Name of Project: When Cure Is No Longer Possible: A Palliative Care System of Excellence for Rural New Mexico
Institution: University of New Mexico, Health Sciences Center, Albuquerque, NM
PI: Walter Forman, MD
Abstract (as described by Project staff)
The project aims to provide education to health care professionals and communities around end-of-life care.
Brief Synopsis of Program Successes and Challenges
Unlike most Promoting Excellence in End-of-Life Care grantees, the University of New Mexico project does not provide any direct patient care. Rather, the core of this project is the “PERT,” the Palliative care Education, Research and Training office, developed through the Promoting Excellence program and located at the University of New Mexico.
The project was originally housed in the School of Medicine, but was moved to the Cancer Research Center in its second year. The Cancer Research Center has a new director, Dr. Cheryl Willman, who has a vision for integrating palliative care into the treatment of cancer, and who appreciates the role that this project is playing in developing palliative care capabilities throughout the state. Dr. Willman has expressed verbal support for the project’s work.
The Albuquerque Indian Health Service (covering 24 tribes) is a full partner in this project, under the direction of Dr. Judith Kitzes, a recent PDIA scholar. In this project, IHS efforts are primarily centered on the creation of a certified hospice on the Zuni Pueblo, one of the communities involved in the PERT network.
The project unites seven rural communities into a palliative care network. Through the network, the communities have access to the palliative care expertise of Dr. Forman and other members of the project team; they also have the opportunity to share information with each other on developing palliative care systems. Each participating community (except Zuni) has an active hospice, with a strong commitment to expand their community-based palliative care efforts. Project staff has recognized the unique aspects of each of these very diverse communities and has attempted to meet individual needs while still building a general infrastructure applicable to all. The project has attempted to refine its purpose and implementation plan in a way that is paced with the tempo of these communities, respectful of geographic and cultural challenges. Ultimately this may prove to be the most effective approach. The communities feel ownership of their palliative care efforts; local palliative care leaders feel supported as they design delivery systems that address their unique community needs; and these rural communities do not feel imposed upon by the University.
During the initial phases of the project, staff conducted extensive interviews with both community members and health care professionals in the seven-networked communities to gather baseline information on perceived end-of-life care needs. Data gleaned from these surveys and focus groups were packaged into comprehensive community reports that serve as powerful planning tools to guide future educational and programmatic efforts.
This project has focused on training: community-based, as well as for health care professionals and students. The project established a goal of having at least one health care professional in each of the seven communities become certified in palliative care. They impressively report that they succeeded! These community clinicians are now viewed locally as palliative care leaders and, among themselves, form a network of end-of-life experts in New Mexico. The project also introduced palliative care into various educational avenues at the University – the orientation program for UNM incoming house officers now includes palliative care; at least three medical students have completed community hospice rotations; and, all geriatric fellows now spend a month with Dr. Forman. The project has a dream of introducing palliative care into the nursing school curriculum.
The predominant characteristic of this project is its rural-ness and its cultural diversity (according to the US Census, New Mexico is the most culturally diverse state in the nation). The rural isolation and the cultural diversity have added to the challenges faced by the project:
Major policy issues cited include:
The project has formed an alliance with Telemedicine New Mexico Telehealth Network as an aid in reaching rural areas. Several sites in the UNM Palliative Care network have been selected as part of Telemedicine New Mexico project. It has been suggested that the project staff also explore Telehospice projects in other states, such as Kansas and Michigan.
When project staff was asked, “What will it take to sustain what you have learned?” they replied:
“We will need to be able to continue our work with the University Medical School and the training centers. Also, we need to continue assisting the hospice programs in rural NM with education. Finally, we will need the cancer center to make us part of their program/s.”
Generalizing the Model
The UNM project has tapped into some of the most difficult challenges facing rural areas as they struggle to find feasible ways of providing end-of-life care. Their tale tells the tale of rural areas across America, to some degree. Through their efforts, the rather sparse body of knowledge on rural palliative care has a chance to grow, if strategic dissemination strategies are employed.
Additionally, this project has spent time ironing out wrinkles in the challenges of providing culturally correct palliative care. What they have learned should be packaged!
Words of Wisdom from the Project
Project staff was asked: “Knowing what you know now, if another institution or project team in another community were to attempt a project similar to yours, what advice would you give them?” They responded, “Patience and then some!”
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