Staying Comfortable

Palliative Care

Palliative care helps patients and families facing serious illness with symptom management, goals of care conversations, and difficult emotions related to their diagnosis, as well as care transitions.  It is appropriate at any stage of illness, including during active cancer treatment.  Palliative care is for all patients with physical, emotional, and existential distress in the face of serious illness.

At UCSF, the Symptom Management Service (SMS) offers palliative care to patients at any stage of their cancer treatment. In order to meet with a member of the SMS team, you will need to get a referral from a member of your health care team. Services are almost always covered by health insurance. 

Our team includes physicians, a nurse practitioner, nurses, and a chaplain who provide:

• Specialized symptom management
• Assistance with decision making and advance care planning
• Supportive counseling for emotional and spiritual distress related to their cancer diagnosis and/or treatment
• Linkage to UCSF and community resources, including Child Life Therapy
• Care integrated with medical oncologists, radiation oncologists, oncologic surgeons, psychologists and social workers

Symptom Relief

The Symptom Management Service manages patients’ symptoms with the aim of improving their quality of life in the face of a serious illness. 

• Pain
• Fatigue
• Nausea
• Anxiety
• Neuropathy
• Constipation
• Diarrhea
• Insomnia
• Depression
• Cough
• Shortness of breath
• Poor appetite

Additional Support

Other services at UCSF, such as Psycho Oncology, nutrition, exercise counseling, and child life therapy, may be just right for your needs.

Symptom Management – Meet the Team

Brieze Bell, MD focuses on each patient's goals and helps to optimize wellness by integrating biomedical treatments with evidence-based integrative therapies. In her research, she investigates the use of integrative palliative care techniques to improve quality of life for people living with serious illnesses. Dr. Bell earned her medical degree from the Icahn School of Medicine at Mount Sinai and completed her residency in internal medicine at the Massachusetts General Hospital. She completed a fellowship in hospice and palliative medicine at UCSF, followed by a fellowship in integrative medicine at the UCSF Osher Center for Integrative Medicine.

Kara Bischoff, MD is a palliative care physician who treats patients with a range of serious illnesses, including neurologic diseases, chronic lung diseases, and cancer. She sees patients in the clinic as well as the hospital. She serves as Medical Director of UCSF's Outpatient Palliative Care Service. Dr. Bischoff earned her medical degree at Harvard Medical School. She completed a residency in internal medicine at UCSF, where she also served as chief resident. She then completed a fellowship in palliative medicine at UCSF.

Daniel Bui, MD is a palliative care physician who specializes in the care of patients with cancer and is passionate about training the next generation of palliative care physicians. Dr. Bui earned his medical degree from the Yale School of Medicine. He remained at Yale for residency in Internal Medicine and after residency, worked at Yale-New Haven Hospital as a hospitalist on the Hematology-Oncology service. Dr. Bui completed a fellowship in Palliative Medicine at the University of Washington.

Dani Chammas, MD is a palliative care physician who has a strong interest in how our culture approaches illness and what it means to live well. She earned her medical degree at UCSF where she completed a residency in adult psychiatry and served as a chief resident at the San Francisco Veterans Affairs Health Care System. She completed a fellowship in hospice and palliative medicine at UCSF, as well. In addition to her work with cancer patients, Dr. Chammas is a published author; she enjoys writing and illustrating in genres ranging from poetry to children’s books.

Stephanie Cheng, MD has special interests in holistic management of symptoms and improving quality of life through integrative approaches. She earned her medical degree at Oregon Health & Science University, then completed a family medicine residency at UCSF-affiliated Contra Costa Regional Medical Center. She completed a fellowship in hospice and palliative medicine, with an integrative medicine focus, at George Washington University. She also completed a chaplaincy training program and is a trained nature and forest therapy guide.

Kiran Gupta, MD, MPH is a palliative care physician who sees patients in the clinic as well as the hospital. She was previously a hospitalist and UCSF’s Medical Director for Quality and Patient Safety. Dr. Gupta earned her medical degree at Harvard Medical School. She completed a residency in internal medicine and a fellowship in Patient Safety and Quality Improvement at Brigham and Women’s Hospital/Harvard University. While in her fellowship, Kiran received a Master of Public Health from the Harvard School of Public Health and became a Certified Professional in Patient Safety. She later completed a fellowship in hospice and palliative care at UCSF. 

Janet Ho, MD, MPH is a palliative care physician and an addiction medicine specialist. Her research focuses on ways to improve care, promote quality of life, and reduce stigma for people experiencing serious illnesses, pain, and who may use substances. Dr. Ho earned her medical degree at the University of California, Irvine. She completed a residency in internal medicine at Yale School of Medicine, serving as chief resident, and fellowships in general internal medicine, palliative care, and addiction medicine at Harvard Medical School, where she trained at Massachusetts General Hospital. She also completed a Master of Public Health degree at the T.H. Chan Harvard School of Public Health.

Anne Kinderman, MD is a palliative care physician with special interests in expanding access to palliative care for patients insured by Medicaid, and promoting best practices in communication for patients who have limited English language proficiency. Dr. Kinderman earned her medical degree at Rush Medical College. She completed a residency in internal medicine at UCSF and a fellowship in hospice and palliative medicine at Stanford University. Prior to joining UCSF, she worked for many years at Zuckerberg San Francisco General Hospital and Trauma Center as the founding director of its Supportive and Palliative Care Service.

Pramita Kuruvilla, MD is a palliative care physician who worked for many years as an ICU physician prior to coming to UCSF, and so has extensive experience caring for patients and families navigating critical illness. She earned her medical degree at Yale University School of Medicine, then completed a family medicine residency at UCSF-affiliated Contra Costa Regional Medical Center. She completed her fellowship in hospice and palliative medicine at UCSF. Prior to joining UCSF, Dr. Kuruvilla was the Assistant Medical Director of Critical Care Services and the Bioethics Committee Chair at Contra Costa Regional Medical Center.

Paul Lindenfeld, MD is a palliative care specialist who works with patients experiencing serious illness, including cancer. His research interests include the development of novel therapeutic agents for pain and symptom management and the repurposing of existing medications for more effective symptom management. Dr. Lindenfeld earned his medical degree from the University of Illinois and completed a residency in internal medicine at the University of Washington. He worked for many years as a primary care physician before completing a fellowship in hospice and palliative medicine at Cedars-Sinai Medical Center.

Mike Rabow, MD is the director of the Symptom Management Service, the medical director of palliative care in the Helen Diller Family Comprehensive Cancer Center, and a national leader in palliative care.  He serves as the Associate Chief of Education & Mentoring in the UCSF Division of Palliative Medicine. Dr. Rabow earned his medical degree at UCSF, where he completed a residency in general internal medicine. He completed fellowships at UCSF in internal medicine and medical education research. Dr. Rabow also directs the MERI Center for Education in Palliative Care, which offers education and programing in palliative care, care partner sustainability, and Poetic Medicine.

Ken Rosenfeld, MD is a palliative care physician with a special interest in improving the quality of care for patients and families affected by serious illness. His research focuses on redesigning care delivery systems, addressing spiritual needs, and improving medical education on palliative care. Dr. Rosenfeld earned his medical degree at UCSF. He completed a residency in internal medicine at Brigham and Women's Hospital and a fellowship in geriatric medicine at Beth Israel Deaconess Medical Center.

Jules Vieaux, MD is a palliative care physician who works with patients experiencing serious illness, including cancer. He seeks to align his patients' treatments with their values and goals. Dr. Vieaux earned his medical degree at the University of California, Davis School of Medicine. He completed a residency in internal medicine at the Kaiser Permanente Oakland Medical Center, followed by a fellowship in hospice and palliative medicine at UCSF.

Natalie Young, MD is a geriatrician and palliative care physician who works with patients experiencing serious illness, including cancer. She specializes in the care of older adults with cancer and conducts research on assessing older adult patients to provide holistic and patient-centered cancer care with the goals of improving patient satisfaction and treatment outcomes. Dr. Young earned her medical degree at UCSF, where she completed a residency in internal medicine. She completed fellowships in geriatrics and in hospice and palliative care medicine at the Icahn School of Medicine at Mount Sinai.

Jeannie Zanetti, NP is a nurse practitioner who cares for patients with cancer, with a particular interest in supporting patients through grief and loss. She earned her master's degree in nursing from the University of Minnesota Twin Cities. She completed the advanced training to become a certified adult-gerontology primary care nurse practitioner at UCSF. She is also certified in hospice and palliative care.

Carly Zapata, MD, MPH is a palliative care physician who cares for patients with cancer and other serious illnesses. In her research, Dr. Zapata investigates the best ways to support caregivers of patients with serious illness, and how to provide high-quality palliative care services to patients with limited English-proficiency. Dr. Zapata earned her medical degree from Harvard Medical School and a Master of Public Health degree from the Harvard T.H. Chan School of Public Health. She completed her residency in internal medicine at UCSF, where she served as chief resident. She also completed a fellowship in hospice and palliative medicine at UCSF.

Additional Members of Our Clinical Team 

Sherlou Himbing, RN, Clinical Nurse

Judy Long, MDiv, BCC, Chaplain

Teddy Scheel, LCSW, MPH, Social Worker

Elizabeth Stewart, RN, Clinical Nurse

Serene Weir, RN, Clinical Nurse

Jeremy Yount, CPhT, PTCB, Pharmacy Technician

Our Administrative Team

Sam Balram, Practice Coordinator

Mikela Barulich, Practice Supervisor

Joe Gonzalez, RN, MSN, CNL, Nurse Manager

Rylen Karchem, Practice Coordinator

Chris Pollak, MBA, Administrative Director

Justina Rivas, Practice Coordinator

Advance Care Planning

What is Advance Care Planning? 

Advance care planning is an important way to ensure that we honor your wishes for health care. 

This planning allows you to:

• name a trusted person to help make medical decisions in case of an emergency.
• tell this trusted person and your doctors what is most important in your life and for your healthcare now and in the future. 

Advance care planning is important for people at any age and any stage of health. Talking to the people who matter most in your life about your medical wishes can reduce stress for you and your family and friends if medical decisions need to be made in the future.

The prostate cancer clinic visit is a great opportunity to talk about your wishes for medical care and to make sure those wishes are in your medical record. This way, all your medical providers will know what is important to you.

How Do I Make My Wishes for Medical Care Known? 

You can state your wishes for medical care in a form called an Advance Directive. Creating an Advance Directive is a way to ensure that your preferences are known, up-to-date and honored.  They can be completed at any age or stage of health. 

We recommend using the free PREPARE website, prepareforyourcare.org.

• The website is in both English and Spanish.
• It is a step-by step program with video stories.
• It will help you talk with your family, friends, and medical providers about your wishes.
• If you are ready, you can also download a free, easy to read PREPARE advance directive from  homepage or go to: https://prepareforyourcare.org/advance-directive
• For California, the PREPARE advance directive is in 10 different languages.
• PREPARE can either walk you through how to complete the form online, or you can download the form to complete on your own.

You can also download a different advance directive from ucsfhealth.org/pdf/advance_health_care_directive.pdf

Why Is It Useful to Have Advance Directive?

• Having an Advance Directive can help reduce chaos and uncertainty in the event of an emergency. It lets doctors know whom to consult with about the patient’s wishes and what type of care the patient does and does not want.
• An Advance Directive can reduce stress for patients and their family and caregivers. Patients feel more secure in knowing that their wishes will be respected. And family members don’t feel that they have to “guess” what type of care the patient wants.
• An Advance Directive helps ensure that the patient’s wishes for care will be honored in the event that the patient cannot speak for themselves. As long as a patient can speak and make medical decisions, the patient’s stated preferences will be honored – regardless of what is written in the Advance Directive.
• Advance Directives can provide specific instructions that are important to the patient, such as “I do not want to allow my sister to make decisions on my behalf.” Or, “ If my care team says that my condition is incurable and I have a short time to live, I do not want to be put on a ventilator.”
• If your preferences about the care you want change, an Advance Directive informs your care providers of your new choices. Advance Directives are not set in stone. They can be changed and updated. 

What Do I Do With an Advance Directive Form?

Once you fill out an advance directive, make sure to save it and give a copy to your doctor and others whom you want to inform of your wishes. Also keep a copy for yourself in a place where you can easily find and update it. Your clinic can help you make copies if needed. Just ask the front desk or your medical provider. 

Your medical providers can also make sure that the forms are placed in your medical record.

What If I Need Help Thinking Through My Options or Filling out an Advance Directive?

If you would like some help in thinking through your options or filling out an Advance Directive, contact your social worker or talk to a member of the Symptom Management Service.  You can also get this information by attending the free monthly workshop described below. 

Monthly Advance Care Planning Workshop - What Matters Most?

UCSF offers free monthly workshops called What Matters Most? in which you can meet with an experienced staff person in a supportive group setting to think through your preferences for future care. This workshop is for everyone – patients and their caregivers, old and young, and healthy and sick. It is designed to help you document your wishes in a document called an Advance Directive To sign up for a What Matters Most? workshop, call the UCSF MERI Center at 415.509.8645 or go to https://meri.ucsf.edu. 

Hospice and End-of-Life Care

Hospice care is often the best form of care for people at the end of life.  Hospice refers to specialized care provided by a team of care providers that focuses on reducing suffering, providing comfort, and improving quality of life. In hospice, the goal is not to cure the disease, but to reduce pain and discomfort.  Hospice care is available for individuals who are expected to live for about six months or less. However, some patients in hospice live for much longer, or, even in some cases recover. You can request information about hospice from a social worker, the Symptom Management Service, or any one of your providers. Hospice care is covered by Medicare and most insurance companies. 

Hospice care provides:

• Drugs and treatment to provide pain and symptom relief
• Emotional and spiritual support to the patient and family
• Care at home or at a hospice facility
• Medical equipment and supplies
• Education to the family about caring for the patient

Medical Aid in Dying

While the vast majority of people at the end of life are able to experience comfort, dignity, and meaningful connection, some people at the end of life consider the question of whether they wish to actively shorten their lives using lethal medication that is prescribed by a physician but administered by the patient themselves.  This is a legal option, with significant restrictions, in California, under legislation called the “End Of Life Option Act.”  Please see the EOLOA Website at UCSF for more details.