PhD Student Improving End-of-Life, Chronic Disease Care

Alex Soltoff's research centers on a fundamental question: How can we deliver care more equitably, compassionately, and in ways that best serve patient needs? 

While working as a clinical research coordinator at Massachusetts General Hospital, Soltoff helped on a project developing palliative care services (care for people living with serious illness) for tribal nations in South Dakota. He noticed how difficult it was for patients with an advanced cancer diagnosis to access care. 

“You might have to do a five-hour drive from where you live,” says Soltoff. “You might be away from your homeland, living in a hotel. You’re away from everything that makes you comfortable. There are just so many barriers to receiving quality advanced care, palliative care, and end-of-life care for people living on reservation land.”

While he was working on this project, his father was diagnosed with leukemia. He moved back to Boston to be with his father, who was receiving world-class inpatient care at the Dana-Farber Cancer Institute in Boston—a 20-minute drive from his home. He realized how different his father’s cancer care experience was from the patients living on rural reservations. 

What mattered most during his father’s end-of-life care was the social and spiritual support from the chaplain and social worker on his care team. They helped his family reflect on meaningful memories, process what the experience meant, and make sense of it together.

"It made me feel like the health system cared about my dad and about my family. And that’s not something that was happening with the patients we interviewed in South Dakota,” says Soltoff. “It also made me realize the aspects that facilitated a good end-of-life care process for my dad were not medical—they were social.” 

Exploring aspects of end-of-life care including empathy, spiritual care, and emotional and mental health care support became the foundation for his doctoral research focus. “After I had this experience, I wanted to understand how we could improve end-of-life care and serious illness care for people across the country—no matter where they live or what their resources are,” says Soltoff.

Private Equity and End-of-Life Care

Soltoff eventually transitioned from clinical research to a doctoral program in the Department of Health Policy and Management at Emory’s Rollins School of Public Health, hoping to improve access to palliative care services for patients and their families. 

At the time, there were growing concerns about questionable business practices and investor involvement in end-of-life care. Using this thread to further hone his research focus, he studied how private equity ownership affects hospice care quality—specifically, how it leads to lower quality ratings.  

"Addressing people’s well-being holistically requires a team of people. What happens in the health care sector when private equity gets involved is that you tend to see cost cutting, often by cutting staff," he explains. While it allows clinics to make more money, it makes it much harder to address patients' 'total pain'—the physical, emotional, social, and spiritual dimensions of serious illness.

His research can help shape policy. States like Massachusetts are already expanding oversight of private equity in health care, and others are considering similar regulations.

Soltoff’s interest in quality care has also expanded beyond end-of-life care. He has looked at how palliative care principles apply to chronic conditions like hidradenitis suppurativa (HS). He found that patient-centered, compassionate care helps individuals people with serious chronic conditions struggling with anxiety, depression, and existential distress. 

Structural Drivers of Quality Patient Care

Soltoff also uses his research to more deeply understand what drives quality care and patient satisfaction.

"Really getting granular about the organizational behaviors that lead to high quality care is where this is all headed," he explains. He is examining how factors such as staffing patterns, data collection practices, training practices, organizational culture, and leadership feedback mechanisms impact patient experiences. 

Soltoff points out that in hospice care, we can’t measure quality through traditional metrics like readmission rates. “Instead, success is measured by asking families directly: ‘Did you like the care you received? Did you feel comforted?’"

Through a research lens shaped by lived experience, Soltoff demonstrates how the most impactful health care interventions are often those that make social, emotional, and spiritual support possible—and how organizational structures that support whole-person care can help us arrive there.