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Social worker turned Ph.D. candidate seeks to improve hospice and palliative care and reduce disparities

Social worker turned Ph.D. candidate seeks to improve hospice and palliative care and reduce disparities

Tuesday, November 17, 2020

Sarah Cross, Ph.D. candidate, Sanford School of Public Policy
Social worker turned Ph.D. candidate seeks to improve hospice and palliative care and reduce disparities

Sarah Cross had a plan: Go to college. Become a social worker. Remain in direct practice. But as we all know, plans change, or at least change direction. Sarah did stick with her plan and became an experienced social worker in home hospice and inpatient palliative care, but quickly realized she wasn’t able to help her patients as much as she wanted. Change needed to happen and she wanted to be a part of the conversation.

Sarah assumed she would stay a clinician and work in the field, but she kept running into the same problems over and over again as she worked with patients and their families. She struggled to get proper care that met their needs and understood that these were problems that she could not attempt to resolve in her capacity as a social worker. There were policy problems that required a change in the system. It also required knowledge and research skills that Sarah hadn’t acquired since she initially wasn’t interested in the research side of the work. She knew that to make a real impact she would need the skills necessary to help change current policy. 

Motivated by the desire to improve the quality of palliative and end-of-life care, particularly focused on the populations traditionally underserved (racial/ethnic minorities, rural, low-income), Sarah decided to go back to school for her Master’s in public health.

Sarah explained, “I began to develop the vocabulary to describe what I had been seeing and now I wanted the skills to figure out how to change it. So, I just took a leap of faith and decided to quit work and go back to school.”

After much research, she chose to continue her studies at the Sanford School of Public Policy at Duke University. What she liked most about the program was that it is very interdisciplinary whereas many similar schools tend to be very Econ-focused. They also include sociology as one of the concentrations, which aligned well with Sarah’s interests. At the Sanford School she further studied concepts such as social determinants of health, which explained what she was seeing in her previous role in social work. Patients who were minorities and poor were dying young and white affluent patients were dying much older. Access to appropriate health care for all was an issue.

Transitioning from the ‘real-world’ back to academia

As a non-traditional student, Sarah enrolled in an economics course, with zero background in the subject. In one seminar they were discussing earnings and she began to wonder, “Why did I decide to go back to school and take five years off during prime earning years? How am I going to know whether or not this was worth it?”

It didn’t take long for Sarah to realize she made the right decision. Research was her passion. She had great mentors and began to work on important projects. Sarah recently collaborated with a colleague, who had been a fellow in cardiology at Duke, and together they published their research in the New England Journal of Medicine. As a graduate student, this isn’t something she could have imagined. National press, including NPR and The New York Times, took notice of their important work.  

“When our research got picked by mainstream media it was amazing since one of the main barriers to improving palliative and end-of-life care is the reluctance to talk about serious illness and death. It’s important to normalize these conversations outside of academia,” said Sarah.

For Sarah, medicine is social science. You simply cannot separate who gets sick and who gets high quality healthcare from social factors.

She explained, “When I was doing home hospice, I was working in South Carolina, which is where I'm from. I grew up in what was considered upper middle class and I was blown away by the poverty that I saw in my own state, in parts of the state that I would never have gone to. Homes I would never have gone into had I not been there in my capacity as a social worker and trying to understand: Okay. We're all going to die. Yes. But imagine how difficult it is to go through that experience when you're struggling to pay your utility bills.”

Many of Sarah’s patients had no reliable transportation and she found herself going above and beyond normal work duties. She would often head to food banks for patients or pool resources together to buy an air conditioner. For a patient in the rural south, who has heart failure, you can't discharge them safely home from the hospital in the middle of the summer knowing temperatures may climb into triple digits and they don’t have air conditioning. It was witnessing these struggles that motivated Sarah to change her plans and go back to school.

Advice to new students

As a student with work experience, Sarah was used to structure and a set 9-5 schedule which has proved to be helpful as she’s transitioned to graduate school. It can be difficult in academia to separate work and the rest of your life since there's always research to do, an article that you need to read, or coursework to finish.

Sarah confessed, “I still respond to emails at 10 o'clock at night if somebody I'm working on a paper with emails me. I need to listen to my own advice. But giving yourself some separation will make you more resilient and keep you from burning out.”

Sarah’s 5 Tips:

  • Read widely (articles, journals, books…)
  • Stay current on what's going on in your field (healthcare changes fast)
  • Attend conferences (virtually)
  • Have multiple mentors (interdisciplinarity is key)
  • Manage your time (keep a schedule)

So, what does the future hold for Sarah? We'll likely find her as researcher in academia, at an institution that has a strong clinical presence. It's important she works in a medical school, or works closely with people in a medical school, who have a commitment to palliative care. What’s most important to Sarah is continuing to grow as a scholar and the end goal has stayed the same: improve the quality of care for people with serious illnesses, or who are at the end-of-life, with a focus on populations that have been underserved.


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