A Continuum of Compassion

‘Palliative care everywhere’ becomes a family’s legacy

“It’s inspiring to see people doing everything they can to live their best life,” says Dr. Laura Shoemaker, Chair of the Department of Palliative & Supportive Care at Cleveland Clinic and holder of the Lois U. and Harry R. Horvitz Endowed Chair for Palliative Medicine. |  Photo: Stephen Travarca

When Ron Siwik was diagnosed with stage 4 colon cancer, he and his wife, Rita, chose to prolong his life with chemotherapy and radiation. Years into treatment, Ron’s oncologist suggested palliative care to help manage disease symptoms and treatment side effects.

That’s when they met Laura Shoemaker, DO, Chair of the Department of Palliative & Supportive Care at Cleveland Clinic and holder of the Lois U. and Harry R. Horvitz Endowed Chair for Palliative Medicine.

“She was a friend as well as a physician,” Rita says. “She was so caring and available for anything we needed. For so long, Ron was pain-free, and she was as excited about that as we were.”

Just as a person with heart disease is referred for treatment to cardiology, someone living with serious illness deserves palliative care — which extends to a patient’s loved ones, according to Dr. Shoemaker. The team can provide care alongside curative treatment at any point during the trajectory of a serious illness.

“When I meet a patient for the first time, I do a comprehensive assessment to find out where the suffering is right now,” says Dr. Shoemaker. “Is it physical? Emotional? Financial? Spiritual? We try to align the patient’s goals and preferences to a care plan. Sometimes patients decide they want to continue with disease-directed therapies, and we support them in that. Sometimes they want help transitioning to a supportive comfort-focus plan of care.”

Last year alone, more than 7,000 Cleveland Clinic patients and families received specialty palliative care services — at six hospitals, in outpatient clinics and in their own homes. “People with serious illness often are in and out of the hospital and seen by physicians in multiple clinical settings,” Dr. Shoemaker says. “We can provide a continuum of integrated care.”

Her goal can be summed up in three words: “palliative care everywhere.” The Lois U. and Harry R. Horvitz Palliative Medicine Program staffs 23 palliative medicine physicians, 17 advanced practice providers and eight dedicated social workers in Northeast Ohio, as well as dedicated palliative social workers and other clinicians.

Beyond patient care, Dr. Shoemaker’s team is involved in advocacy and research. They also provide training and education in palliative care to physicians, nurses, medical students, case managers, bioethicists and chaplains.

“Traditional medical education is getting better, but it doesn’t really attend to primary palliative care competencies,” says Dr. Shoemaker. “It’s typically more focused on diagnosis and disease-modifying therapies, often missing the recognition and management of symptoms and complex psychosocial needs that accompany the disease and its treatment. We need to be out there on the hospital floors and in the medical schools, infusing this into the education.”

Having personally benefitted from palliative care at Cleveland Clinic, the Lois and Harry Horvitz family has generously invested in the specialty since 1992. Son Michael says it’s gratifying to be involved in such an “innovative” venture that is having such a “huge impact around the world.” Their continued financial commitment is allowing a significant broadening of the vision and mission.

In addition to advancing the field of palliative care through research and innovation, the ongoing support from the Horvitz family creates a number of avenues, including the Lois U. and Harry R. Horvitz Grand Rounds in Palliative Medicine, to train not only the next generation of palliative care specialists, but also the broader workforce. “The aim is to assure that every patient and family with a serious illness receives a palliative touch, even if they don’t end up receiving a specialty palliative care consultation,” Dr. Shoemaker says. “When our fellow caregivers engage with education from our team, they walk away with primary palliative care skills they can take to the bedside right away, including relationship-centered communication and recognizing and responding to symptoms and psychosocial distress.”

Being granted the Lois U. and Harry R. Horvitz Endowed Chair is a huge honor and responsibility, says Dr. Shoemaker. “It’s more meaningful that it was generated from a patient experience,” she says. “Lois and Harry were moved by this different kind of care that they received.”

Offering that level of compassionate care to others isn’t something that she takes lightly. “It’s inspiring to see people doing everything they can to live their best life,” says Dr. Shoemaker. “I walk away feeling grateful for all that I have in my life … but also grateful that people are willing to be vulnerable with me. It’s a privileged space.”