[...]... not fit neatly into a palliative care definition The need for symptom control unrelated to treatment generally increases as a person approaches death, but at least for some patients, it begins much earlier Symptom control is never, however, a substitute for primary cancer care that is desired by a patient 4 IMPROVING PALLIATIVE CARE FOR CANCER INTENT OF THIS REPORT The National Cancer Policy Board (NCPB)... separation of palliative and hospice care from potentially lifeprolonging treatment within the health care system, which is both influenced by and affects reimbursement policy; 6 IMPROVING PALLIATIVE CARE FOR CANCER • inadequate training of health care personnel in symptom management and other palliative care skills; • inadequate standards of care and lack of accountability in caring for dying patients;... Center Researchers at the University of California-Davis (UC Davis) Medical Center and the West Coast Center for Palliative Education, Sacramento, California, have developed the Simultaneous Care project to extend palliative care to patients undergoing active, anticancer treatments (who would otherwise be ineligible for hospice care) In Simultaneous Care, palliative care staff work together with clinical... full report, we are not close to meeting this mandate for care at the end of life, either for cancer or for other conditions (Table 2) Research and demonstration programs will be needed before even a preliminary set of satisfactory indicators can be devel- 14 IMPROVING PALLIATIVE CARE FOR CANCER TABLE 1 Clinical Practice Guidelines for End-of-Life Care: Status, Source, and Further Development Needed... quality care from diagnosis to death for all Americans Kathleen M Foley, M.D Director, Project on Death in America, The Open Society Contents SUMMARY Introduction, 1 What Is Palliative Care? , 3 Intent of This Report, 4 Barriers to Excellent Palliative and End-of-Life Care, 5 End-of-Life and Palliative Care: Evolution of the Issue, 25 The 1990s: Signal Efforts and Events Around Palliative and End-of-Life Care, ... on any aspect of symptom control, palliative care, or end-of-life research or training WHAT IS PALLIATIVE CARE? The World Health Organization (WHO) defines palliative care in cancer as the “active total care of patients whose disease is not responsive to curative treatment.” The definition is extended in an important way with the statement, “Many aspects of palliative care are also applicable earlier... benefits of hospice care, achieving an average length of stay of 18 days As part of the effort, Project Safe Conduct is also developing innovative palliative care curricula for the Case Western Reserve Schools of Medicine and Nursing, as well as postgraduate training for specialists in oncology 4 Improvements in End-of-Life Care for Selected Populations—University of California-Davis Cancer Center Researchers... Involvement in Palliative and End-of-Life Care, 37 1 CONCLUSIONS AND RECOMMENDATIONS 43 REFERENCES 48 APPENDIX A Table A-1: NCI Funding for Palliative Care Research: Specific Projects, Fiscal Year 1999, 52 51 Table A-2: NCI Funding for Palliative Care Research: Institutional Grants, Fiscal Year 1999, 55 APPENDIX B: Recommendations from Enhancing Data Systems to Improve the Quality of Cancer Care (IOM,... for care In a third component of the project, staff are working with California Department of Corrections and health care teams in the women’s prison to offer palliative care training and begin development of a prison hospice program to serve inmates who are dying 11 12 IMPROVING PALLIATIVE CARE FOR CANCER dards of competence for those who provide psychosocial and spiritual services at the end of life... coordination among training programs for the variety of professionals involved in the care of dying patients, • guidelines for residency programs and increased palliative and endof-life content in licensing and certifying examinations, and • improving the research base for palliative care education SUMMARY 13 Inadequate Standards of Care and Lack of Accountability in Caring for Dying Patients Practice Guidelines . substitute for primary cancer care that is desired by a patient. 4 IMPROVING PALLIATIVE CARE FOR CANCER INTENT OF THIS REPORT The National Cancer Policy Board (NCPB) recognized that excellent palliative. control, palliative care, or end-of-life research or training. WHAT IS PALLIATIVE CARE? The World Health Organization (WHO) defines palliative care in can- cer as the “active total care of patients. 1 What Is Palliative Care? , 3 Intent of This Report, 4 Barriers to Excellent Palliative and End-of-Life Care, 5 End-of-Life and Palliative Care: Evolution of the Issue, 25 The 1990s: Signal Efforts