Nancy Dudley, PhD, RN, saw firsthand how the chronically ill often fell through cracks in a medical system not prepared to deal with them. Typically these were older patients living for five to 10 years with advanced illnesses such as cancer, heart failure, dementia or end-stage renal disease. They often visited the emergency department, when what they really needed, Dudley realized, was help coordinating all of their care needs.
It was a problem she wanted to fix, so she returned to graduate school and is now the first nursing postdoctoral scholar at Stanford. Her goal: to provide a systematic method of getting palliative care services to patients so they can live well with serious illness with less pain and fewer symptoms.
What led to your dedication to care for older adults?
My interest in caring for the aging began at an early age accompanying my grandmother on her visits in her small town to what she called 'her people.' Her people were socially isolated, lonely older adults. It was her calling to advocate for them, provide social engagement and just check on their needs. She would arrange medical appointments, provide medication management, transportation, food delivery and care support.
My grandmother was not a nurse. She was a comptroller for a large lumber company — unusual for a woman at that time. She learned advocacy from her mother, my great-grandmother, a midwife who helped Native Americans in the Pacific Northwest.
My mother was a high school nurse health administrator who worked with teenagers who had difficult family issues such as drug dependency, and she also created programs in elementary schools to teach students about healthy bodies and nutrition.
What motivated you to focus your research on palliative care?
My passion for palliative care stems from my work as a manager in Stanford Health Care's Aging Adult Services program. I was seeing a common pattern of older adults being readmitted to the emergency department. These patients came in with advanced illnesses that had gotten out of control, their caregivers were in distress and nobody was playing quarterback to coordinate their care. I wanted to help solve this problem.
I decided to go back to school to get a PhD in health policy to help implement change in the health system to meet the changing needs of our aging population. I am driven by a desire to better meet the needs of the seriously ill — those older adults who are suffering daily and their families who are often overwhelmed by the burden of care.
What exactly is palliative care and what role can it play in caring for the seriously ill?
The goal of palliative care is to improve the quality of life for both seriously ill patients and their families. Palliative care services include basic symptom management, routine discussions about goals of care and advance care planning to align care with patients' wishes, priorities and values.
There is a growing need for more health care professionals who specialize in palliative care.
What is your current research focused on, and what do you see as the future of palliative medicine?
I’m focused on figuring out the best way to help Stanford implement palliative care in ambulatory care settings and on how to develop a palliative care workforce that can meet a growing demand for these services.
The future of palliative medicine depends on a multidisciplinary approach to health care. There needs to be coordination between primary care professionals and subspecialty care teams to be prepared to refer to specialists trained in palliative care as the disease burden increases.
I was excited to learn about this fellowship in nursing science within the division of primary care and population health thanks to a grant from the Stanford Nurse Alumnae.
Photo by Nicole Dudley