Like many of you, my work as a social worker and researcher has focused on improving the care of individuals impacted by cancer, with a focus on post-treatment survivorship. My own experiences as a two-time cancer survivor informed and fueled a passion to help others through their experiences.

One of the most profound moments came when my best friend Holly received news that her breast cancer had metastasized, and shortly thereafter was given two weeks to live. Fortunately, Holly beat the odds and lived many years past this. However, it raised my attention to expanding my work in survivorship to include those living with cancer as a chronic illness. Of particular interest is that only a small minority (15 percent) of individuals with metastatic breast cancer (MBC) who died at a major comprehensive cancer center within the past two years had a documented advance directive document. Enter: Four Conversations.

Through funding by the National Comprehensive Cancer Network and Pfizer, we are studying a psychosocial intervention named Four Conversations that aims to improve shared decision making between individuals with MBC and their:

• healthcare providers,
• loved ones,
• spirit, and
• themselves.

Also, the project aims to demonstrate whether Four Conversations influences patient, caregiver and provider end-of-life care knowledge and MBC quality of life. The four-module intervention will be delivered online using Adobe Connect for live sessions and web-based video content.

Four Conversations is based on the Seven Pillars of Personal Strength™ (Smith, O’Donnell, Abernethy, MacDermott, Staley, & Samsa, 2015), a standardized, innovative curriculum that was awarded the LiveStrong Community Impact Project Award. Two important deliverables will be the development of a Worries to Wishes Treatment Plan and advance directive documents that a person with MBC can share with his/her provider as a means to improve patient-provider communication.

Finally, I had the opportunity to represent oncology social work research by participating in a palliative care panel at the 2016 National Comprehensive Cancer Network 21st Annual Conference (NCCN) in Florida earlier this year. I advocated for social work’s role on a multidisciplinary team, the increasing burden of financial distress on families and the importance of introducing palliative care early in the survivorship trajectory (i.e., at diagnosis). You can read more about the panel on the NCCN website.

Enrollment for the Four Conversations study will begin this fall. Please contact me at if you and/or your MBC patient population are interested in participating.