New York, NY—The Project on Death in America (PDIA) of the Open Society Institute today announced $1.3 million in grants to nine emerging leaders in healthcare who are improving care for dying patients and their families. "These faculty scholars are providing critical leadership to influence and facilitate a broader societal change," said Susan Block, M.D., director of the PDIA Faculty Scholars Program.
PDIA Faculty Scholars strengthen popular and professional understanding of what constitutes good care at the end of life and encourage a wider commitment to caring well for people as they die. In the last 7 years PDIA has appointed 87 faculty scholars in 58 medical and nursing schools in the United States and Canada. This new cohort of scholars includes 4 physicians, 2 physician researchers, 1 nurse, and 2 Ph.D. researchers. They will examine barriers to quality care, test new programs at their home institutions, and then disseminate their work nationally. Their projects include:
- A Brown University study of barriers to timely hospice referrals;
- A physician training program at Long Island Jewish Medical Center to improve advance care planning with terminally-ill patients; and
- A program at the University of Alabama, Birmingham Medical Center to integrate palliative care curricula into oncology and geriatrics fellowship programs.
"PDIA Faculty Scholars are working to transform our society's medical culture to now give priority to education, training, and clinical service in end-of-life care issues," said Kathleen Foley, M.D., director of the Project on Death in America.
The Faculty Scholars Program identifies outstanding role model clinician-researchers committed to improving end-of-life care, and provides support for disseminating existing models of good care, developing new models for improving care of the dying, and developing new approaches to the education of health professionals about the care of dying patients and their families
The Open Society Institute, a private operating and grantmaking foundation, is part of the network of foundations, created and funded by George Soros, active in more than 50 countries around the world. OSI's U.S. Programs seek to strengthen democracy in the U.S. by addressing barriers to opportunity and justice, broadening public discussion about such barriers, and assisting marginalized groups to participate equally in civil society and to make their voices heard. OSI supports initiatives in access to justice for low and moderate income people; judicial independence; ending the death penalty; reducing gun violence and over-reliance on incarceration; drug policy reform; inner-city education and youth programs; fair treatment of immigrants; reproductive health and choice; campaign finance reform; and improved care of the dying.
2002 Faculty Scholars
F. Amos Bailey, M.D.
Safe Harbor Project
Birmingham VA Medical Center
University of Alabama, Birmingham
Birmingham, AL
Integration of Palliative Care Training into the Curricula of Medical Oncology and Geriatric Medicine Fellowship Training at UAB
Subspecialty training programs in medical oncology, geriatrics, pulmonary medicine, cardiology, nephrology, and neurology rarely include palliative medicine in the curriculum even though physicians trained by these programs will care for patients with serious and life-threatening illnesses and will provide the bulk of care to our aging population. In this project, Dr. Bailey will develop a model palliative care curriculum, then test, evaluate, and disseminate the results.
Bruce Himelstein, M.D.
Children's Hospital of Wisconsin
Milwaukee, WI
Rapid-Cycle Quality Improvement in Pediatric Palliative Care Education
In order to improve care for children with life-threatening illnesses, educational deficits in pediatric palliative care must be addressed. Although relevant curricular materials are available, little is known about the best way to teach this material. In this project, Dr. Himelstein will use rapid-cycle quality improvement methodology to improve the training and practice of interdisciplinary pediatric healthcare teams, and will create an educational model that can be adapted to other pediatric healthcare institutions.
Eric Krakauer, M.D., Ph.D.
Massachusetts General Hospital
Harvard Medical School
Boston, MA
Clinical Policy Development for Optimum End-of-Life Care
This project aims to reduce barriers to optimum care by developing and advocating for institutional policies and clinical practice guidelines for end-of-life care. Based on evidence that such policies can improve clinical outcomes and patient satisfaction, the policies and guidelines will be designed to be adaptable by institutions nationwide.
Terri Maxwell, R.N., M.S.N.
Center for Palliative Care
Thomas Jefferson University
Philadelphia, PA
Health System-Wide Quality Improvement Initiative for Palliative Care
In response to the need to improve care of seriously-ill patients and their families, the Center for Palliative Care was established in 1999 in the Department of Family Medicine at Thomas Jefferson University. Terri Maxwell will bring together the Quality Council of the Jefferson Health System and the Center for Palliative Care to collaborate on a system-wide palliative care quality improvement initiative. The project will provide a new model for improving care at the end of life by combining educational and curriculum initiatives with a system-wide performance improvement project.
Susan C. Miller, Ph.D., M.B.A.
Community Health Center for Gerontology and Health Care Research
Brown University School of Medicine
Providence, RI
Timely Access to Hospice Care—Understanding Barriers and Influencing Change
Research has shown that a large proportion of nursing home and community-based hospice residents have lengths of stay of one week or less, and that this trend has increased significantly in recent years. Short lengths of stay in hospice represent a major challenge to the provision of high-quality end-of-life care. Dr. Miller, working with Home and Hospice Care of Rhode Island, will examine the circumstances of earlier and later hospice referral, and of non-referral to hospice. She will incorporate findings from this work into clinical and administrative case studies to be disseminated nationally.
Holly G. Prigerson, Ph.D.
Yale University School of Medicine
New Haven, CT
Psychiatric Disorders in Dying Patients and the Family Caregivers Who Survive Them
Little is known about the prevalence and treatment of psychiatric disorders among terminally-ill patients and their caregivers, the ways that mental health affects the patient's comfort at death, and the impact this may have on the caregiver's experience of grief and bereavement. The goal of this project is to determine how the diagnosis and treatment of psychiatric disorders among dying cancer patients and their caregivers affects the quality of the patients' death and the surviving caregivers' adaptation to the death.
Tammie E. Quest, M.D.
Emory University School of Medicine
Atlanta, GA
Emergency Medicine as a Partner in End-of-Life Care: A Palliative Care Curriculum for Emergency Medicine Residents
No training requirement currently exists for emergency medicine trainees in palliative or end-of-life care despite the fact that persons at the end of life have a high symptom burden and often use emergency services for medical, social, and/or psychological reasons. Dr. Quest will create a directed educational model to provide emergency physicians with the appropriate skills needed to care for dying patients in the emergency department setting.
Michael W. Rabow, M.D.
University of California, San Francisco Medical School
San Francisco, CA
Between the Blackboard and the Bedside: An Examination of the Hidden Curriculum in End-of-Life Care
Medical education in end-of-life care involves not only the accumulation of knowledge and skills, but also a process of socialization and the creation of professional identity. To be effective, medical education reform to improve end-of-life care and training must include attention to the unofficial and informal influences on students. In this project, Dr. Rabow will assess the hidden end-of-life care curriculum at the University of California, San Francisco Medical School, and develop an intervention to address educational barriers to optimal training in end-of-life care. Findings will be shared nationally, focusing on how such an assessment might be applied to other training settings.
Joseph S. Weiner, M.D., Ph.D.
Long Island Jewish Medical Center
New Hyde Park, NY
Emotional Distress of Physicians Discussing Advance Care Planning: Impact of a New Training Program for Fellows, Interns, and Medical Students
Many physicians are unwilling to discuss advance care planning with their patients. Without such discussions, physicians may incorrectly assume or ignore patients' treatment preferences. Dr. Weiner will develop structured communication training programs in advance care planning for physicians and medical students. These programs will address physicians' emotional, cognitive, and skills barriers, and will encourage greater willingness to engage in advance care planning with patients.