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  1. 1. How to Develop a Palliative Care Program Kathleen M. Foley, MDKathleen M. Foley, MD European Association of PalliativeEuropean Association of Palliative Care MeetingCare Meeting Aachen, GermanyAachen, Germany April 10, 2005April 10, 2005
  2. 2.  The mission of the Project on Death inThe mission of the Project on Death in America is to understand and transform theAmerica is to understand and transform the culture and experience of death and dyingculture and experience of death and dying in America through funding initiatives inin America through funding initiatives in research, scholarship, the humanities, andresearch, scholarship, the humanities, and the arts; and to foster innovations in thethe arts; and to foster innovations in the provision of care, public education,provision of care, public education, professional education, and public policy.professional education, and public policy. The Project on Death in America
  3. 3. Professional Education – Faculty Scholars ProgramFaculty Scholars Program – Social Work LeadershipSocial Work Leadership Development ProgramDevelopment Program – Nursing Leadership ConsortiumNursing Leadership Consortium
  4. 4. Faculty Scholars Program  Promotes the visibility and prestige of clinicians in end-of-life care.  Enhances their effectiveness as academic leaders and mentors for future generations of health professionals.  To date, PDIA has supported 87 Faculty Scholars, representing more than 57 medical schools in the United States and Canada.
  5. 5. Faculty Scholars Program  Internal MedicineInternal Medicine  NeurologyNeurology  PsychiatryPsychiatry  Intensive CareIntensive Care  OncologyOncology  PediatricsPediatrics  GeriatricsGeriatrics  Family PracticeFamily Practice  Medical EthicsMedical Ethics  HospitalistHospitalist  Medical EducationMedical Education  Nursing EducationNursing Education  PsychologyPsychology
  6. 6. Social Work LeadershipSocial Work Leadership  Identify outstanding social work facultyIdentify outstanding social work faculty  Support to disseminate existing models of goodSupport to disseminate existing models of good carecare  Encourage leadership within institutionsEncourage leadership within institutions  Promote collaborative models of teaching,Promote collaborative models of teaching, practice, policy development, and researchpractice, policy development, and research  To date, 44 social work leaders have beenTo date, 44 social work leaders have been selected.selected.
  7. 7. Nursing Leadership  To develop a cadre of expert nursingTo develop a cadre of expert nursing educators,educators,  To coordinate national nursing efforts inTo coordinate national nursing efforts in end-of-life care,end-of-life care,  To facilitate the dissemination of a coreTo facilitate the dissemination of a core curriculum that provides practicing nursescurriculum that provides practicing nurses with the basic knowledge and skills neededwith the basic knowledge and skills needed to appropriately care for dying patients.to appropriately care for dying patients.
  8. 8. Faculty Scholars in the UnitedFaculty Scholars in the United States & Canada (N= 87)States & Canada (N= 87) MA - 8 CT - 1 MD - 2 VA - 6 NC - 4 NH - 1 NY - 13 PA - 4 AL - 2 TX - 2 CA - 12 OR - 1 WA - 4 MN - 1 WI - 3 IL - 2 Canada: Nova Scotia – 1 Manitoba - 1 British Columbia – 1 DC - 2 SC - 1 CO - 1 NM - 1 KY - 1 FL - 1 GA - 1 RI - 1 NJ - 5 UT - 2 VT - 1 OH - 1
  9. 9. Medical & Nursing SchoolMedical & Nursing School RepresentationRepresentation Faculty Scholars representFaculty Scholars represent – 57 medical schools. Top 3:57 medical schools. Top 3: – Harvard Medical SchoolHarvard Medical School (7)(7) – University of WashingtonUniversity of Washington (4)(4) – Univ. of Medicine & Dentistry NJ (Univ. of Medicine & Dentistry NJ (44) – 4 Nursing schools4 Nursing schools – Mount Sinai, NYUMCMount Sinai, NYUMC – New Hampshire Technical CollegeNew Hampshire Technical College – UCSFUCSF – Thomas Jefferson UniversityThomas Jefferson University
  10. 10. Additional Grant FundingAdditional Grant Funding  As Faculty Scholars, 66 have garnered 351As Faculty Scholars, 66 have garnered 351 additional grantsadditional grants  Total funding = $113,588,653Total funding = $113,588,653  Top 5 funding agenciesTop 5 funding agencies  Robert Wood Johnson (37)Robert Wood Johnson (37)  NIH (13)NIH (13)  Greenwall Foundation (11)Greenwall Foundation (11)  NCI (10)NCI (10)  Fan Fox & Leslie R. Samuels Foundation (8)Fan Fox & Leslie R. Samuels Foundation (8)
  11. 11. Additional Grant Funding  Faculty Scholars (n=66/87 reporting)Faculty Scholars (n=66/87 reporting) have garnered 351 additional grantshave garnered 351 additional grants Total funding = $113,588,653Total funding = $113,588,653
  12. 12. Contributions to the literature  Faculty Scholars (n=76/87 reporting) haveFaculty Scholars (n=76/87 reporting) have published a total of 1807 publications in 689published a total of 1807 publications in 689 different sources.different sources.  Top 5 journals:Top 5 journals: – J Palliative MedicineJ Palliative Medicine 131131 – J Pain Symptom ManagementJ Pain Symptom Management 8585 – J General Internal MedicineJ General Internal Medicine 8484 – JAMAJAMA 5454 – J Clinical OncologyJ Clinical Oncology 5353
  13. 13. Contributions to theContributions to the LiteratureLiterature  An additional 1807 publications representingAn additional 1807 publications representing 689 different sources have been generated689 different sources have been generated by 76 Scholars since their inception in theby 76 Scholars since their inception in the Program (aprox. 24 per scholar).Program (aprox. 24 per scholar). Journal of Palliative Medicine 131 Journal of Pain and Symptom Management 85 Journal of General Internal Medicine 84 JAMA 54 Journal of Clinical Oncology 53
  14. 14.  EPECEPEC  Harvard Program in PalliativeHarvard Program in Palliative Care Education and Practice (1Care Education and Practice (1 wk x 2)wk x 2)  ASCO EOL Teaching syllabusASCO EOL Teaching syllabus  Individual Medical School/Individual Medical School/ Residency Programs (EPERC)Residency Programs (EPERC) Faculty DevelopmentFaculty Development
  15. 15. Palliative CarePalliative Care FellowshipsFellowships  > 25 US fellowships> 25 US fellowships – 1 and 2 year1 and 2 year – Academic and community practice orientedAcademic and community practice oriented – VA program—interdisciplinaryVA program—interdisciplinary – Oncology-- Pall Care FellowshipOncology-- Pall Care Fellowship  Voluntary Training StandardsVoluntary Training Standards  18 Accredited Fellowship Programs18 Accredited Fellowship Programs  Move towards specialty statusMove towards specialty status – ACGME application ~2005ACGME application ~2005 – ABMS application ~2006ABMS application ~2006
  16. 16. Educational ResourcesEducational Resources  EPERCEPERC www.eperc.mcw.eduwww.eperc.mcw.edu  AAHPM core syllabusAAHPM core syllabus – UNIPACS (AAHPM)UNIPACS (AAHPM)  EPECEPEC  ASCO EOL Syllabus (29 modules)ASCO EOL Syllabus (29 modules)  Fast Facts and ConceptsFast Facts and Concepts
  17. 17. EPERCEPERC End of Life Physician Education Resource CenterEnd of Life Physician Education Resource Center  Course curricula with goals and objectives,Course curricula with goals and objectives, teaching formats, and evaluation methodsteaching formats, and evaluation methods  Actual topic-specific teaching modules (e.g.,Actual topic-specific teaching modules (e.g., pain, giving bad news) intended audience, apain, giving bad news) intended audience, a teaching plan, audiovisual materials, and/orteaching plan, audiovisual materials, and/or evaluation tools for EOL educators to adaptevaluation tools for EOL educators to adapt for use at their own sitesfor use at their own sites  EPERC e-newsletterEPERC e-newsletter http://www.eperc.mcw.edu/start.cfm
  18. 18. Continuing EducationalContinuing Educational ProgramsPrograms  EPEC-Education for physicians in end-EPEC-Education for physicians in end- of-life care (of-life care (www.epec.netwww.epec.net))  ELNEC-Education and learning forELNEC-Education and learning for nurses in end-of-life carenurses in end-of-life care (http://www.aacn.nche.edu/elnec/)(http://www.aacn.nche.edu/elnec/)
  19. 19. Education for PhysiciansEducation for Physicians on End-of-Life Care (EPEC)on End-of-Life Care (EPEC) http://www.epec.nethttp://www.epec.net  Designed by experts toDesigned by experts to educate physicians oneducate physicians on the essential clinicalthe essential clinical competencies in end ofcompetencies in end of life care.life care.  Combines didacticCombines didactic sessions, videotapesessions, videotape presentations,presentations, interactive discussions,interactive discussions, and practical exercises.and practical exercises.
  20. 20. Certification in Palliative MedicineCertification in Palliative Medicine  For physiciansFor physicians -over 2000 physicians certified-over 2000 physicians certified  For nursesFor nurses -over 10,000 nurses certified-over 10,000 nurses certified
  21. 21. For more information: See the PDIA website: www.soros.org/death

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