"I felt discomfort in handing off patients to hospice. It is a feeling of loss. I wanted to integrate hospice into overall care.”Institution
--James K.V. Willson, MD
Project Safe Conduct
Enrollment of patients began in June 1999.
To date, 145 lung cancer patients have been enrolled in the project.
James K.V. Willson, MD
Meri Armour, MSN
Program Mission and Objectives
To create a seamless transition from curative to palliative to end-of-life care for patients and families by bringing palliative principles into the acute-care setting and involving patients and families at an early stage in decision making. To achieve this goal, project directors at Ireland Cancer Center proposed the following four outcomes:
During the pilot study for Project Safe Conduct, baseline data showed only 13% of patients were in hospice at the time of death. That figure grew to 77% by winter 2001. During the same time period, the median length of stay in hospice increased from three days to 26 days.Historical Perspective
During a planning year, Willson and his colleagues met with the administrative director of the cancer center, the head of the HWR foundation, pain management experts, psychologists and others. Willson recalls these meetings as highly rewarding experiences during which the planning team articulated and integrated goals.Research
Professional education associated with Project Safe Conduct includes programs for physicians, nurses and fellows. Community outreach includes special events, speakers and town hall meetings organized around end-of-life care themes.
Project Safe Conduct partners with the Hospice of the Western Reserve and Ireland Cancer Center.
Marketing is still in the planning stages.
Funding for Project Safe Conduct comes from the cancer center and from national and community foundation grants.
James Willson’s long-range vision is to develop a strategy for mainstreaming palliative care so that it is offered to all cancer patients. He wants to translate what his team has learned in an academic medical setting into a community-based oncology setting. Willson has identified five regional programs affiliated with the cancer center that can act as satellite sites.
A National Perspective
Elements and Measures of Program Success
Success has been measured in terms of adequate pain control and timeliness of hospice referral. Willson and his colleagues have discovered a third measure: a reduction in family discord.
What I Wish I’d Known Then . . .
“This has been a learning process for all of us. I wish I had known more about the discovery process—that is, how to measure impact.”
--James K.V. Willson, MD
“Yes, we have learned a lot. These things may seem obvious but they are not intuitive, at least not amongst my colleagues over the past 28 years. First, I have learned that the effect of a good team is synergistic. It’s not so much what the team does as it is the gestalt of the members’ ‘combinedness.’ Second, I know now that the spiritual care component is sorely needed by patients and families. I had significantly underestimated its importance. Lastly, I have been greatly impressed with the support and enthusiasm physicians have for high-quality end-of-life care when they themselves are being supported in the process. Patients deserve both high-quality, high-tech cancer care and high-quality, highly engaged palliative care simultaneously.”
--Meri Armour, MSN
This descriptive summary is based on an interview conducted by Jane Grant Tougas with project staff in January and February 2001.
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