Alumnae/i Feature

Breaking Ground with Qualitative Research in Hospice Care

Stephanie Wladkowski ’14PhD

“My mentors really instilled confidence in me, convincing me that I could push the field forward with my research.”

Stephanie Wladkowski ’14PhD was a clinical social worker in hospice care when policy changes impacted her clinical practice. In a search for answers, Wladkowski began her PhD in Social Work at Simmons. Her dissertation, “Dementia Caregivers and Live Discharge from Hospice: What Happens When Hospice Leaves?,” has inspired further research in the field.

As a clinical social worker in hospice care, Stephanie Wladkowski ’14PhD worked for several years with patients at the end of life, offering support for the patient and the family. Her mentor, Professor Hugo Kamya, encouraged her to apply for the PhD in Social Work at Simmons.

“I like that Simmons values clinical experience and scholarship. It’s about making sure the research informs the practice, and the practice informs the research. You don’t find that in a lot of programs.” Wladkowski continued to work as a clinician while pursuing her PhD. “It was the best of both worlds,” she says. “I was able to gain research skills while still engaging in clinical practice.”

At the start of her PhD, Wladkowski was considering a career in clinical practice once she completed her doctorate. However, her practice and research would overlap to alter the trajectory of her career. Due to a change in Medicare guidelines that determined how long patients could receive hospice care, Wladkowski observed “live discharges” of patients from hospice when they were deemed no longer eligible. “These [patients and family members] were using all the services the hospice had to offer — music therapy, chaplains, social workers — but they no longer met the medical needs determined by Medicare. Their health wasn’t declining fast enough, so they were discharged.”

This change caused Wladkowski to reflect on the holistic work done in hospice care, and how stringent medical insurance policies could interrupt those practices. While she had no previous interest in policy, taking Policy Analysis in Political, Social and Economic Contexts (PhD) course with Professor Michelle Putnam broadened her perspective. “I wanted to know why or what the intention of this policy change was when there was such a significant clinical impact that it changed how people received care,” says Wladkowski. She noted that many patients discharged from hospice end up back in the hospital; leaving hospice is likely to have a negative impact on health outcomes.

From this came her dissertation, and a resulting article, “Dementia Caregivers and Live Discharge from Hospice: What Happens When Hospice Leaves?” Wladkowski’s research focused on the experiences of caregivers for adults with dementia and Alzheimer’s Disease, and the patient’s ability to secure — and remain in — hospice care. “There was no research to grasp on to,” says Wladkowski, who addressed the issue by conducting a qualitative study of 24 caregivers, including family, friends, and neighbors; anyone not being paid by an agency to provide care. “I learned so much about their experiences,” she says. “The topic spoke to me. It was something I was passionate about, as a clinician and a researcher.”

There is often hesitancy around PhD students doing strictly qualitative research [focused on subjective data], rather than quantitative research [numeric and objective], as it can take longer to finish. “It made sense, because there was limited research on this topic,” Wladkowski says. “It felt ambitious, but it was the right thing to do, and I had the support to do it.” With the support of Professor Putnam as her dissertation Chair, and then-Director of the PhD Program Kathleen Millstein (now Emerita), Wladkowski took the leap. “Recruitment [of participants] was slow, as it is with any community-based research,” she says. “I considered shifting the focus [from unpaid caregivers] to providers and clinicians, but luckily I was able to get a decent sample for qualitative interviews.”

As a result of the study, Wladkowski wrote one of the first papers on the subject of “live discharges.” That paper has since been heavily cited, and she was interviewed for a 2018 article in The Washington Post, among other publications. “This work has become a catalyst for my work, and other people’s work.”

While Wladkowski would prefer for hospice patients to remain in care for the rest of their lives, her research is devoted to addressing the reality of the situation. “I’ve focused my recent efforts on the fact that there is no standardized discharge process,” she says. “All health care systems have discharge planning guidelines that they follow, except for hospice. I’ve developed a live discharge plan that considers the impact on both the patient and the caregiver. Once I get the protocol finished, I can look at financial implications. If we can improve the discharge process, we may be able to minimize those cases and lessen the financial impact.”

Wladkowski credits Simmons, and the guidance of her mentor, Professor of Social Work Michelle Putnam, with setting her on this pathway. “[Professor Putnam] was really good at helping me see the research trajectory,” recalls Wladkowski, whose decision to focus on live discharges was determined by her clinical experience. “I knew that someone needed to do this work, or else nothing would ever change. Though, even at the time, I thought, I’m just a doctoral student, who am I? But that study was really important and is now a part of the national conversation.”

To Wladkowski, the PhD in Social Work at Simmons is unique in its focus on clinical work. “A lot of social work scholars have limited clinical experience,” she says. “They are doing research on the profession and expanding the profession. Simmons emphasizes that as a clinician scholar you can do all of that. My mentors really instilled confidence in me, convincing me that I could push the field forward with my research.” Even now, 10 years after completing her PhD, she knows that she can call on her mentors for continued guidance.

Wladkowski encourages current clinicians to consider the PhD program at Simmons. “Feel confident in what you know as a clinician. You bring valuable experience, and that is an asset to the program and your doctoral journey. Bring your expertise to the table, even if that means becoming an expert in your content area. I didn’t have anyone on the Simmons faculty sharing my research interests, but I had their support.”