Field of Work: End-of-Life Care

Problem Synopsis: During the 1980s and 1990s, Americans began to be concerned about the long period of suffering many people endured before their deaths. Little attention had been given to the need for continuity of care from acute-care services to palliative, end-of-life care.

Synopsis of the Work: From October 1998 to December 2003, with $450,000 from RWJF's Promoting Excellence in End-of-Life Care national program (as well as funding from the Cleveland Foundation, the Elisabeth Severance Prentiss Foundation and Case Western Reserve University [CWRU]) staff at CWRU, in partnership with Hospice of the Western Reserve and the Ireland Cancer Center at University Hospital, created Project Safe Conduct. Safe Conduct was defined as the dimension of care that guides a patient through a maze of uncertain, perplexing and distressing events. Safe Conduct's overarching goal was to eliminate the artificial boundaries separating acute care from end-of-life care by providing "safe conduct" for patients with terminal illnesses. Safe Conduct served 221 patients with advanced lung cancer.

Key Results: Project staff reported the following results:

• In 1997, prior to the project's inception, 13 percent of advanced lung cancer patients at Ireland Cancer Center were receiving either hospice or home care services at the time of their death. At the end of the project in 2003, 80 percent of patients who died were receiving hospice services.
• The average length of time in hospice increased from 10 days in 1997 to 44 days in 2003.
• The Ireland Cancer Center hired all three members of the Safe Conduct team in order to continue the project when RWJF funding ended.
• The project received the 2002 Circle of Life Citation of Honor from the American Hospital Association.

The national program office reported that the rate of admissions to Ireland Cancer Center declined by 67 percent after Project Safe Conduct began, and that lung cancer patients averaged 3.2 hospital admissions in the year before Project Safe Conduct started. Starting one year after Project Safe Conduct and every year thereafter, lung cancer patients averaged 1.05 admissions per year.