As a pediatric oncologist and clinical investigator, Dr. Mack’s research has three core themes: communication in serious illness in children; care and communication among adolescents and young adults (AYAs); and patient experiences of care across the age spectrum. The overarching objective of her work is to build patient-clinician relationships and improve patient outcomes through effective communication. Through this work, she has created an evidence base about topics that have received limited previous study yet underpin centrally important patient experiences.
Her research on prognosis communication in pediatric oncology provided a new, previously lacking evidence base for communication about serious illness. This research has changed the way clinicians talk with parents of seriously ill children. Openness about prognosis, even when prognosis is poor, is recognized not only as ethically appropriate but also potentially therapeutic, a path toward relieving uncertainty and addressing issues most important to patients and families.
She has extended this work to AYAs with cancer, demonstrating that these vulnerable young patients strongly desire information about their conditions and want to engage in decisions about care. To help support AYAs’ priorities for care, she has developed standards for end-of-life care quality for AYAs with advanced cancer. These standards recognize their strong need for personal connections, normalcy, and opportunity to work toward attainment of life goals.
Finally, she has examined end-of-life communication in adult cancer patients, demonstrating that conversations about end-of-life care planning happen in the last weeks of life. Earlier conversations are associated with less aggressive care, raising the prospect that communication can reduce suffering at the end of life. This work has been widely disseminated through the American Society of Clinical Oncology (ASCO) and the National Academy of Medicine as evidence for the need for consistent, compassionate, early conversations about prognosis and serious illness for all patients and families.