Special Series: Tribute to J Randall Curtis
- There is an expression, often attributed to Einstein, “If I had 60 minutes to save the world, I would spend the first 55 trying to figure out what was wrong with it.” Dr. J. Randall (Randy) Curtis’ approach to improving serious illness care has been so effective for exactly this reason. Before considering how to make things better, you must first understand what is happening and how we got to our current state. For critical care, that required listening to clinician and family communication —what people actually said— while it was happening in the intensive care unit (ICU).
- Palliative care history is short, and the history of its research is even shorter. In 1997, when I first met Randy Curtis at a Project on Death in America Faculty Scholars meeting, the field of palliative care as we now know it did not exist. The American Academy of Hospice and Palliative Medicine (AAHPM), a tiny organization, had just emerged from the even tinier Academy of Hospice Physicians. American Board of Medical Specialties board certification would not appear for nearly another decade. And, whereas our clinical and educational infrastructure felt threadbare, the palliative care research landscape was completely unstitched.
- J. Randall Curtis (“Randy”) has had a profound impact on the culture and state of the science of palliative care in serious illness, particularly in the critical care setting. He has accomplished this by bringing rigorous and innovative empirical research into understanding and improving communication, decision-making, and culture around end-of-life care in the intensive care unit (ICU). His legacy extends far beyond his scientific contributions through the personal impact of his compassion, creativity, and visionary brilliance on the cultures of ICUs and hospitals around palliative care.
- Anesthesia and anesthesiologists have deep roots within the specialty of intensive care medicine,1 but anesthesiologists in the United States comprise only 13% of intensivists, compared to 20% with specialization in surgery and 65% internal medicine.2 With frequently separate training programs, different funding options, and departmental divides, anesthesiologists can sometimes feel as an “other” within the field of critical care. Yet, innovative leaders and mentors such as Randy Curtis bridge that divide.
- We met each other through academic medicine, in search for answers, and found friendship. Its value in my life was abundant, unearned grace. In Dr. Curtis, I learned the truth of the words of Thomas Mann, “Illness was merely transformed love.”
- Each year, approximately one million older adults die in American intensive care units (ICUs) or survive with significant functional impairment. Inadequate symptom management, surrogates’ psychological distress and inappropriate healthcare use are major concerns. Pioneering work by Dr. J. Randall Curtis paved the way for integrating palliative care (PC) specialists to address these needs, but convincing proof of efficacy has not yet been demonstrated.
- Palliative care research is deeply challenging for many reasons, not the least of which is the conceptual and operational difficulty of measuring outcomes within a seriously ill population such as critically ill patients and their family members. This manuscript describes how Randy Curtis and his network of collaborators successfully confronted some of the most vexing outcomes measurement problems in the field, and by so doing, have enhanced clinical care and research alike. Beginning with a discussion of the clinical challenges of measurement in palliative care, we then discuss a selection of the novel measures developed by Randy and his collaborators and conclude with a look toward the future evolution of these concepts.