Name of Project: Project Safe Conduct
Institution: Ireland Cancer Center, Cleveland, OH
PI: James Willson, MD
Abstract (as described by Project staff)
Project Safe Conduct’s overall goal is 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, the following four outcomes were originally proposed:
Brief Synopsis of Program Characteristics, Successes and Challenges
The name Project Safe Conduct is taken from a description in Avery Weisman’s Coping with Cancer that reads: “Safe Conduct: Guiding patients and families through the maze of perplexing events of survival and through the end of life.” This name reflects the philosophy of the partners on this collaborative grant: Ireland Cancer Center of Case Western Reserve University/University Hospitals (ICC), an acute care comprehensive cancer center, and Hospice of the Western Reserve (HWR), a large community-based hospice program. Part of the success of this program is attributable to the strength of this partnership and the support at the senior leadership levels, through the commitments of Jim Willson, MD, Director of ICC and David Simpson, Director of HWR. The collaboration is perhaps best seen at the operational level through the leadership of Project Director Elizabeth Pitorak, from HWR, and Meri Armour, RN, Vice President at ICC, who have been meeting weekly since the conception of the grant.
The overall goal of Project Safe Conduct is to improve care and services to persons dying of cancer and their families (in the ambulatory care setting) by integrating the principles of palliative care. At the heart of the model is the Safe Conduct Team (SCT) composed of a nurse practitioner, social worker and spiritual counselor. However, the Safe Conduct Team has a unique twist: they are employees of HWR but are located at ICC and viewed as ICC staff, complete with ICC name badges. The original idea was to take the palliative care expertise offered by HWR and truly make it part of the cancer center, allowing the patient’s oncologist to continue to be part of the care. As a result, the SCT, which works much the same as a hospice team, is now integrated into the existing oncology teams that provide chemotherapy and radiation therapy for lung cancer patients in the ambulatory clinic. This team guides the patients and families through the maze of perplexing events around their therapies and assists them in early decision-making around end-of-life care. A psychologist and pain specialist are consultants to the team and patients; the oncologist is also a member of the team for the individual patient he or she follows. Staff notes that involvement of spiritual care through SCT was initially very foreign in the acute care setting; however, this discipline has become the “shining star” of the team.
Great attention was paid at the onset of the program to melding the two very different cultures of hospice and acute cancer care by orienting ICC staff to Project Safe Conduct, and by orienting SCT to the world of cancer centers. ICC physicians and key clinical staff attended a half-day retreat to learn about Safe Conduct prior to its implementation and members of the SCT observed at ICC by ‘shadowing’ cancer center staff during chemotherapy administration, physician visits and radiation therapy.
SCT has been instrumental in educating nurses and physicians in ICC regarding pain, symptom management, delivering bad news, and end-of-life care and options. They also have educated patients and families about earlier decision-making around end-of-life care. On the community level, the project has sponsored annual “Town Hall Meetings” inviting community members to hear national speakers discuss palliative care.
Staff reports that changes within ICC are apparent as a result of the project, noting that:
Exportable Products/Tools
Policy Issues
Staff has echoed concern raised by other Promoting Excellence cancer center grantees: it is neither ethical nor acceptable for IRBs to approve Phase 1 and Phase 2 studies without offering palliative care as a treatment option. It is not acceptable for patients volunteering for science to have to choose between participation in clinical trials to the exclusion of hospice care.
Project staff stresses the need for NCI to fund research in palliative care and to place palliative care experts on proposal review panels.
Communications
Several natural audiences emerge, including cancer centers, NCI, hospices and hospitals. SCT has also mentioned the impact of the spirituality component of their project and recommend disseminating information about the project to the American Council of Churches and other such groups.
Additionally, the project appears to have unearthed a previously unmet patient need, finding that approximately 25 percent of patients need psychological consults. Thus, information about the project should be of interest to psychologists.
Generalizing the Model
When project staff was recently asked what it would take to generalize what they have learned, they replied:
Words of Wisdom from the Project
When staff was asked what advice should be given to another institution interested in initiating a similar project, they replied: