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Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center

Norris Cotton logo.Project Overview

In this project, three rural New Hampshire communities (Lebanon, Manchester and Berlin) worked with the Norris Cotton Cancer Center at Dartmouth to improve end-of-life care for cancer patients.

Project ENABLE (Educate, Nurture, Advise Before Life Ends) coordinated care between the cancer center and local health care providers and hospices. They did so by integrating the curative care provided by the Dartmouth-based cancer center with the palliative, or comprehensive comfort and supportive care, provided by the local hospice teams.

ENABLE's palliative care coordinators worked with patients and families following diagnosis, helping to individualize each person's care plan in accordance with their and their family's preferences. They also worked to ensure continuity of care during the course of the illness.

Concurrently, each of Project ENABLE's three communities had palliative care teams consisting of a pain management specialist, a psychiatrist or psychologist, a hospice or home health liaison, a social worker or case manager and a pastoral caregiver. Each team tailored its work to the specific health care system in the community.

In addition to Project ENABLE's holistic approach to patient care, families and patients attended educational seminars. These sessions helped families and patients navigate the health care system, have open and meaningful dialogue with physicians, understand advanced care planning, individualize decision-making and symptom and stress management, and understand the stages of dying and normal issues of life completion and life closure.

"Project ENABLE allowed us to demonstrate that, regardless of geographic location, cultural identification, or clinical sophistication, patients need not be abandoned when a cure for their disease seems no longer possible," said E. Robert Greenberg, M.D., Principal Investigator for the project.

The project team helped develop the Charting Your Course program, a series of four seminars meant to help navigate the health care system. Charting Your Course is intended for people recently diagnosed with cancer, their family members and friends.



After the Grant

Dartmouth-Hitchcock Medical Center expanded Project ENABLE into a clinical service, with some modifications. The educational component continues, and the project investigators received NIH funding for a clinical trial to further test ENABLE.

Contact Information

Principal Investigator:
E. Robert Greenberg, M.D.
Director, Norris Cotton Cancer Center
Dartmouth-Hitchcock Medical Center
Norris Cotton Cancer Center
One Medical Center Drive
Lebanon, NH 03756
Phone: 603.650.6300
Fax: 603.650.6333
Email: [email protected]

Web sites:

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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.