Keri Brenner

All Publications

• Avoidance: Exposure Therapy Informed Communication for Serious Illness Care. Journal of palliative medicine Chammas, D., Jackson, V., Brenner, K. O. 2026: 10966218261431684

  Abstract

  Patients facing serious illness may respond to distressing medical information with avoidance or denial, limiting their ability to engage in values-based decision-making. Exposure therapy-an evidence-based psychological treatment for anxiety disorders-offers conceptual tools that can inform communication and therapeutic approaches with patients who struggle with avoidance in the context of serious illness. This article describes the care of a patient with advanced cancer who declined prognostic and hospice conversations due to death-related anxiety. Drawing on core exposure therapy principles-including safety, individualization, titration, and enhancement of coping-we illustrate how serious illness communication strategies can be intentionally adapted to support patient engagement, reduce distress, and strengthen psychological resilience. Through techniques such as progressive disclosure, calibration of language potency, and the "container" metaphor, clinicians can match communication to patients' emotional readiness, enhancing tolerance over time. Integrating exposures-informed approaches into palliative care practice helps bridge the gap between emotional avoidance and values-concordant care.

  View details for DOI 10.1177/10966218261431684

  View details for PubMedID 41858215

• Overwhelming Uncertainty: Acceptance and Commitment Therapy Informed Communication for Serious Illness Care. Journal of palliative medicine Williamson, B., Merrill, G., Slomoff, T., Brenner, K. O., Gamble, A., Chammas, D. 2026: 10966218261433430

  Abstract

  Acceptance and commitment therapy (ACT) is a psychotherapeutic model that focuses on developing psychological flexibility by encouraging patients to attune to their present moment experience, cultivate openness to those experiences, and respond to those experiences with committed action that is rooted in their values. By combining the six core processes of ACT (attention to the present moment, self-as-context, defusion, acceptance, values, and committed action) with serious illness communication skills, palliative care clinicians can nurture psychological flexibility for patients facing uncertainty and difficult internal experiences common in serious illness. This article reviews a case study with examples of language and tools clinicians can use to bring these core processes into their work with patients.

  View details for DOI 10.1177/10966218261433430

  View details for PubMedID 41841463

• Domains of prognostic awareness, quality of life, and psychological distress in patients with advanced cancer. The oncologist Amonoo, H. L., Centracchio, J., Greydanus, C., Lavoie, M. W., Keane, E. P., Greer, J. A., Lindenberger, E. C., Brenner, K., Ufere, N. N., Traeger, L., Temel, J. S., Park, E. R., Jackson, V., El-Jawahri, A. 2025

  Abstract

  Prior studies have shown mixed findings regarding the relationship between prognostic awareness with quality of life (QOL) and psychological distress in patients with advanced cancer. Prognostic awareness is a multidimensional construct including a cognitive component (ie, the ability to understand one's life-limiting illness) and an emotional coping component (ie, the capacity to process terminal prognosis). Yet, it remains unclear which domains of prognostic awareness are associated with QOL and psychological distress.We conducted a cross-sectional study of adults with metastatic solid tumors treated with non-curative intent at a single academic center from 11/2019-6/2022. We used the Prognostic Awareness Impact Scale (PAIS) to measure components of prognostic awareness, including the cognitive and emotional coping components. We used the Functional Assessment of Cancer Therapy-G and Hospital Anxiety and Depression Scale to measure QOL and psychological distress, respectively. Linear regression models were used to examine the relationship between the PAIS domains and patient-reported outcomes.We enrolled 61.9% (632/1021) of eligible patients. Cognitive understanding of prognosis was not associated with QOL (B=-2.3, P = 0.114), anxiety (B = 0.7, P = 0.057), or depression symptoms (B = 0.4, P = 0.293). However, higher emotional coping with prognosis was associated with better QOL (B = 1.7; p < 0.001), lower anxiety (B=-0.6; p < 0.001), and depression (B=-0.3; p < 0.001).Patients' emotional coping with their prognosis, rather than cognitive acknowledgment of their incurable cancer, was associated with QOL and psychological distress. Our findings underscore patients' ability to tolerate an accurate understanding of their prognosis and the critical need to incorporate effective coping strategies during prognostic discussions.

  View details for DOI 10.1093/oncolo/oyaf344

  View details for PubMedID 41072926

• Process Rounds to Elevate Psychological Skills in Palliative Care. Journal of palliative medicine Chammas, D., Rosenberg, L. B., Moment, A., Shalev, D., Brenner, K. 2025

  Abstract

  Background: A half-day workshop improved palliative care clinicians' ability to integrate psychological concepts into serious illness communication but created demand for longitudinal learning. Objective: To pilot "Process Rounds," a four-session, case-based, adapted psychotherapeutic supervision group reinforcing formulation, countertransference, and mindful intervention. Methods: Workshop graduates from four cohorts were invited; 25/143 enrolled. Each cohort met for four 60-minute sessions over 6-8 weeks. Eight-week postworkshop surveys included specific items for Process Rounds participants. Facilitators were interviewed about their experiences and themes. Results: Participants were highly satisfied with the Process Rounds. Compared with nonparticipants, Process Rounds attendees reported greater improvement in comfort teaching formulation (p = 0.013) and stronger clinical impact (p = 0.028). Participants and facilitators found value in the structured format; scheduling conflicts were the chief barrier. Conclusions: Process Rounds, an adapted model of psychotherapeutic supervision, was acceptable to palliative care clinicians and deepened learning about psychologically informed serious illness communication.

  View details for DOI 10.1177/10966218251376725

  View details for PubMedID 40929019

• Oncology and Suffering: Strategies on Coping With Grief for Health Care Professionals. American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting Brenner, K. O., Nathanson, A., Slawkowski-Rode, M. 2025; 45 (3): e482244

  Abstract

  This article comprises three integrated sections exploring the multidimensional suffering experienced in oncology-from the perspective of both patients and health care professionals. It explores how oncology clinicians can better understand, address, and accompany the suffering of patients with advanced illness and what resources the patients themselves may appeal to when facing a terminal diagnosis. Section 1 outlines a clinical framework for attending to patient suffering when there is no cure, emphasizing psychologic formulation, attunement, and countertransference as therapeutic tools. Section 2 addresses provider overwhelm and distress in response to patient grief, with strategies grounded in neuroscience, meaning making, and emotional regulation. Section 3 considers attending to suffering in oncology in the context of spirituality and focuses in particular on when patients and providers are unable to draw support from religious belief. Together, these insights offer a narrative-driven, psychologically attuned, and spiritually inclusive approach to care.

  View details for DOI 10.1200/EDBK-25-482244

  View details for PubMedID 40397844

• Top Ten Tips Palliative Care Clinicians Should Know About Supporting Coping in Serious Illness. Journal of palliative medicine Chammas, D., Moment, A., Leff, V., Buxton, D., Rosa, W. E., Brenner, K. 2025

  Abstract

  Palliative care (PC) clinicians regularly encounter a spectrum of coping strategies, from responses such as humor, legacy-building, and meaning-making to more ambivalent behaviors such as avoidance, splitting, or control-seeking. Supporting adaptive coping is central to the role of all interprofessional PC clinicians to improve quality of life and patient outcomes. Drawing upon principles from psychotherapy, behavioral medicine, and PC research, this article provides guidance to understand, assess, and engage with patients' coping with intentionality. Harnessing a shared language and approach allows teams to align, self-reflect, collaborate, and respond with greater nuance and empathic attunement during profound moments in our patients' lives.

  View details for DOI 10.1089/jpm.2025.0223

  View details for PubMedID 40405812

• Primary Mental Health Competencies for Hospice and Palliative Medicine Physicians: A Delphi Study. Journal of pain and symptom management Podgurski, L., Chammas, D., Brenner, K. O., Rosenberg, L. B., Goyal, N. G., Lapid, M. I., Morris, S. E., Pirl, W. F., Sumser, B., Thompson, B. W., Wright, L., Shalev, D. 2025

  Abstract

  CONTEXT: Psychiatric and psychological care in serious illness is a core domain of hospice and palliative medicine (HPM), encompassing both normative psychosocial responses and mental health comorbidities. While social workers serve as psychosocial leaders on HPM interdisciplinary teams, commitment to supporting whole-person care remains the responsibility of the entire team. However, training and scope of practice for HPM physicians in the mental health domain are poorly standardized.OBJECTIVES: To establish and prioritize 'primary mental health competencies' for specialist hospice and palliative medicine physicians using expert consensus methods.METHODS: We convened a panel of 8 physicians, 1 social worker, 2 psychologists, and 1 nurse practitioner with expertise at the intersection of palliative care and mental health. Using group meetings and 1:1 interviews with the project leads, the expert panel generated initial competencies. A purposive voting panel of 36 palliative care physicians representing a range of practice settings and areas of career focus finalized high-priority competencies using a two-phase modified Delphi approach.RESULTS: The expert panel proposed 68 competencies divided into: (A) psychological foundations of serious illness care, (B) diagnosis and management of mental health disorders in serious illness, and (C) systems-based practice. After first-round voting, 23 competencies were recirculated for a second vote. Following second-round voting, 32 competencies were included in the final list: 7 from part A, 20 from part B, and 5 from part C.CONCLUSIONS: This consensus-based, expert-led process successfully generated and prioritized essential competencies in the psychological and psychiatric aspects of palliative care for specialist physicians.

  View details for DOI 10.1016/j.jpainsymman.2025.05.009

  View details for PubMedID 40403778

• Integrating Psychotherapeutic Concepts to Enhance Serious Illness Communication: Assessment of a Model Curriculum. Journal of palliative medicine Chammas, D., Brenner, K., Moment, A., Byrne-Martelli, S. E., Rosenberg, L. B., Shalev, D. 2025

  Abstract

  Background: Serious illness communication training often focuses on sharing medical information, discussing goals of care, and supporting patients and caregivers. Few communication frameworks explicitly integrate psychosocial concepts to improve therapeutic efficacy. Objectives: To develop, implement, and evaluate a half-day workshop that integrates psychotherapeutic concepts into palliative care communication across four professional settings. Methods: Using Kern's six-step curriculum development model, we created an interactive workshop focused on psychological formulation and countertransference. The workshop was delivered to four cohorts: a national conference, an international palliative care congress, a fellows' education day, and a social work-focused summit. Pre-, post-, and eight-week follow-up surveys were administered, assessing Kirkpatrick's four levels of training evaluation. Results: In total, 203 palliative care clinicians completed the presurvey, 168 completed the post-survey, and 79 completed the eight-week follow-up. Knowledge of formulation increased from a median of 3 (interquartile range [IQR] 2-4) preworkshop to 5 (IQR 4-5) at eight weeks (p < 0.001). Knowledge of countertransference increased from 4 (IQR 3-4) to 5 (IQR 4-5) (also p < 0.001). Satisfaction was high (92% satisfied or highly satisfied), and most participants reported meaningful impact on their clinical practice (89%), teaching (93%), and team collaboration (93%) at eight-week follow-up. Conclusions: A multisite, half-day workshop significantly enhanced palliative care clinicians' knowledge and perceived application of core psychotherapeutic concepts. Future work should explore remote and longitudinal modalities to support ongoing skill integration.

  View details for DOI 10.1089/jpm.2025.0183

  View details for PubMedID 40384456

• When Patients Express Anger Chammas, D., Scheel, T., Polisso, M., Brenner, K. ELSEVIER SCIENCE INC. 2025

  View details for Web of Science ID 001476359700049

• Death Anxiety: Ubiquitous Yet Unspoken Chammas, D., Brenner, K., Saks, N., Solomon, S., Bowman, T. ELSEVIER SCIENCE INC. 2025: E482-E483

  View details for Web of Science ID 001483248900032

• Bogetz Lecture: Palliative Care for Patients With Long-Standing Eating Disorders Rosenberg, L., Datta-Barua, I., Cramer, M., Brenner, K., Treem, J., Conviser, J., Johnson, L. ELSEVIER SCIENCE INC. 2025: E476-E477

  View details for Web of Science ID 001483248900034

• We've Got Your Back: Pearls for Interdisciplinary Psychological and Psychiatric Palliative Care Rosa, W., Brenner, K., Robbins-Welty, G., Polisso, M., Linderman, E., Shalev, D., Chammas, D. ELSEVIER SCIENCE INC. 2025

  View details for Web of Science ID 001476359700021

• Realizing the Imperative: The Future of Mental Health and Palliative Care Integration. Journal of palliative medicine Shalev, D., Brenner, K. O., Fitzgerald Jones, K., Kozlov, E., Portz, J. D., Rosenberg, L. B., Ufere, N. N., Wallace, C. L., Webb, J. A., Chammas, D. 2024

  View details for DOI 10.1089/jpm.2024.0460

  View details for PubMedID 39655624

• Facing Illness Together: Understanding the Role of the Couple in Palliative Care. The American journal of hospice & palliative care Chammas, D., Fishel, A., Kramer, M., Brenner, K. O., Rosenberg, L. B. 2024: 10499091241302413

  Abstract

  Serious illness is rarely experienced by patients in isolation.  Many patients present to palliative care (PC) accompanied by their intimate partner. The intimate partnership is a critical axis around which many patients' experiences of serious illness revolve. However, there is a lack of literature and training on how PC clinicians can effectively support couples as a unit. Many existing PC communication strategies can be expanded to the dyadic unit, offering more holistic support for patients, partners, and the entity of their relationship. This paper integrates concepts from couples therapy, psychology, and PC communication to provide insights into the emotional, psychological, interpersonal, and practical challenges couples face during serious illness, as well as opportunities for growth and resilience. Key strategies for PC clinicians include helping couples navigate shifts in relational identity, share the "emotional housework," and transform conflict into connection. Concrete techniques are illustrated throughout this manuscript, employing clinical micro-vignettes to demonstrate their practical application in PC practice. Recognizing the couple as a unified entity empowers clinicians to foster open communication, helping couples maintain connection and evolve intimacy throughout the illness journey. By applying relational concepts and acknowledging the couple's shared experience, PC clinicians can enhance the quality of life for both patients and their partners. Conceptualizing the couple as a distinct entity within PC practice can deepen clinician-patient communication and improve therapeutic effectiveness.

  View details for DOI 10.1177/10499091241302413

  View details for PubMedID 39566476

• Formulation in Palliative Care: Elevating Our Potential for Therapeutic Communication. The American journal of hospice & palliative care Chammas, D., Moment, A., Rosenberg, L., Shalev, D., Brenner, K. O. 2024: 10499091241300614

  Abstract

  A fundamental principle of clinical reasoning is that assessment precedes plan; clinicians are taught to base interventions on the presumed etiology of a presentation. A notable exception is in the domain of communication education, where training is focused heavily on tools and interventions, with minimal focus on the assessment that informs which tools or strategies to select with a given patient. The concept of formulation (foundational in psychotherapy education) provides a framework with which to address this gap, enhancing a clinician's ability to be more therapeutically effective with the communication tools at their disposal. Our formulation serves as the compass that guides our decisions around communication, allowing us to conceptualize communication as a therapeutic intervention and align our approach to communication with the broader philosophy of clinical reasoning. This manuscript explores the concept of formulation, the direct relevance and applicability to palliative care, sample cases to underscore the impact of this framework, and high-yield tips for use of formulation in general palliative care practice. Palliative care clinicians and IDTs can readily apply formulation in synergy with the communication tools they already possess, elevating their ability to address patients' psychological needs.

  View details for DOI 10.1177/10499091241300614

  View details for PubMedID 39526843

• Top Ten Tips Palliative Care Clinicians Should Know About Applying Key Psychotherapy Concepts in Practice. Journal of palliative medicine Chammas, D., Williamson, B., Scheel, T., Goyal, N., Rosenberg, L. B., Shalev, D., Gamble, A., Polisso, M., Rosa, W. E., Brenner, K. O. 2024

  Abstract

  Psychological symptoms are notably prevalent in palliative care (PC) settings, significantly impacting quality of life for patients and their families. Given the inherent multidimensionality of suffering in PC, addressing these psychological aspects is essential. This article aims to introduce and integrate discrete concepts from various schools of psychotherapy, which are directly applicable to PC practices, thereby providing clinicians with a rich toolkit to manage psychological distress. The article focuses on 10 key concepts from different psychotherapeutic traditions. They are a small sample from the vast and deep pool of wisdom contained in psychotherapeutic theory, and they were selected due to their direct applicability to PC practice. Adopting psychotherapeutic principles, along with leveraging the interdisciplinary wisdom inherent in PC practice, enhances our therapeutic relationships in PC and empowers patients to navigate their illness with greater resilience and adaptive coping.

  View details for DOI 10.1089/jpm.2024.0317

  View details for PubMedID 39269882

• Top Ten Tips Palliative Care Clinicians Should Know About Diagnosing, Categorizing, and Addressing Fatigue. Journal of palliative medicine Robbins-Welty, G. A., Chammas, D., Silverman, E. J., Lowry, M. F., Hale, E., Martinez, C., Nakatani, M. M., Shalev, D., Noufi, P., Riordan, P. A., Brenner, K. O., Rosa, W. E., Jones, C. A. 2024

  Abstract

  Fatigue is a multifactorial symptom that is commonly faced by patients with cancer, chronic disease, and other serious illnesses. Fatigue causes suffering across biopsychosocial domains and affects patients and their loved ones. In this article, a consortium of professionals across cancer care, physical therapy, exercise, pharmacy, psychiatry, and palliative medicine offers tips and insights on evaluating, categorizing, and addressing fatigue in the setting of serious illness. The comprehensive approach to managing fatigue underscores the importance of collaborative efforts characteristic of interdisciplinary palliative care. Prioritizing screening, diagnosing, and treating fatigue is crucial for enhancing patients' and families' overall quality of life.

  View details for DOI 10.1089/jpm.2024.0232

  View details for PubMedID 39052494

• Mind the Gap: Understanding Palliative Care Clinician Attitudes Toward Mental Health Training. The American journal of hospice & palliative care Shalev, D., Chammas, D., Brenner, K. O., Moxley, J. H., Reid, M. C., Rosenberg, L. B. 2024: 10499091241265107

  Abstract

  Background: Palliative care (PC) clinicians provide mental healthcare to individuals with serious illnesses. Despite this, there is limited knowledge regarding their mental health training opportunities. Methods: To identify predictors of satisfaction with mental health training opportunities and assess the relationship between training opportunities and clinician comfort in managing mental health comorbidities, we conducted a secondary analysis of a nationwide survey involving 708 PC clinicians. Results: Satisfaction with mental health training was moderate (M = 2.75/5, SD = .915). Access to lectures/webinars was the most common training opportunity (54%). Significant predictors of satisfaction with training included access to lectures/webinars (β = .328, P <.001) and case discussions (β = .231, P = .007). Academic practice settings and satisfactory mental health referrals were associated with a greater number of different training opportunities. Clinicians in academic settings had higher odds of accessing various training opportunities, such as lectures/webinars (OR = 2.58, P <.001) and longitudinal training pathways (OR = 4.51, P <.001). A moderate, positive correlation was found between training satisfaction and comfort in managing mental health comorbidities (r = .30, P <.001). Discussion: This study is among the first to elucidate factors influencing PC clinicians' satisfaction with mental health training. Low-resource training opportunities, such as webinars and lectures, significantly predict satisfaction, suggesting the potential of these scalable solutions to enhance training. The findings underscore the importance of expanding evidence-based mental health training for PC clinicians to improve patient care.

  View details for DOI 10.1177/10499091241265107

  View details for PubMedID 39046032

• Top Ten Tips Palliative Care Clinicians Should Know About the Psychiatric Manifestations of Nonpsychiatric Serious Illness and Treatments. Journal of palliative medicine Robbins-Welty, G. A., Riordan, P. A., Shalev, D., Chammas, D., Noufi, P., Brenner, K. O., Briscoe, J., Rosa, W. E., Webb, J. A. 2024

  Abstract

  Mental health issues are widespread and significant among individuals with serious illness. Among patients receiving palliative care (PC), psychiatric comorbidities are common and impact patient quality of life. Despite their prevalence, PC clinicians face challenges in effectively addressing the intricate relationship between medical and psychiatric disorders due to their complex, intertwined and bidirectionally influential nature. This article, created collaboratively with a team of psychiatric-palliative care experts, is the second in a two-part series examining the bidirectional relationship between medical and psychiatric illness in PC. This article explores 10 prevalent psychiatric manifestations associated with severe illness and its treatment. Building upon the first article, which focused on 10 common physical manifestations of psychiatric illness among patients receiving PC, these two articles advocate for an integrated approach to PC that prioritizes mental and emotional wellbeing across the continuum of serious illness.

  View details for DOI 10.1089/jpm.2024.0135

  View details for PubMedID 38727571

• Top Ten Tips Palliative Care Clinicians Should Know About the Physical Manifestations of Psychiatric Illness and Treatment. Journal of palliative medicine Robbins-Welty, G. A., Shalev, D., Riordan, P. A., Noufi, P., Webb, J. A., Brenner, K. O., Rosa, W. E., Chammas, D. 2024

  Abstract

  Addressing the psychiatric aspects of serious illness in palliative care (PC) is crucial to both care delivery and outcomes. Psychiatric comorbidities are common among patients with PC needs and can significantly impact their total burden of symptomatic distress, overall quality of life, functional independence, and healthcare utilization. Yet, these aspects of care are often deferred to mental health consultant teams in the context of busy PC services and often limited human resources. To provide comprehensive and person-centered care, PC clinicians must understand the interplay between medical conditions and psychiatric presentations within a biopsychosocial framework to respond empathically, efficiently, and effectively. This article is the first of a two-part series developed in collaboration with a group of psychiatric-palliative care specialists. This article explores ten common physical manifestations of psychiatric illness and treatment among patients facing serious illnesses. The second article will provide pragmatic tips PC clinicians should know about the psychiatric manifestations of nonpsychiatric serious illness and treatment. Combined, these two articles support a holistic approach that PC clinicians can use to prioritize and integrate both mental and emotional well-being throughout the continuum of serious illness.

  View details for DOI 10.1089/jpm.2024.0131

  View details for PubMedID 38722082

• Primary Mental Health Competencies for Palliative Medicine Physicians: A Consensus-Prioritized List Podgurski, L., Brenner, K. O., Chammas, D., Goyal, N., Lapid, M., Morris, S. E., Pirl, W. F., Rosenberg, L. B., Sumser, B., Thompson, B., Shalev, D. ELSEVIER SCIENCE INC. 2024: E726

  View details for Web of Science ID 001282805300352

• Letter to the Editor: Advancing the Psychological Elements of Palliative Care: From Theory to Teaching. Journal of palliative medicine Shalev, D., Chammas, D., Brenner, K., Rosenberg, L. 2024; 27 (3): 294-295

  View details for DOI 10.1089/jpm.2023.0687

  View details for PubMedID 38427909

• Palliative Care Psychiatry: Building Synergy Across the Spectrum. Current psychiatry reports Shalev, D., Brenner, K., Carlson, R. L., Chammas, D., Levitt, S., Noufi, P. E., Robbins-Welty, G., Webb, J. A. 2024

  Abstract

  Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry.PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.

  View details for DOI 10.1007/s11920-024-01485-5

  View details for PubMedID 38329570

  View details for PubMedCentralID 4671283

• Top Ten Tips Palliative Care Clinicians Should Know About the Psychological Aspects of Palliative Care Encounters. Journal of palliative medicine Chammas, D., Brenner, K. O., Gamble, A., Buxton, D., Byrne-Martelli, S., Polisso, M., Shalev, D., Rosenberg, L. B. 2023

  Abstract

  Palliative care clinicians enhance the illness experiences of patients and their families through building therapeutic relationships. Many psychological concepts underlie a clinician's approach to a specific patient. Through high-yield tips, this article highlights ten selected psychological elements that palliative care clinicians often use to support patients. As we all (both clinicians and patients) bring our own histories and unique biographies to the work of palliative care, a more explicit focus on the psychological aspects of this work can enhance our own experience and efficacy as providers. With a thoughtful focus on the psychological aspects of how we engage with patients, palliative care clinicians can offer a more meaningful therapeutic encounter.

  View details for DOI 10.1089/jpm.2023.0390

  View details for PubMedID 37449809

• Looking Within, Together: Optimizing Interdisciplinary Team Meetings with Key Psychodynamic Concepts Rosenberg, L. B., Chammas, D., Brenner, K. O., Shalev, D., Natarajan, S., Scheel, T., Long, J. ELSEVIER SCIENCE INC. 2023: E287-E288

  View details for Web of Science ID 001038555400084

• Authors' Response to Reader Comments to Jackson et al. Psychological Elements of Palliative Care Series (DOI: 10.1089/jpm.2022.0061). Journal of palliative medicine Rosenberg, L. B., Shalev, D., Brenner, K. O., Seaton, M., Jacobsen, J. C., Jackson, V. A. 2022; 25 (5): 701-702

  View details for DOI 10.1089/jpm.2022.0132

  View details for PubMedID 35499367

• Turning the Lens Inward: The Psychological Elements of Clinician Well Being. Journal of palliative medicine Shalev, D., Traeger, L. N., Doyle, K., Kiser, S. B., Brenner, K. O., Rosenberg, L. B., Jacobsen, J. C., Seaton, M., Jackson, V. A. 1800

  Abstract

  This is the seventh entry in the Psychological Elements of Palliative Care (PEPC) series. Previous articles have focused on the psychological elements of the care we provide patients and the relationships we build with our referring clinician colleagues. In this entry, we focus on how the PEPC also impact clinician well being. The PEPC are bidirectional: we impact patients, but patients also impact us. The reactions that we have to patients and the boundaries we set around the care we provide are two examples of psychological factors of care that can influence our well being. Creating spaces to explore and reflect on the psychological impact of the clinical care we provide is a key component of wellness. Such spaces vary in their configuration, but all share the opportunity to self-reflect and to experience emotional validation, normalization, and reality testing from peers or mentors. In mental health training, clinical supervision is one common format for creating such a space. While this can be replicated in the palliative care setting, other strategies include integrating a psychological orientation into interdisciplinary team meetings, creating peer support or process groups, and creating small groups within teams for longitudinal self-reflection.

  View details for DOI 10.1089/jpm.2021.0548

  View details for PubMedID 35085468

• (Don't) Leave Me Alone: Attachment in Palliative Care. Journal of palliative medicine Shalev, D., Jacobsen, J. C., Rosenberg, L. B., Brenner, K. O., Seaton, M., Jackson, V. A., Greer, J. A. 1800; 25 (1): 9-14

  Abstract

  This is the fifth article in the psychological elements of palliative care 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 discuss attachment-the system by which people form bonds in relationships. The different styles that people have in navigating relationships such as clinician-patient relationships develop from early life onward. Attachment styles are not pathological. But they are helpful to understand because they are a relatively stable factor that impacts how people relate to caregivers like clinicians. Our patients all express unique relational needs to us; some of our patients need closeness and reassurance to feel comfortable, others value independence and space. These needs are highly significant to palliative care clinicians; they inflect our patients' goals of care and values, they modulate our patients' psychosocial needs, and they elucidate the ways our patients respond to a range of therapeutic interventions. Understanding attachment gives us a window into these individual care needs and empowers us to tailor the care we provide for a wide range of patients.

  View details for DOI 10.1089/jpm.2021.0491

  View details for PubMedID 34978911

• Referral Relationship: Illuminating the Ways Palliative Care Creates a Holding Environment for Referring Clinicians. Journal of palliative medicine Brenner, K. O., Logeman, J., Rosenberg, L. B., Shalev, D., Jackson, V. A., Seaton, M., Jacobsen, J. C., Emanuel, L. L. 2022

  Abstract

  Palliative care supports referring colleagues in multiples ways. This support to referring colleagues is not often explored in the literature, yet the psychological concept that best describes it is the holding environment. The holding environment is the relational space palliative care offers referring clinicians for processing emotions and information. Using the case of Gloria, a patient living with cancer, this article discusses ways palliative care creates a holding environment for her referring oncologist, Dr. Ko. As palliative care clinicians, we create this relational space for referring clinicians when we change the dynamic, accompany the clinician, recognize challenges, establish expectations, and share a clinical second look. This article is the sixth in a series exploring the psychological elements of palliative care.

  View details for DOI 10.1089/jpm.2021.0527

  View details for PubMedID 35020480

• To Accompany, Always: Psychological Elements of Palliative Care for the Dying Patient. Journal of palliative medicine Rosenberg, L. B., Brenner, K. O., Shalev, D., Jackson, V. A., Seaton, M., Weisblatt, S., Jacobsen, J. C. 2022

  Abstract

  Palliative care clinicians provide psychological support throughout their patients' journeys with illness. Throughout our series exploring the psychological elements of palliative care (PEPC), we suggested that the quality of care is enhanced when clinicians have a deeper understanding of patients' psychological experience of serious illness. Palliative care clinicians are uniquely poised to offer patients a grounded, boundaried, and uplifting relationship to chart their own course through a life-altering or terminal illness. This final installment of our series on PEPC has two aims. First, to integrate PEPC into a comfort-focused or hospice setting and, second, to demonstrate how the core psychological concepts previously explored in the series manifest during the dying process. These aspects include frame/formulation, attachment, attunement, transference/countertransference, the holding environment, and clinician wellness.

  View details for DOI 10.1089/jpm.2021.0667

  View details for PubMedID 35263176

• Defining Clinical Attunement: A Ubiquitous But Undertheorized Aspect of Palliative Care. Journal of palliative medicine Jacobsen, J., Brenner, K. O., Shalev, D., Rosenberg, L. B., Jackson, V. A. 2021

  Abstract

  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 Rosenberg, L. B., Brenner, K. O., Jackson, V. A., Jacobsen, J. C., Shalev, D., Byrne-Martelli, S., Cramer, M. A. 2021

  Abstract

  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

• Exploring the Psychological Aspects of Palliative Care: Lessons Learned from an Interdisciplinary Seminar of Experts. Journal of palliative medicine Brenner, K. O., Rosenberg, L. B., Cramer, M. A., Jacobsen, J. C., Applebaum, A. J., Block, S. D., Doolittle, D. B., El-Jawahri, A., Emanuel, L. L., Greer, J. A., Margulies, A. S., Logeman, J., Rinaldi, S. P., Ritchie, C. S., Rodin, G. M., Sirois, M., Tarbi, E. C., Temel, J. S., Jackson, V. A. 2021; 24 (9): 1274-1279

  Abstract

  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

• Foundations for Psychological Thinking in Palliative Care: Frame and Formulation. Journal of palliative medicine Shalev, D., Rosenberg, L. B., Brenner, K. O., Seaton, M., Jacobsen, J. C., Jackson, V. A. 2021; 24 (10): 1430-1435

  Abstract

  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 Bleymaier, C., Bragg, A., Smith, G., Brenner, K., Yotopoulos, A., Lee, C. 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 Brenner, K., Greer, J. A., Jackson, V., Park, E., Wright, E., Jacobsen, J., Topping, C., Jagielo, A., Elyze, M., Sereno, I., Temel, J. S., El-Jawahri, A. 2021

  Abstract

  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 Sereno, I. I., Brenner, K., Greer, J. A., Jackson, V. A., Park, E. R., Jacobsen, J., Temel, J. S., El-Jawahri, A. 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 Gamble, A., Riordan, P. A., Jordan, A. E., Webb, J. A., Brenner, K. O., Buxton, D. 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 Chammas, D. M., Brenner, K. O. ELSEVIER SCIENCE INC. 2020: 436–37

  View details for Web of Science ID 000509464700113

• Relationship Between Perceptions of Treatment Goals and Psychological Distress in Patients With Advanced Cancer. Journal of the National Comprehensive Cancer Network : JNCCN El-Jawahri, A. n., Forst, D. n., Fenech, A. n., Brenner, K. O., Jankowski, A. L., Waldman, L. n., Sereno, I. n., Nipp, R. n., Greer, J. A., Traeger, L. n., Jackson, V. n., Temel, J. n. 2020; 18 (7): 849–55

  Abstract

  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

• An Integrative Framework of Appraisal and Adaptation in Serious Medical Illness. Journal of pain and symptom management Bickel, K. E., Levy, C. n., MacPhee, E. R., Brenner, K. n., Temel, J. S., Arch, J. n., Greer, J. A. 2020

  Abstract

  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

• Circle of Trust: How Psychodynamic Themes Such as the 'Holding Environment' Optimize Coping with Serious Illness Brenner, K., Jackson, V., Emanuel, L. ELSEVIER SCIENCE INC. 2019: 426–27

  View details for DOI 10.1016/j.jpainsymman.2018.12.153

  View details for Web of Science ID 000456406900161