September 14, 2018

End-of-Life Conversations: Advice from a Palliative Care Physician

A Q&A with Laura Shoemaker, DO


Q. What do you wish others knew about having such conversations?

Dr. Shoemaker: First, I wish physicians appreciated how much patients want their doctors to start the conversation. Doing so does not dash hope or create anxiety. Instead, initiating the conversation demonstrates sincere interest and respect. It can lead to better outcomes and lessen family stress near the end of life.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Second, “the conversation” is the essential piece of advance care planning. Completing documents without the associated meaningful conversations with loved ones falls short of the goal. The Conversation Project website is a fantastic help! My family used it and I refer my patients there regularly after I’ve initiated the conversation in my clinic.

Q. Palliative care is often confused with hospice. What are the differences?

Dr. Shoemaker: Most healthcare professionals do understand that there is a difference and want to guide patients appropriately, but because they don’t totally get the difference, I hear things like “this patient is not ready for palliative care” or “this patient is ‘going palliative’ instead of hospice.”

Palliative care is appropriate for any patient suffering with serious illness, regardless of age or stage. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a specially trained team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It can be provided along with curative treatment.


If you ask most patients and families if they would like additional support from a doctor or nurse who specializes in improving their quality of life while they live with the physical, emotional and spiritual burdens of serious illness, most will say yes. Hospice, which falls under the umbrella of palliative care, is conservative, comfort-focused care for patients with a life-limiting disease and a prognosis of months or less.

Q. Have you had to discuss end-of-life with any of your family members?

Dr. Shoemaker: I talk with patients and families every day about their care goals and preferences, but when it comes to family, I sometimes find myself tongue-tied. Last fall Ellen Goodman came to Cleveland to discuss the The Conversation Project. I went with my parents and this gave us the stimulus and tools we needed to turn abstract conversations into concrete ones. We had our best conversation in the car on the way home. We then included my brother in the conversations during Thanksgiving, and now the advance directive paperwork is done too.

Q. Why do you choose to practice at Cleveland Clinic?

Dr. Shoemaker: Because it is a place where I feel confident bringing my own family for care. It feels good to work among colleagues practicing at the top of their fields. Cleveland Clinic is an extremely collegial place, where staff go out of their way to help patients and co-workers.


Q. Something your colleagues may be surprised to learn about you?

Dr. Shoemaker: I love competitive sports. I play tennis and softball, as well as I can at this age, and enjoy almost any spectator sport, including college football (Go Blue!), professional football, basketball and baseball. I’m pretty loyal to Cleveland teams.

Q. Advice you would give to your 20-year-old self?

Dr. Shoemaker: Spend a little more time in the moment.

Related Articles

Physician with patient
February 21, 2024
Strategies for Improving Clinical Trial Equity

Cleveland Clinic Cancer Institute takes multi-faceted approach to increasing clinical trial access

How antibody drug conjugates work
February 13, 2024
Real-World Use of Trastuzumab Deruxtecan

Key learnings from DESTINY trials

February 7, 2024
Advances in Bone Marrow Transplant Have Improved Outcomes in Fanconi Anemia

Overall survival in patients treated since 2008 is nearly 20% higher than in earlier patients

February 5, 2024
Haploidentical Bone Marrow Transplant Has Durable Engraftment in Patients With Sickle Cell Disease

Two-year event-free survival comparable to matched sibling donor myeloablative transplant

February 1, 2024
Possibilities of CRISPR Technology (Podcast)

Gene editing technology offers promise for treating multiple myeloma and other hematologic malignancies, as well as solid tumors

January 30, 2024
Gene Therapy Trials Show Positive Results in Sickle Cell Disease and Thalassemia

First-in-human trials of CRISPR-Cas12a gene editing demonstrate safety and meaningful event-free survival

photo of Elekta Esprit Gamma Knife machine
January 26, 2024
The Evolution of Gamma Knife Technology (Podcast)

Improvements enable targeting of brain tumors with single-session, fractionated or neoadjuvant approaches

Disparities in multiple myeloma
January 25, 2024
Major Study Identifies Global Disparities in Drug Toxicity for Multiple Myeloma Treatment

Study of 401,576 patients reveals differences in cancer burdens as well as overall survival