Cedars-Sinai Blog

Emphasis on Empathy

Andrew Hendifar, MD. Director of Pancreatic Cancer at Cedars-Sinai.

Dr. Andrew Hendifar takes pride in his tenacity. Years ago, he decided to focus his practice on pancreatic cancer because fighting the disease demands that trait.

"I don't like to give up on things," says Dr. Hendifar, who also puts his perseverance to the test by competing in triathlons in his free time.

In recent years, though, Dr. Hendifar has developed skills in an area that relies on a more tender side of his personality—serious illness communication.

"The earlier and more often that we engage in these conversations with patients and their families, the better off everyone will be over the course of their care."

In fact, he is one of the champions of a new program known as the Serious Illness Communication Initiative. The program is in its early stages at Cedars-Sinai, but several physicians already have received training. Eventually, all Cedars-Sinai healthcare professionals will be encouraged to go through the program.

The most intensive training is intended for physicians primarily responsible for the care of patients with serious, life-limiting illnesses.

The purpose of the initiative is to ensure that every Cedars-Sinai patient receives comprehensive and compassionate care that is consistent with their goals, values and preferences.

"The earlier and more often that we engage in these conversations with patients and their families, the better off everyone will be over the course of their care," says Dr. Bradley Rosen, one of the executive co-sponsors of the program and a vice president at Cedars-Sinai.

About five years ago, Dr. Hendifar received serious illness communication training from the same organization Cedars-Sinai is partnering with to provide classes for staff. He remembers feeling humbled by the one-day program after recognizing that he had been having these kinds of conversations with patients for years, but he had never received any formal education on how to do it well.

"It's a topic that's really hard for everybody—hard for the patient, hard for providers—but I think if you've been trained, you'll be a little bit more comfortable doing it, and you'll be better at it," Dr. Hendifar says.

"We never broached this topic in medical school, or in residency and fellowship, which is probably a real disservice to the providers and the patients."

Early on in his career, Dr. Hendifar remembers his approach to these conversations left room for improvement.

"I wasn't really organized in my approach," he says. "A lot of times, I would just kind of intuitively work my way through a conversation."

The serious illness communication class he took opened his eyes to the value of talking with patients early on in their care about their goals and values. He embraced a technique he learned called "reframing," which broadens conversations to ensure that the discussions during clinic visits are not limited to the illness and treatment options.

"When you start to reframe the conversation, you start to ask about what else is important to the patient, not just the ability to extend life, and what other important goals a patient has," Dr. Hendifar explained.

So, he asks patients about what they are doing outside of their treatment. He takes the time to get to know his patients as people, each of whom has lives, interests and hobbies separate from the diagnosis.

"Especially with my cancer patients, if they ever mention to me that there's something they've been meaning to do, I always take that as an opportunity to say, 'Well, you know, the therapies' effectiveness is limited. So, any opportunity you have to do what is important to you and accomplish any of these goals is very important.'"

The aim, he says, is to help them make good decisions that are in line with their values.

"These are really precious moments of connection with our patients that we want to get right," says Dr. Rosen.