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University of California, San Francisco
When individuals in today's society are dying, they often feel forced to decide between life-prolonging medical care and hospice support for themselves and their families. Under the direction of Michael W. Rabow, M.D., assistant clinical professor in medicine, researchers at the University of California-San Francisco's Collaborative Innovation in Primary Care Program and Hospice by the Bay collaborated to address this all-too-common problem in today's American health care system.
Researchers conducted a controlled trial to evaluate a Comprehensive Care Team program in which palliation of symptoms and reasonable curative attempts were pursued simultaneously. This program’s interdisciplinary team of physicians, nurses and social workers provided comprehensive care and family caregiver support for seriously ill outpatients who were near the end of their lives. Using a case management model, the program drew heavily on local volunteer support services, faith communities and social agencies.
The Comprehensive Care Team project used a sophisticated randomized study to assess the feasibility, impact and cost-effectiveness of removing the dichotomy between life-prolonging care and hospice-type services. Under the Comprehensive Care Team program, patients received state-of-the-art medical care and at the same time, hospice, or palliative care.
The project assessed the team's impact on patient quality of life, level of symptom control, psychosocial and spiritual well-being, advance care planning and health care utilization. The program provided regional and national health care planners with valuable data concerning the costs of merging medical care with palliative or hospice care.
After the Grant
The institutions sustained some portions of the original project, and the GYN-oncology outpatient practice at the University of California – San Francisco Comprehensive Cancer Center adapted the program to its services.
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.