Q&A with Jennifer M. Snaman, MD
June 26th, 2020
Jennifer M. Snaman MD is an attending physician in the Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute, and the Cancer and Blood Disorders Center at Boston Children's Hospital. She is an Assistant Professor in Pediatrics at Harvard Medical School and will be serving as Co-Director of Palliative Care Education and Practice (PCEP) for the coming year.
Why did you decide to work in palliative care?
I went to St. Jude for my pediatric hematology-oncology fellowship and, halfway through my first year of training, the program got hospice and palliative medicine fellowship slots, becoming the fifth pediatric fellowship in the country. I decided to do a palliative care fellowship with the goal of becoming a better oncologist through learning communication skills and better symptom management. I had to quit my oncology fellowship, get hired as the hospice and palliative medicine fellow, and then get rehired as an oncology fellow again at the end. I ended up doing a four-year combined pediatric oncology and hospice and palliative medicine fellowship.
It was a bit of an “a-ha” moment when I realized that I loved doing palliative care as much as I loved oncology, so I knew I had to find a way to do both because I loved them equally. I was really lucky to find a job where I was able to do that, both as a fellow and later as an attending.
Tell us about your research. What drew you to this?
During my hospice and palliative medicine fellowship, I started working with a number of bereaved parents who were on a steering council at St. Jude with the goal of improving bereavement support for families after the death of a child. I became very close with this group of parents and they helped me a lot in thinking about my research. We did a number of focus groups with parents to learn more about the ways that families want medical teams to communicate with them when their child is very ill and towards the end of life, and what kind of support they need after their child dies. After working with these parents and doing more research, I worried that we risk pathologizing what is a normal grief process after the loss of a child. How do we know what’s normal in after this terrible loss and how do we identify those parents that need additional support, and what support is best for them?
We now have a study examining at early outcomes for bereaved parents. We have a sense of what happens to parents many years after the death of a child, but what happens in the first couple of months is less well known. What we focus on primarily are the negative outcomes of depression, anxiety and post-traumatic stress, which are based on literature about grief that adults experience after the death of a spouse, but what is normal after the death of a child is really unknown.
In order to characterize what this early period looks like, we’re conducting a large survey with 150 parents early in their grief experience. The survey asks a series of questions regarding their mental and physical health and what supports they find helpful. Our goal is to then develop interventions to help offset later negative outcomes in parents.
My other area of research is focused on adolescents and young adults with advanced cancer. During my oncology fellowship, my panel of patients primarily consisted of aa group of quiet and solemn teenage boys. I wasn’t sure what it was about them, but I seemed to be drawn to that patient population. Throughout my fellowships, I was struck by how the end of life experience was very different in this group than with younger kids or adults. I wanted to find ways to better support adolescents in making their own voice heard in their medical care by helping them figure out what’s important to them and communicate that with their parents and their medical team. I started to think about new ways to do this and came across a methodology from marketing research called conjoint analysis, which takes a complex decision and breaks it down into all its components. Using this framework, I developed a survey called MyPref, short for “My Preferences”, for adolescent young adults with advanced cancer. The survey provides a series of different treatment choices, for example, would you rather a treatment with better quality of life but more side effects, or treatment with worse quality of life but less side effects? At the end of the survey, it provides a summary of what is most important to the patient. We pilot tested this with adolescents and their parents and we’re now starting to bring this to the clinic, where we show the survey results to oncologists and audio record the conversations that they have with adolescents using this summary report. We hope to figure out how oncologists think about what is important to their patients and how they help them make a decision based on that.
What’s your favorite part of your job?
My favorite part of my job is the amazing people that I work with. I love interacting with people face-to-face, I love having the support of my team members, and I love getting to physically be with patients and families, so that’s made the last few months very challenging.
I enjoy being a part of the larger Psychosocial Oncology and Palliative Care department and have learned so much from every person on our team. The research and clinical parts of POPC are so well integrated and I have the perfect job where I get to do clinical work in both oncology and palliative care, while having the amazing opportunity to do clinical research in the two areas that I love.
Tell us more about yourself.
I am one of four siblings and we are all “J’s”. My family is Jim, Jeff, Jenn, Julie, Jessie, and my mom is Flo. My dad was in the army, so each of my siblings were born in a different state. I was born in Hawaii and my middle name is Malia (Mary in Hawaiian), though I sadly have not been back since.
I married my husband Josh, who is also a “J”, and I have two kids (6 and 8) who are adorable hellions with a ton of energy.
In your spare time, what do you do for fun?
In my spare time, I mostly chase around my kids. We love soccer, we love the beach, and we try to get outside as much as possible. We have enjoyed getting out into nature over the past several months and explored many local hiking trails.