palliative care clinicians must repeatedly balance patients' readiness to talk about the future with the cadence of the illness and need for medical decision making. Using the case of Gloria, an example patient living with cancer, this article discusses three skills to foster clinical attunement: asking, repairing disconnections, and offering containment. It is the fourth in a series exploring the psychological elements of palliative care.
View details for DOI 10.1089/jpm.2021.0442
View details for PubMedID 34714128
The Meaning of Together: Exploring Transference and Countertransference in Palliative Care Settings.
Journal of palliative medicine
Establishing an empathic clinical relationship is a cornerstone of high-quality palliative care. More than simply approaching patients with a pleasant affect or "being nice," we propose that skilled clinicians routinely employ distinct psychological elements when creating effective bonds with seriously ill patients and their families. Palliative care involvement has been shown to improve a variety of outcomes for patients with serious cancer, and yet the components of this salutary effect are still becoming known in the literature. Many believe that a successful interpersonal relationship is the essential factor. In this article, we will apply the psychological constructs of transference and countertransference to the unique arena of palliative care communication. Although most palliative care clinicians are not mental health clinicians and have not received training or certification in psychotherapeutic techniques, there are elements from these frameworks that may be advantageously applied. We will draw on sources from psychology and psychiatry to explore the in-between spaces of clinical encounter. Using the case of Gloria, a patient living with cancer drawn from our clinical experience, we will offer adapted definitions and novel applications of these psychological concepts. Branching from the theory to everyday practice, we will then offer practical suggestions to guide the palliative care clinician in recognizing and managing strong countertransference reactions. This article is the third installment of a series on the psychological elements of palliative care.
View details for DOI 10.1089/jpm.2021.0240
View details for PubMedID 34491110
Foundations for Psychological Thinking in Palliative Care: Frame and Formulation.
Journal of palliative medicine
2021; 24 (10): 1430-1435
This is the second article in the psychological elements of palliative care (PEPC) series. This series focuses on how key concepts from psychotherapy can be used in the context of palliative care to improve communication and fine tune palliative care interventions. In this article, we introduce two foundational concepts: frame and formulation. The frame is the context in which care is delivered; it includes concrete aspects of clinical care such as where it takes place, for how long, and with what frequency. It also includes the conceptual aspects of care, including the specific roles of the clinician and the patient, emergency contingencies, and the extent to which emotion is invited within the clinical encounter. Defining and discussing the frame with patients are especially important in palliative care because of the strong emotions that arise when talking about serious illness and because many patients may not be familiar with palliative care before they are in care. Formulation is the process by which we make judgment-neutral psychological hypotheses to understand the feelings and behaviors of our patients. It is an ongoing, dynamic process whereby as we learn more about our patients, we integrate that data to improve our explanatory model of who they are. This helps us tailor our interventions to meet their unique needs and respect their life experiences, aptitudes, and vulnerabilities. Both concepts are foundational PEPC; understanding them will prepare readers to continue to the next four articles in the series.
View details for DOI 10.1089/jpm.2021.0256
View details for PubMedID 34596473
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
Development of a Prognostic Awareness Impact Scale for Patients with Advanced Cancer.
Journal of palliative medicine
Background: No reliable instruments exist to measure prognostic awareness and its psychological and behavioral impacts for patients with advanced cancer. Methods: We developed the Prognostic Awareness Impact Scale (PAIS) using a qualitative approach. During phase 1, we convened a working group with a transdisciplinary team of clinicians from oncology (n = 2), psychology (n = 2), psychiatry (n = 1), palliative care (n = 3), and survey development (n = 1) to identify key domains of PAIS. Using a consensus-driven process, the team generated an item bank for each domain. During phase 2, we conducted cognitive interviews with 39 patients with advanced cancer to assess the understandability of the PAIS. Results: The working group developed a conceptual framework for PAIS, identifying three domains: (1) cognitive understanding of prognosis (capacity to understand intellectually one's prognosis), (2) emotional coping (capacity to process prognostic uncertainty and terminal prognosis), and (3) adaptive response (capacity to use prognostic awareness to inform life decisions). Cognitive interviews revealed that patients had an accurate understanding of most PAIS items. Patients reported difficulty with binary response options for questions pertaining to emotional coping. They expressed difficulty answering numerous questions regarding their cognitive understanding of their prognosis. We revised the PAIS by (1) replacing binary response options with ordinal agreement scales; and (2) reducing the number of items focused on cognitive understanding of prognosis. Conclusion: We developed a conceptual framework to capture prognostic awareness and its psychological and behavioral impacts for patients with advanced cancer using the PAIS. Future work should focus on validating the PAIS by testing its psychometric properties.
View details for DOI 10.1089/jpm.2021.0238
View details for PubMedID 34637630
DEVELOPMENT OF A PROGNOSTIC AWARENESS QUESTIONNAIRE (PAQ) FOR PATIENTS WITH ADVANCED CANCER
OXFORD UNIV PRESS INC. 2020: S261
View details for Web of Science ID 000546262400548
Psychiatrist in My Pocket: Essential Psychiatric Skills for the Palliative Care Provider
ELSEVIER SCIENCE INC. 2020: 401–2
View details for Web of Science ID 000509464700048
Lessons from a Therapist's Chair: Optimizing Palliative Communication Through Psychotherapy Best Practices and Skills
ELSEVIER SCIENCE INC. 2020: 436–37
View details for Web of Science ID 000509464700113
An Integrative Framework of Appraisal and Adaptation in Serious Medical Illness.
Journal of pain and symptom management
Multiple randomized clinical trials have demonstrated that palliative care improves the quality of life of individuals with serious medical illness. Research also suggests that in patients with advanced cancer, palliative care's focus on symptom management, coping with illness, goals of care, and treatment decisions may be associated with improved patient quality of life in part by increasing patients' use of active (versus passive) and approach-oriented (versus avoidant) coping strategies. However, without a framework outlining the process that individuals with serious medical illness and their loved ones undergo, it is challenging to discern exactly where, how, and why palliative care may affect the serious medical illness experience. To address this gap, we propose a clinically applicable framework, derived from existing theory and research in the social and behavioral sciences. This framework, called the Integrative Framework of Appraisal and Adaptation in Serious Medical Illness, describes how patients and their loved ones cognitively and emotionally process the various events that may occur as they navigate serious medical illness and the end of life. The framework also describes how individuals and their loved ones use that event processing to determine next steps, while considering the impact of their surrounding external environment, their individual social roles and their connections on this decision making. The framework presented in this article is intended to improve our ability to understand and to care for individuals with serious medical illness and their loved ones, while stimulating further discussion and research to test and refine these ideas.
View details for DOI 10.1016/j.jpainsymman.2020.05.018
View details for PubMedID 32446974
Relationship Between Perceptions of Treatment Goals and Psychological Distress in Patients With Advanced Cancer.
Journal of the National Comprehensive Cancer Network : JNCCN
2020; 18 (7): 849–55
Studies have shown gaps in prognostic understanding among patients with cancer. However, few studies have explored patients' perceptions of their treatment goals versus how they perceive their oncologist's goals, and the association of these views with their psychological distress.We conducted a cross-sectional study of 559 patients with incurable lung, gastrointestinal, breast, and brain cancers. The Prognosis and Treatment Perception Questionnaire was used to assess patients' reports of their treatment goal and their oncologist's treatment goal, and the Hospital Anxiety and Depression Scale was used to assess patients' psychological symptoms.We found that 61.7% of patients reported that both their treatment goal and their oncologist's treatment goal were noncurative, whereas 19.3% reported that both their goal and their oncologist's goal were to cure their cancer, 13.9% reported that their goal was to cure their cancer whereas their oncologist's goal was noncurative, and 5% reported that their goal was noncurative whereas their oncologist's goal was curative. Patients who reported both their goal and their oncologist's goal as noncurative had higher levels of depression (B=0.99; P=.021) and anxiety symptoms (B=1.01; P=.015) compared with those who reported that both their goal and their oncologist's goal was curative. Patients with discordant perceptions of their goal and their oncologist's goal reported higher anxiety symptoms (B=1.47; P=.004) compared with those who reported that both their goal and their oncologist's goal were curative.One-fifth of patients with incurable cancer reported that both their treatment goal and their oncologist's goal were to cure their cancer. Patients who acknowledged the noncurative intent of their treatment and those who perceived that their treatment goal was discordant from that of their oncologist reported greater psychological distress.
View details for DOI 10.6004/jnccn.2019.7525
View details for PubMedID 32634779
- Circle of Trust: How Psychodynamic Themes Such as the 'Holding Environment' Optimize Coping with Serious Illness ELSEVIER SCIENCE INC. 2019: 426–27