A Conversation with Tracy Fasolino

Show Notes

Health Affairs' Jeff Byers interviews Tracy Fasolino about her experience with creating the podcast series No One Gets Out of Here Alive for the Health Affairs Podcast Fellowship.

What is Health Affairs Pathways?

Health Affairs Pathways explores the avenues and alleyways of the health care system through a variety of storytelling – from investigative journalism and health policy explainers to long-form interviews.

Unique series are created by fellows at Health Affairs Podcast Fellowship Program, designed to support early to mid-stage professionals pursue an audio project, tell a unique health care story, and highlight voices that may not be heard otherwise.

Join the Health Affairs Podcast Fellows on their journey to unearth a new health care story on such topics as health care consolidation, independent primary care, behavioral health, climate change, health equity, and more.

Health Affairs, the leading journal of health policy research, offers a nonpartisan forum to promote analysis and discussions on improving health.

00;00;07;13 - 00;00;33;13
Jeff Byers
Hello and welcome to Health Affairs Pathways. It's another special bonus episode. I'm your host, Jeff Byers, Senior Content Marketing Manager here at Health Affairs. And today we have a conversation with Tracy Fasolino from Clemson University. She was the producer of the series you just listened to called No One Gets Out of Here Alive, focused on palliative and hospice care.

00;00;34;04 - 00;00;55;12
Jeff Byers
Hope you enjoyed the series. I know I did. I interviewed Tracy in late January to talk about the series and what she got out from the project and what we can hear from her in the future. So it's a great conversation. I hope you enjoy it. This is the last episode of Health Affairs Pathways for the year 2023.

00;00;55;25 - 00;01;11;16
Jeff Byers
Make sure you stay subscribed to this feed and we look forward to sharing more stories with you. And with that, let's go to my interview with Tracy Fasolino. Thanks.

00;01;14;06 - 00;01;16;06
Jeff Byers
Tracy Fasolino, welcome to the program.

00;01;16;13 - 00;01;17;09
Tracy Fasolino
Thank you.

00;01;18;12 - 00;01;41;07
Jeff Byers
Thanks for joining us today. So if people are listening to this episode, most likely they have listened to your series, No one Gets Out of Here Alive. One of the unique podcast series that you developed as part of the Health Affairs Podcast Fellowship program. But just in case, can you talk a little bit about the series and what it entails?

00;01;41;20 - 00;02;07;27
Tracy Fasolino
Sure, sure. I am hopeful that they've listened to the podcast, but if they haven't, the title is somewhat of a catchy one, right? No One Gets Out of Here Alive. It's actually referencing the dynamics of hospice and palliative care because ultimately none of us have found, you know, the fountain of youth and we haven't figured out how to live forever.

00;02;08;06 - 00;02;39;00
Tracy Fasolino
So we're all going to experience the process of dying, whether it's dying in a, you know, a tragedy or more of a kind of a critical illness and dying through that passage way. So my podcast really looks at policies that are impacting hospice services, which is your end of life and palliative care, which is more geared towards symptom management, goals of care conversations, communication.

00;02;39;07 - 00;03;12;20
Tracy Fasolino
It's uncoupled some from palliative care and it talks about how these policies have shaped the past of palliative care and hospice. The current delivery of these services, and then what's going to happen in the future. And it's coming from the voice of a nurse who is your boots on the ground, been a nurse practitioner for some 20 years now and have had an opportunity to experience what it's like to work in rural communities and also work in kind of a hospital setting where palliative care is readily available.

00;03;13;01 - 00;03;47;14
Jeff Byers
When we reviewed your proposal, I think what struck us at Health Affairs was that it's a topic that is somewhat taboo, but for lack of a better term. So it's a, it can be a touchy subject. And for a lot of individuals, present company included. But it is a very somber topic. And so I wanted to ask you what, you know, what drove you to tell this story?

00;03;47;28 - 00;04;22;07
Tracy Fasolino
I think that you did kind of hit the nail on the head there, that sometimes this topic is taboo. And because of that, we don't talk about these things, end-of-life or talk about our suffering sometimes. And so working as a nurse practitioner, I have heard many of these stories and have witnessed situations where a parent or a child or a grandparent is actually in the hospital and at end-of-life or having to make some critical decisions for them on their behalf because they're not able to.

00;04;22;16 - 00;05;05;00
Tracy Fasolino
And the family just struggles, right? If they don't know what grandpa would want. And they have some complex emotions that go along with it. And then as they make some of these decisions, they end up I feel like having some complex grieving because they didn't get a chance to talk about it. And so that was probably the biggest reason why I wanted to share this story about palliative care and even a story about a particular patient that was one of mine so that others will understand the importance of, you know, coming forward and kind of normalizing dying and addressing the symptoms that people have when it comes to chronic diseases and serious illnesses and want to be

00;05;05;00 - 00;05;10;12
Tracy Fasolino
able to give them the tools that they know that are available and services that they can access.

00;05;11;17 - 00;05;42;22
Jeff Byers
Great. And I want to stay on this topic for a little bit, which is still a little bit more somber. But and then I kind of want to talk a little bit more about the process of putting the podcast together. But as you were talking, just a question that I had for you coming from the nurse perspective, when you see death, maybe not on a daily basis, but on a regular basis, how does that inform your relationship to death and also to life?

00;05;43;20 - 00;06;12;08
Tracy Fasolino
Well, that is a very deep, deep question there, Jeff. So how does it inform my take on death? Well, I think I probably am someone who might get a little less sensitive about the topic because I am around it and because I do see it. And I feel such like it's so important that we talk about it and that we recognize that we all are going to die.

00;06;12;20 - 00;06;42;16
Tracy Fasolino
And so I may come across sometimes as a little bit, you know, like, does this not bother you? Are you not sensitive to all this? I certainly am, right? And I, as a matter of fact, I am so much that I do want to talk about it and I do want to normalize it. And the, you know, it feeds into the living from the perspective that I want to look at a day and say, you know, I want everybody to feel their best as much as they possibly can and every day.

00;06;42;20 - 00;07;00;29
Tracy Fasolino
And that's where I think palliative care can really kind of feed into that, too, because you have patients who have lots of serious illnesses and chronic diseases, and they're just dealing with all these symptoms that they don't know how to get addressed. And so I look at it as, you know, life should be full of joy and happiness.

00;07;01;16 - 00;07;16;18
Tracy Fasolino
And even some folks have really amazing deaths, have mini stories that I try to put in the podcast to help people understand that it isn't such a, you know, a grim kind of experience, that it can be a very joyful time as well.

00;07;17;01 - 00;07;38;06
Jeff Byers
Well, thanks for that. We can, we don't have to be that deep here, but I do appreciate that, that was very thoughtful. That being said, I do want to ask on the topic of palliative care, what's something that, so you and I are, I'm in the health care industry in a different way that you're in the health care industry,

00;07;38;06 - 00;07;47;11
Jeff Byers
But for someone that's maybe not in the health care industry, what might not they understand about palliative care that you think they should know?

00;07;47;21 - 00;08;18;07
Tracy Fasolino
Yeah, thank you for actually pointing that out too, because that was one of the motivations for this podcast, was the fact that a lot of people really think of palliative care as death and dying and they don't understand that it is actually uncoupled in a lot of ways that all patients should receive palliative management or palliative services. Good communication skills, addressing symptoms and that it is different in some respects with hospice.

00;08;18;07 - 00;08;49;06
Tracy Fasolino
A hospice is a beautiful kind of format in dealing with end of life, but palliative care belongs from birth to death and anybody should be receiving those services. And as you move into more complicated illnesses and maybe complicated conversations with your family members, you want to bring in the specialty palliative care. And that's really the emphasis for palliation was thinking about it as an extra layer of support and also helping navigate through the serious illness pathways.

00;08;50;19 - 00;09;23;02
Jeff Byers
Fantastic. Thanks for that answer and thanks for walking us through that. Going back to the process of the podcast, so for those that may not be aware, we've done the Health Affairs Podcast Fellowship program two years in a row now. We had about 60 something applicants and narrowed it down to two. I know everyone probably has a different motivator for joining the program, but what was your motivation for joining this program and what were you excited to learn through the process?

00;09;23;27 - 00;09;49;23
Tracy Fasolino
I was really excited about this idea of learning more about policies. As a clinician, you know, we don't really tend to get too much in the policy realm, and I know from prior podcasts listening and understanding the, kind of the frame of Health Affairs you guys are really keenly watching and navigating through policy. And when I saw the call, I thought, wow, there's a couple of things here that would be really cool.

00;09;50;16 - 00;10;22;13
Tracy Fasolino
One, learning about policy, working with Health Affairs, but then also how do you make a podcast and how do you go about doing it? And that's the biggest reason why I applied is I thought this would give me an opportunity to really push myself outside of just the day to day clinical pieces and learn about policy and then definitely add another layer of a steep learning curve on helping, you know, like navigating the interviews and creating the podcast.

00;10;22;13 - 00;10;25;28
Tracy Fasolino
And so that's what I got really excited about, were those two things.

00;10;27;06 - 00;10;36;01
Jeff Byers
Fantastic. Well, I hope we were able to deliver on the promise of the program. So you're on the other end of it. Congratulations.

00;10;36;02 - 00;10;36;22
Tracy Fasolino
Thank you.

00;10;36;29 - 00;10;45;05
Jeff Byers
All the episodes are posted at this point. So what did you find the most challenging? What did you find the most rewarding after all is said and done?

00;10;46;22 - 00;11;06;06
Tracy Fasolino
I think probably the most challenging, there's a couple of things, actually, and I have to share that because of the topic, and you and I talked about this a lot too, Jeff, is how do we keep it to where people won't cut off when they hear about death and dying because of the kind of the taboo around that.

00;11;06;06 - 00;11;25;02
Tracy Fasolino
So how did I, how were we going to make sure that the conversations that were being presented in the recording was light enough that people would want to hear it, but yet still get the message through? And that was challenging, right? There was challenging, there was several times when I was listening as my recordings and I'm like, wow, that's really deep.

00;11;25;02 - 00;11;47;28
Tracy Fasolino
Or, oh man, there needs to be a lighter moment there, because otherwise they're just going to say, I can't. I, you know, I can't, I can't take this anymore. So that was a very challenging thing. And then the creation of the podcast, not having any real background or education in it. And I was trying to figure out what platforms to use, what software to use.

00;11;48;05 - 00;11;59;09
Tracy Fasolino
How do you stream it together? How do you tell the story in a concurrent, you know, a cohesive manner? And it was just great to be able to use your team to help me, help me through that.

00;11;59;22 - 00;12;16;04
Jeff Byers
So for someone that's thinking about starting a podcast, how would you rate it 1 to 10? Easy being ten, hard being a one, or we're not going to use the decimal system here. How easy is it to create a podcast?

00;12;17;05 - 00;12;36;02
Tracy Fasolino
I would say it's not as easy as it sounds when you're listening to it. There is a lot of work that goes behind the production to make it such a wonderful, easy listening podcast, so I would not rate it as easy. I would probably put it, if you're going to use your 1 to 10, so I'll help here.

00;12;36;02 - 00;12;53;23
Tracy Fasolino
One being pretty easy, ten being really hard. I put it right around an eight or nine because if you're not familiar with the equipment, you're not familiar with the software, and then you've got to tell the story. So there are like two layers to this, right? It's the podcast production, but it's also the story. So I'm going to rank it up

00;12;53;23 - 00;12;56;11
Tracy Fasolino
there about an eight or nine on hardness.

00;12;58;06 - 00;12;59;29
Jeff Byers
Right? So no one's coming for my job yet.

00;13;00;06 - 00;13;01;12
Tracy Fasolino
I don't think so, Jeff.

00;13;01;12 - 00;13;22;10
Jeff Byers
Yeah, so we're speaking today at the very end of January. The episodes have yet to publish as we're talking, but they will by the time listeners hear this. What do you hope is the one thing that listeners took away from the series? We've touched on a lot, but if you have any other thoughts on that.

00;13;22;29 - 00;13;52;20
Tracy Fasolino
I think the biggest thing is that death and dying has to be, you know, we have to normalize that some. We have to accept that it is part of our trajectory, but that it can't, it doesn't always have to be, you know, this deep, dark, you know, bad kind of experience that, you know, again, a lot of people that I talk to aren't necessarily worried about the dying, but they're worried about the process of which they're going to die.

00;13;53;00 - 00;14;13;26
Tracy Fasolino
And I think that's where I'm hoping that this podcast helps people understand. You know, this is where we were at years ago with people who had severe cancer or they were very, very sick and they had no support. This is where we are today with palliative care in certain pockets and certain areas. Here's where we're at with hospice policies.

00;14;13;26 - 00;14;38;24
Tracy Fasolino
And, you know, we've got some of this coverage, but we still have a long way to go that there's not enough of palliative care services, there's not enough hospice services. They need to be kind of the quality care that is being advertised and helping folks understand that this is policy driven, too, right? If there's no coverage for the benefit, then how are they going to get it?

00;14;38;24 - 00;15;01;00
Tracy Fasolino
And that means that someone would be suffering and not being able to get the services they need. So it needs to be a call to action for those that are in those strategic positions to make things happen and helping to move forward, to make sure that we're going to be able to provide services to our aging population as well.

00;15;01;00 - 00;15;11;18
Jeff Byers
Fantastic. And so Tracy Fasolino, what's next for you? If we were talking before we started recording and you have another podcast on the way or what's next.

00;15;11;19 - 00;15;37;22
Tracy Fasolino
Yeah, I you know, I guess they talk about getting bit by the policy bug and I definitely have because of this podcast, but then all of a sudden I find myself saying, you know, this could be a really good podcast and this would be a really great way to do some education for nursing students and I’m very fortunate that my Clemson University is supporting this creation of a podcast that we're hoping will kind of take off.

00;15;37;22 - 00;15;59;16
Tracy Fasolino
But I've just finished a podcast with a perinatal nurse practitioner and going to be using that as an educational tool for our undergraduate students as we work harder to integrate palliative care. Now, I don't know if this will continue, but it’s a lot of fun to create podcasts, even though it's difficult and takes some time, it is a lot of fun to put the final product together.

00;16;00;27 - 00;16;07;24
Jeff Byers
Fantastic. And so final question is where can people find you on social media? If you have anything else you want to plug?

00;16;08;13 - 00;16;23;08
Tracy Fasolino
Well, you can find me on the Health Affairs Fellowship podcast. I do encourage you to listen to that. And then I’m readily available at Clemson University on my email address, not really on social media too much, Jeff.

00;16;23;08 - 00;16;43;29
Jeff Byers
That’s, you know, and I'm right there with you. Well, fantastic. Tracy Fasolino, it was great catching up with you and very excited to hear about those new podcasts coming out after people have of course listened to the Health Affairs Pathways series, No One Gets Out of Here Alive. Tracy Fasolino, thanks for joining.

00;16;44;09 - 00;17;02;26
Tracy Fasolino
Thank you. Big shout out to you all for producing this for us too. Thanks.