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Journal of Palliative Medicine

Special series features Promoting Excellence in End-of-Life Care

Journal of Palliative Medicine coverThe Journal of Palliative Medicine continues a special series of articles describing the experiences and exciting results of 22 innovative projects funded by Promoting Excellence in End-of-Life Care. The articles, edited by Ira Byock, M.D., Promoting Excellence Director, are included in the Innovations section of the journal.

Authored by team members of the projects featured, the articles present a broad range of contexts of care, and discuss potential future directions for their programs. They also reflect on the implications of their projects’ experiences for similar patient populations and settings elsewhere.

The articles are available by journal subscription by visiting the Journal of Palliative Medicine Web site. Address reprint requests or correspondence to the authors (e-mail addresses listed below).



June 2004: Volume 7, No. 3:

  • The Balm of Gilead Project: A Demonstration Project on End-of-Life Care for Safety-Net Populations describes a comprehensive end-of-life program for the populations served by the “safety net” public health system in Alabama’s largest county. The Balm of Gilead, located at Cooper Green Hospital in Birmingham, serves terminally ill persons, predominantly of minority ethnic status, who as a group are relatively younger than the national hospice population and typically lack personal financial resources. The demonstration project addressed the holistic needs associated with terminal illness in each of its stages and each of its treatment settings. Authors of the article are Elizabeth A. Kvale, M.D., Beverly R. Williams, Ph.D., James L. Bolden, M.B.A., Carol G. Padgett, Ph.D. and F. Amos Bailey. M.D. (Pages 486-493)


April 2004: Volume 7, No. 3:

  • Project ENABLE: A Palliative Care Demonstration Project for Advanced Cancer Patients in Three Settings describes Project ENABLE (Educate, Nurture, Advise Before Life Ends), one of four cancer center/hospice collaborations in the 22 original Promoting Excellence demonstration projects. The jointly sponsored Norris Cotton Cancer Center/Hospice of Vermont and New Hampshire program provided an integrated approach to the management of life-limiting cancer. Project ENABLE was aimed at alleviating the symptoms of disease and treatment, enhancing clinician and patient/family communication, offering support for families, friends and other caregivers, addressing emotional and spiritual needs of dying people and providing conceptual and administrative structure to provide end-of-life care consistent with patients’ values and preferences. Authors of the article are Marie Bakitas, M.S., ARNP, Marguerite Stevens, Ph.D., Tim Ahles, Ph.D., Marie Kirn, M.A., Karen Skalla, M.S., ARNP, Nancy Kane, M.S., R.N. and E. Robert Greenberg, M.D. (Pages 363-372)
  • The GRACE Project: Guiding End-of-Life Care in Corrections 1998-2001, by Margaret Ratcliff, M.S.W. and Elizabeth Craig, discusses the GRACE (Guiding Responsive Action in Corrections at End of Life) Project, a collaborative venture between Volunteers of America and several partners that promotes the development of end-of-life care programs in correctional settings. The project established a resource center, developed and published standards and a handbook, and pioneered demonstration programs at four sites. (Pages 373-379)


February 2004: Volume 7, No. 1:

  • “Integrating Case Management and Palliative Care” discusses a partnership between Mount Sinai School of Medicine in New York, Franklin Health (a care management organization) and South Carolina Blue Cross Blue Shield. The project developed an enhanced model of care for seriously ill patients’ complex needs by combining palliative care with a case management approach. Diane E. Meier, M.D., William Thar, M.D., Ashby Jordan, M.D., Suzanne L. Goldhirsch, M.A., Albert Siu, M.D. and R. Sean Morrison, M.D. author the article. (Pages 119-134)

  • “Palliative Care in the Pueblo of Zuni,” by Bruce Finke, M.D., Theresa Bowannie, and Judith Kitzes. M.D., M.P.H., presents a New Mexico collaboration between a tribally operated home health care agency and a federally operated Indian Health Service hospital, with the support of a palliative care center within an academic medical center, that brings culturally proficient palliative care services to the American Indian population. (Pages 135-143)


December 2003: Volume 6, No. 6:

  • “The FOOTPRINTS SSM Model of Pediatric Palliative Care,” by Suzanne Toce, M.D. and Mary Ann Collins, M.H.A., describes an innovative program of advance care planning and end-of-life care coordination for children at SSM Cardinal Glennon Children’s Hospital in St. Louis. (Pages 989-1000)

  • “The PhoenixCare Program” discusses the three-year demonstration established by the Phoenix-based Hospice of the Valley that provided patient access to palliative care and supportive services prior to hospice eligibility – within a managed care setting. The article is authored by Carol A. Lockhart, Ph.D., Barbara E. Volk-Craft, R.N., M.B.A., Gillian Hamilton, M.D., Ph.D., Leona S. Aiken, Ph.D. and Frank G. Williams, Ph.D. (Pages 1001-1012)


October 2003: Volume 6, No. 5:

  • “Palliative Care Management: A Veterans Administration Demonstration Project,” (Kenneth Rosenfeld, M.D. and Jennifer Rasmussen, M.P.H.) describes Pathways of Caring, a three-year Veterans Health Administration (VA) project in Los Angeles, California, targeting patients with inoperable lung cancer and advanced heart failure as well as chronic lung disease. Because of its success, this program will be expanded and its care model extended institution-wide. (Pages 831-839)

  • “Completing a Life: Development of an Interactive Multimedia CD-ROM for Patient and Family Education in End-of-Life Care” (Karen Ogle, M.D., Darcy Drew Greene, M.F.A., Brian Winn, M.S., Dan Mishkin, Leslie G. Bricker, M.D., and Angela K. Lambing, M.S.N., R.N.C.S.) describes a comprehensive, interactive, educational CD-ROM that assists people with terminal illness in addressing important end-of-life issues. The format and design of the CD, developed by the Henry Ford Health System and Michigan State University in East Lansing, Michigan, generate a sense of empowerment at a time when patients often express a loss of control. (Pages 841-850)

August 2003: Volume 6, No. 4:

  • “‘Do It Your Way’: A Demonstration Project on End-of-Life Care for Persons with Serious Mental Illness” (Mary Ellen Foti, M.D.) describes a demonstration project developed and implemented in a Massachusetts public mental health system that improves access to advance care planning and end-of-life care for people with serious mental illness. (Pages 661-669)

  • “CHOICES: Promoting Early Access to End-of-Life Care Through Home-Based Transition Management” (Brad Stuart, M.D., Carol N. D’Onofrio, Dr.P.H., Susanne Boatman, R.N., GNP, and Glen Feigelman, LCSW) A comprehensive home-based care coordination program designed to bridge the gap between home health and hospice for Medicare + Choice enrollees with advanced chronic illness. This article describes the San Francisco East Bay region's CHOICES program, which demonstrates that concurrent disease modifying and palliative care for patients with advanced illness can be based in home settings. Included are eligibility and discharge criteria examples, as well as with the CHOICES Program Sutter VNA & Hospice Advanced Directive Intervention List. (Pages 671-683)
  • Project Safe Conduct Integrates Palliative Goals into Comprehensive Cancer Care describes Project Safe Conduct, a collaborative venture between a National Cancer Institute comprehensive cancer center -- Ireland Cancer Center at Case Western Reserve University and University Hospitals of Cleveland – and a freestanding, community-based hospice – Hospice of the Western Reserve – to make palliative care accessible to persons suffering from advanced lung cancer as they pursued life-prolonging treatments. This innovative project was one of four winners of the 2002 Circle of Life Award. Authors of the article are Elizabeth Ford Pitorak, M.S.N., APRN, CHPN, Meri Beckham Armour, M.S.N., R.N. and Holly D. Sivec. (Pages 645-655)


June 2003: Volume 6, No. 3:

  • “The Comprehensive Care Team: A Description of a Controlled Trial of Care at the Beginning of the End of Life” (Michael W. Rabow, M.D., Jane Petersen, B.A., Karen Schanche, M.S.W, Suzanne L. Dibble, DN.Sc., and Stephen J. McPhee, M.D.) describes an outpatient palliative care consultation service for patients with serious illness who are continuing to receive treatment for their underlying disease. The study, conducted at the University of California, San Francisco, revealed that the patients, all with cancer, advanced congestive heart failure or advanced chronic obstructive pulmonary disease, found the palliative care consultation and services helpful. The patients reported improved satisfaction with their family, their primary care physicians and the medical center. However, barriers to the implementation of palliative care treatments must still be explored, as this study revealed that primary care providers did not implement a significant number of the consultation team’s recommendations. (Pages 489-498)
  • “Establishing a Culturally Sensitive Palliative Care Program in Rural Alaska Native American Communities” (Christine A. DeCourtney, M.P.A., Kristina Jones, R.N., M.P.H., Melanie P. Merriman, Ph.D., Nina Heavener, R.N., B.S.N., and P. Kay Branch, M.A.) describes the Helping Hands Program, developed by the Bristol Bay Health Corporation in Dillingham, Alaska. Palliative care programs that provide an option for patients to die at home are available in most U.S. communities. However, Alaska Natives living in remote Alaska villages often die alone in hospitals and nursing homes hundreds of miles from home. The Helping Hands Program is a village-focused, culturally sensitive, volunteer and primary care program combined with a regionally based physician and home health nurse to deliver multi-disciplinary palliative care and end-of-life services to remote communities. Since the program was implemented in 1999, the percentage of home deaths for selected causes has changed from 33% in 1997 to 77% in 2001. The program may be expanded throughout Alaska, centralized in Anchorage. (Pages 501-510)
  • “Enhancing Communication for End-of-Life Care: An Electronic Advance Directive Process” (Leslie J. Bricker, M.D., Angela Lambing, M.S.N. and Carolyn Markey, M.S., R.N.) describes the development of an electronic advance directive in the Henry Ford Health System in Detroit, Michigan. With the integration of an electronic advance directive note within the electronic medical record, patients’ treatment wishes can be accessed at any site within the Henry Ford system. This article describes the development and implementation of the integration process, shares the health system’s policy and procedure on advance directives and reports on the successes of the program. (Pages 511-519)


April 2003: Volume 6, No. 2:

  • Expanding the Realm of the Possible, by Ira Byock, M.D. and Jeanne Sheils Twohig, M.P.A., introduces the 21-article Promoting Excellence in End-of-Life Care series that showcases the original 22 demonstration projects funded by the Promoting Excellence national program office. This article explains the selection process, the criteria for funding, common programmatic threads that emerged with the diverse projects, typical services offered by the projects, evaluation methods and future implications of project findings. (Pages 331-333)
  • Integrating Palliative Care into Nursing Homes is an interview conducted by the Journal of Palliative Medicine’s “Innovations” Associate Editor, Anna L. Romer, Ed.D. with Howard Tuch, M.D. and Pamela Parrish, R.N., B.A., CHPN, researchers with a collaborative project between Genesis ElderCare and the University of Pennsylvania School of Nursing. This Promoting Excellence demonstration project explored and compared two interventions aiming to integrate palliative care expertise and practice into the nursing home setting. (Pages 297-309)
  • Palliative Excellence in Alzheimer Care Efforts (PEACE): A Program Description discusses the PEACE program, a disease management model for dementia that incorporates advance planning, patient-centered care, family support and a palliative care focus with dementia patients from the time of diagnosis through its terminal stages. The PEACE demonstration project provides an innovative model for providing quality palliative care for dementia patients and their caregivers, and is coordinated through the primary care geriatrics practice of the University of Chicago. Authors of the article are Joseph W. Shega, M.D., Amy Levin, R.N., B.S.N., Gavin W. Hougham, M.A., Ph.D., Deon Cox-Hayley, D.O., Daniel Luchins, M.D., Patricia Hanrahan, Ph.D., Carol Stocking, Ph.D. and Greg A. Sachs, M.D. (Pages 315-320)
  • The Renal Palliative Care Initiative, by David M. Poppel, M.D., Lewis M. Cohen, M.D. and Michael J. Germain, M.D., explains a collaborative effort in Massachusetts between a large tertiary care hospital, Baystate Medical Center, and a large nephrology practice, the Western new England Renal and Transplant Associates, to bring the practices of palliative medicine to eight dialysis clinics in the Connecticut River Valley. The initiative introduced an improved approach to symptom assessment and control, advance care planning and high quality palliative care to dialysis patients, and developed an annual renal memorial service that is widely attended by center staff and patient families. (Pages 321-326)

Journal of Palliative Medicine Web site

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Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families.