Rachel Schwartz received her BA in Linguistics from UCLA followed by a PhD in Communication Sciences and Disorders from McGill University. She completed postdoctoral fellowships in Delivery System Science (AcademyHealth, Palo Alto Medical Foundation Research Institute), and Health Services Research & Development (VA Palo Alto Health Care System and Stanford Center for Heath Policy / Primary Care & Outcomes Research). She has experience leading research in pediatrics (Lucile Packard Children’s Hospital), neurology (Palo Alto Medical Foundation), emergency medicine (Stanford) and primary care (Stanford and Palo Alto VA).
Her research interests center around systems-level interventions for improving provider wellness and medical education initiatives that provide physicians with tools for navigating psychosocial aspects of the clinical encounter.
Service, Volunteer and Community Work
Families At The Border
Families At The Border is a group of medical professionals working to bring supplies and medical care to immigrants at the California border. More information here: https://www.gofundme.com/f/supplies-for-family-amp-children-at-the-border
Harnessing the Chaplain's Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department.
Journal of palliative care
OBJECTIVE: To explore chaplains' ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients.METHODS: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received.RESULTS: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC.CONCLUSION: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.
View details for DOI 10.1177/08258597211003359
View details for PubMedID 33818162
- Emotion in the Clinical Encounter https://www.mhprofessional.com/9781260464320-usa-emotion-in-the-clinical-encounter edited by Schwartz, R., Hall, J. A., Osterberg, L. G. McGraw Hill. 2021
Retaining VA Women's Health Primary Care Providers: Work Setting Matters.
Journal of general internal medicine
BACKGROUND: When an experienced provider opts to leave a healthcare workforce (attrition), there are significant costs, both direct and indirect. Turnover of healthcare providers is underreported and understudied, despite evidence that it negatively impacts care delivery and negatively impacts working conditions for remaining providers. In the Veterans Affairs (VA) healthcare system, attrition of women's health primary care providers (WH-PCPs) threatens a specially trained workforce; it is unknown what factors contribute to, or protect against, their attrition.OBJECTIVE: Based on evidence that clinic environment, adequate support resources, and workload affect provider burnout and intent to leave, we explored if such clinic characteristics predict attrition of WH-PCPs in the VA, to identify protective factors.DESIGN: This analysis drew on two waves of existing national VA survey data to examine predictors of WH-PCP attrition, via logistic regression.PARTICIPANTS: All 2,259 providers from 140 facilities VA-wide who were WH-PCPs on September 30, 2016.MAIN MEASURES: The dependent variable was WH-PCP attrition in the following year. Candidate predictors were clinic environment (working in: a comprehensive women's health center, a limited women's health clinic, a general primary care clinic, or multiple clinic environments), availability of co-located specialty support resources (mental health, social work, clinical pharmacy), provider characteristics (gender, professional degree), and clinic workload (clinic sessions per week).KEY RESULTS: Working exclusively in a comprehensive women's health center uniquely predicted significantly lower risk of WH-PCP attrition (adjusted odds ratio 0.40; CI 0.19-0.86).CONCLUSIONS: A comprehensive women's health center clinical context may promote retention of this specially trained primary care workforce. Exploring potential mechanisms-e.g., shared mission, appropriate support to meet patients' needs, or a cohesive team environment-may inform broader efforts to retain front-line providers.
View details for DOI 10.1007/s11606-020-06285-0
View details for PubMedID 33063204
How do laypeople define empathy?
JOURNAL OF SOCIAL PSYCHOLOGY
The term "empathy" is popular, yet fuzzy. How laypeople define it has not been investigated. In Study 1, we analyzed 99 participants' free narratives describing their personal definition, and in Study 1 (N = 191) and Study 2 (N = 351), we asked participants to rate a list of specific behaviors and tendencies for how well each one matched their personal definition. Out of 10 coded components, perspective taking was mentioned most often and personal distress (anxious reactivity in emotional situations) was never mentioned. Item ratings revealed four Empathy Concept factors: Prosocial Emotional Response, Interpersonal Perceptiveness, Other Perspective, and Anxious Reactivity. Other Perspective and Prosocial Emotional Response were most highly endorsed while Anxious Reactivity showed the lowest endorsement. Individuals varied widely in their endorsements of the factors. These results demonstrate that laypeople hold a multifactorial set of definitions of empathy and differ widely from one another in which ones they endorse.
View details for DOI 10.1080/00224545.2020.1796567
View details for Web of Science ID 000564987200001
View details for PubMedID 32870130
Developing institutional infrastructure for physician wellness: qualitative insights from VA physicians
BMC Health Services Research
2020; 20 (7)
View details for DOI 10.1186/s12913-019-4783-9
Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
2020; 323 (1): 70-81
View details for DOI 10.1001/jama.2019.19003
Addressing Postpandemic Clinician Mental Health : A Narrative Review and Conceptual Framework.
Annals of internal medicine
Previous pandemics have seen high psychiatric morbidity among health care workers. Protecting clinician mental health in the aftermath of coronavirus disease 2019 (COVID-19) requires an evidence-based approach to developing and deploying comprehensive clinician mental health support. In a narrative review of 96 articles addressing clinician mental health in COVID-19 and prior pandemics, 7 themes emerged: 1) the need for resilience and stress reduction training; 2) providing for clinicians' basic needs (food, drink, adequate rest, quarantine-appropriate housing, transportation, child care, personal protective equipment); 3) the importance of specialized training for pandemic-induced changes in job roles; 4) recognition and clear communication from leadership; 5) acknowledgment of and strategies for addressing moral injury; 6) the need for peer and social support interventions; and 7) normalization and provision of mental health support programs. In addition to the literature review, in collaboration with the Collaborative for Healing and Renewal in Medicine (CHARM) network, the authors gathered practice guidelines and resources from health care organizations and professional societies worldwide to synthesize a list of resources deemed high-yield by well-being leaders. Studies of previous pandemics demonstrate heightened distress in health care workers years after the event. The COVID-19 pandemic presents unique challenges that surpass those of previous pandemics, suggesting a significant mental health toll on clinicians. Long-term, proactive individual, organizational, and societal infrastructures for clinician mental health support are needed to mitigate the psychological costs of providing care during the COVID-19 pandemic.
View details for DOI 10.7326/M20-4199
View details for PubMedID 32822206
View details for PubMedCentralID PMC7450528
Can Patient-Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review.
Journal of general internal medicine
Human connection is at the heart of medical care, but questions remain as to the effectiveness of interpersonal interventions. The purpose of this review was to characterize the associations between patient-provider interpersonal interventions and the quadruple aim outcomes (population health, patient experience, cost, and provider experience).We sourced data from PubMed, EMBASE, and PsycInfo (January 1997-August 2017). Selected studies included randomized controlled trials and controlled observational studies that examined the association between patient-provider interpersonal interventions and at least one outcome measure of the quadruple aim. Two abstractors independently extracted information about study design, methods, and quality. We characterized evidence related to the objective of the intervention, type and duration of intervention training, target recipient (provider-only vs. provider-patient dyad), and quadruple aim outcomes.Seventy-three out of 21,835 studies met the design and outcome inclusion criteria. The methodological quality of research was moderate to high for most included studies; 67% of interventions targeted the provider. Most studies measured impact on patient experience; improvements in experience (e.g., satisfaction, patient-centeredness, reduced unmet needs) often corresponded with a positive impact on other patient health outcomes (e.g., quality of life, depression, adherence). Enhanced interpersonal interactions improved provider well-being, burnout, stress, and confidence in communicating with difficult patients. Roughly a quarter of studies evaluated cost, but the majority reported no significant differences between intervention and control groups. Among studies that measured time in the clinical encounter, intervention effects varied. Interventions with lower demands on provider time and effort were often as effective as those with higher demands.Simple, low-demand patient-provider interpersonal interventions may have the potential to improve patient health and patient and provider experience, but there is limited evidence that these interventions influence cost-related outcomes.
View details for DOI 10.1007/s11606-019-05525-2
View details for PubMedID 31919725
Neurologist Strategies for Optimizing the Parkinson's Disease Clinical Encounter.
Journal of geriatric psychiatry and neurology
For patients with Parkinson's disease (PD), effective communication during neurology encounters is critical to ensuring the treatment plan maximizes quality of life. However, few research studies have engaged neurologists as key experts in identifying opportunities to optimize the clinical encounter. In this study, 16 neurologists from 4 clinic sites participated in hour-long semistructured interviews targeting opportunities to better address patients' quality of life needs.Neurologists identified opportunities to meet needs across 4 domains: (1) PD patient education materials and self-management tools to facilitate clinical communication; (2) techniques for improving clinical communication, including strategies for eliciting nonmotor symptoms and contextualizing symptoms to better meet patient quality of life needs; (3) addressing system-level barriers, including time constraints and the lack of an identified specialist referral network; and (4) training in how to lead difficult conversations.Neurologists identified specific barriers, and proposed solutions, to improving care delivery for patients with PD. Integrating practice tools to address quality of life needs, training neurologists in communication around end-of-life care, and strengthening referral networks for rehabilitation and psychosocial support hold promise for improving quality of life for patients with PD.
View details for PubMedID 31046525
Transdisciplinary Strategies for Physician Wellness: Qualitative Insights from Diverse Fields
Journal of General Internal Medicine
While barriers to physician wellness have been well detailed, concrete solutions are lacking.We looked to professionals across diverse fields whose work requires engagement and interpersonal connection with clients. The goal was to identify effective strategies from non-medical fields that could be applied to preserve physician wellness.We conducted semi-structured interviews with 30 professionals outside the field of clinical medicine whose work involves fostering effective connections with individuals.Professionals from diverse professions, including the protective services (e.g., police officer, firefighter), business/finance (e.g., restaurateur, salesperson), management (e.g., CEO, school principal), education, art/design/entertainment (e.g., professional musician, documentary filmmaker), community/social services (e.g., social worker, chaplain), and personal care/services (e.g., massage therapist, yoga instructor).Interviews covered strategies that professionals use to initiate and maintain relationships, practices that cultivate professional fulfillment and preserve wellness, and techniques that facilitate emotional presence during interactions. Data were coded using an inductive thematic analysis approach.Professionals identified self-care strategies at both institutional and individual levels that support wellness. Institutional-level strategies include scheduling that allows for self-care, protected time to connect with colleagues, and leadership support for debriefing after traumatic events. Individual strategies include emotionally protective distancing techniques and engagement in a bidirectional exchange that is central to interpersonal connection and professional fulfillment.In this exploratory study, the purposive sampling technique and single representative per occupation could limit the generalizability of findings.Across diverse fields, professionals employ common institutional and personal wellness strategies that facilitate meaningful engagement, support collegiality, and encourage processing after intense events. The transdisciplinary nature of these wellness strategies highlights universal underpinnings that support wellbeing in those engaging in people-oriented professions.
View details for DOI 10.1007/s11606-019-04913-y
Changing the game for hand hygiene conversations
2018; 8 (3): 168-169
View details for DOI 10.1542/hpeds.2017-0205
Empathy present and future.
The Journal of social psychology
The empathy concept has central significance for social and personality psychology and in many other domains, including neuroscience, clinical/abnormal psychology, and the health professions. However, the current diversity in conceptual and operational definitions, and the promiscuous use of the term "empathy," threaten the ability of researchers to advance the field. The present article provides a quantitative review and conceptual analysis of empathy definitions and usages by examining 393 studies published between 2001 and 2013, and 96 studies published in 2017. We document the prevalence and diversity of definitions, as well as inconsistencies between conceptual definitions and measurements employed. We discuss ways to refine the conceptualization and operationalization of the empathy construct, including for many purposes, bypassing the term empathy in favor of lower-level construct labels that more precisely describe what is actually being measured. In many cases we see no added theoretical or empirical value in applying the term empathy.
View details for DOI 10.1080/00224545.2018.1477442
View details for PubMedID 29781776
"It's a disease of families": Neurologists' insights on how to improve communication and quality of life for families of Parkinson's disease patients.
Objectives Parkinson's disease presents an evolving challenge for patients and families due to an unpredictable disease trajectory and symptoms that complicate social interactions. In this study, we explore neurologists' perspectives on the challenges Parkinson's disease presents for families and the strategies they use to improve communication and quality of life. Methods We conducted hour-long semi-structured interviews with 16 neurologists at 4 care delivery institutions in the San Francisco Bay Area, focusing on techniques neurologists use to support families through the Parkinson's disease journey. Results Neurologists identified strategies for addressing caregiver-patient disagreements around symptom accuracy and negotiating driving safety. Family education is needed to contextualize patient symptoms and to identify psychosocial support resources. Unmet caregiver needs remain, particularly in the form of psychosocial support, respite care and support for unequal gender dynamics in the Parkinson's disease caregiving experience. Discussion Family members of Parkinson's disease patients face unique caregiving and interpersonal challenges due to the nature of the disease. Targeted education and structural support are needed to alleviate current burdens and allow for improved patient- and family-centered care.
View details for PubMedID 30208725
- When emotion and expression diverge: The social costs of Parkinson's disease JOURNAL OF CLINICAL AND EXPERIMENTAL NEUROPSYCHOLOGY 2017; 39 (3): 211-230
Unaltered emotional experience in Parkinson’s disease: Pupillometry and behavioral evidence
Journal of Clinical and Experimental Neuropsychology
View details for DOI 10.1080/13803395.2017.1343802
Emotional Speech Processing at the Intersection of Prosody and Semantics
2012; 7 (10)
The ability to accurately perceive emotions is crucial for effective social interaction. Many questions remain regarding how different sources of emotional cues in speech (e.g., prosody, semantic information) are processed during emotional communication. Using a cross-modal emotional priming paradigm (Facial affect decision task), we compared the relative contributions of processing utterances with single-channel (prosody-only) versus multi-channel (prosody and semantic) cues on the perception of happy, sad, and angry emotional expressions. Our data show that emotional speech cues produce robust congruency effects on decisions about an emotionally related face target, although no processing advantage occurred when prime stimuli contained multi-channel as opposed to single-channel speech cues. Our data suggest that utterances with prosodic cues alone and utterances with combined prosody and semantic cues both activate knowledge that leads to emotional congruency (priming) effects, but that the convergence of these two information sources does not always heighten access to this knowledge during emotional speech processing.
View details for DOI 10.1371/journal.pone.0047279
View details for Web of Science ID 000310600500015
View details for PubMedID 23118868
View details for PubMedCentralID PMC3485297