Abstract
Dear Editor:
An estimated 61 million people globally have unmet palliative care needs.1–3 The lack of access to palliative care is a global health inequity issue. To address these needs, a parallel concern is inequity in funding, hiring, and leadership opportunities for a growing body of interdisciplinary scientists committed to advancing the science of hospice and palliative care.
Nonclinical PhDs are important partners for examining the complex impact of serious illness on individuals, families, communities, and society because our training allows us to focus on the social, cultural, organizational, and economic aspects of living with illness. Our training in research theory and methods allows us to investigate important determinants that impact access to and outcomes of serious illness care: cost, policy, systems, education, ethics, literacy, access, disparities, communication, and burden. A researcher with a PhD in policy evaluates the ways in which different reimbursement policies influence the provision of clinical care. A researcher with a PhD in communication examines the ways that dominant discourses impact our ability to freely and openly express ourselves and our values when making decisions. A researcher with a PhD in anthropology or sociology illuminates how the culture of medicine impacts the delivery and receipt of health care from multiple perspectives. Over the past 10+ years, efforts to grow the evidence and number of scientists in hospice and palliative care have been successful.2,3 However, there is still no national conference or professional organization focused on the science of palliative care and where nonphysician scientists are adequately represented in senior leadership positions or equally eligible for awards. Only the Palliative Care Research Cooperative and National Palliative Care Research Center reflect the interdisciplinary landscape of palliative care and provides a unifying home that transcends discipline.
We risk losing the next generation of nonclinician scientists contributing to evidence-based hospice and palliative care if we do not provide equitable opportunities for leadership within palliative care. Some progress has been made toward equity. The Cambia Sojourns program recently expanded their eligibility criteria and accepted their first nonclinician scholars. All interdisciplinary team members are eligible for National Palliative Care Research Center's career development awards. 4 For the first time, a PhD received the Early Career Investigator Award within The American Academy of Hospice and Palliative Medicine (AAHPM). Yet, barriers remain. Nominees for AAHPM's recent call for emerging leaders must be board certified in palliative care; not all interdisciplinary scientists can become fellows of the academy, and nonclinicians are ineligible for many National Institutes of Health (NIH) funding opportunities. Opportunities such as these are evidence of a national profile in science necessary for obtaining grant funding and promotion. Without access to these opportunities, nonclinical PhD scientists may forgo their focus on palliative care to other fields that value and integrate their expertise.
Because living with a serious illness and caring for someone with a serious illness are a nonclinical endeavor as much as it is a clinical endeavor, interprofessionalism should extend beyond the clinical arena to make our science and our clinical practice better for the diverse populations and needs we serve.