Promoting Excellence : Integrating Cancer Care and Palliative Care : University of California, Davis School of Medicine

"I couldn’t just turn my back on cancer patients who had completed their experimental therapy. Palliative care is a part of comprehensive, good cancer care. I have grown as an individual by knowing many patients and families from all walks of life. It makes me a better doctor.”

--Frederick J. Meyers, MD

Institution
University of California, Davis School of Medicine
Sacramento, California

Program
West Coast Center for Palliative Care Education and Research

Year Started

UC Davis Hospice: 1982
West Coast Center for Palliative Care Education and Research: 1994

Patients Seen

UC Davis Hospice: 60-70 patients, average daily census; thousands since 1982
West Coast Center: 10-12; more than 50-60 since 1994

The hospice program at UC Davis serves about 70% cancer patients and 30% patients with nonmalignant disease.

Principal Investigator
Frederick J. Meyers, MD
916-734-8596
[email protected]

Project Director
Joan Blais, MPA
916-734-2187
[email protected]

Program Mission and Objectives
To enhance the science and art of palliative care.

The West Coast Center for Palliative Care Education and Research will be a regional, national and international asset and resource for palliative care. Palliative care reduces the violence of life-limiting illness. Palliative care is a philosophy of care delivery by an interdisciplinary team, which combines active and compassionate therapies. The West Coast Center for Palliative Care Education and Research assembled a multidisciplinary faculty to:

Partner with other providers;
Synthesize innovative research;
Provide leadership for effective education;
Focus care on the quality of life of patients and families facing life-limiting illness.

Goals

Sustainability
Replicable models
Dissemination
Strategic partnerships

Program Description
The West Coast Center for Palliative Care Education and Research focuses on cancer and AIDS. Its core effort is a model-building, simultaneous care study involving cancer patients undergoing investigational therapy. Traditionally, these patients are not eligible for hospice care as long as they are still having therapy. Thus, these patients are faced with an either/or choice—investigational therapy or end-of-life care. The West Coast Center model is designed to show that patients can have both hospice/palliative care and disease-directed therapy simultaneously.

The palliative care team is composed of oncologists, nurses and social workers. The program can refer to other providers as needed. The team also includes educators and health services researchers.

Patients entering the investigational cancer therapy program are assigned a nurse and a social worker who oversee both their chemotherapy and their palliative care—from symptom control to helping the patient and family prepare for death. Patients come to the hospital for treatment, but reside at home.

Historical Perspective
UC Davis has had its own hospice program since 1982. In 1986, Frederick Meyers, MD, became this program’s medical director. In the 1980s and early 1990s, a number of medical students rotated through the hospice, and in 1994, the program received a National Cancer Institute (NCI) grant to formalize its hospice educational program.

At the same time, Meyers and his colleagues were considering more end-of-life care outreach. They started a prison hospice program at the California Medical Facility at Vacaville. At this time, before the introduction of life-prolonging drugs, as many as 30 prisoners per week were dying from AIDS. The NCI hospice education grant, along with the prison outreach program, allowed Meyers and his colleagues to formalize their plan and make a commitment to introducing palliative care earlier in the disease process.

Because of the long tradition of hospice care at UC Davis, medical center leaders supported the concept of a palliative care program. The center already had been providing end-of-life care for a number of years without a hospice benefit. In addition, in 1991, Meyers had been appointed chief of hematology and oncology. In 1997, he became chief of medicine and retained his position as medical director of the hospice. Meyers is a rarity in that he is both a department chair and a hospice medical director, which makes him the ideal program champion.

Meyers and his colleagues did not have to overcome the integration challenges faced by many other palliative care programs. The hospice was already in place within the center and was providing clinical care. Rather, their challenge was to be more than hospice—that is, to develop models that systematized palliative care throughout the disease process. Yet another challenge was research. The hospice had significant experience in education after all those years of medical students rotating through, but Meyers was not an experienced health services researcher and had to learn how to measure outcomes, a task which is at the heart of the program.

Research
The research being conducted in the simultaneous cancer care program is at the core of the West Coast Center’s effort.

Education
The education component of the original hospice program continues. Today, students from all over the country visit the center.

Partnerships
Frederick Meyers sees the West Coast Center as one element in what will become a multi-institutional approach to simultaneous care.

Marketing
Eventually, marketing will be needed.

Funding
The West Coast Center is funded by grants and philanthropy.

Vision
It is Meyers’ vision to develop models for improved care throughout the health care system, not just in cancer. Eventually, he hopes to expand the model developed by the West Coast Center for Palliative Care Education and Research to include heart failure patients and COPD patients.

The West Coast Center is also part of Meyers’ overall vision to bring palliative care to underserved populations. The investigational cancer therapy patients and the prisoner at Vacaville are two examples. Meyers and his colleagues have also started a rural palliative care initiative.

After finishing the simultaneous care study and establishing a framework for the program to continue, Meyers hopes to investigate other areas in palliative care such as the doctor–patient relationship and distress management.

A National Perspective
Elements and Measures of Program Success

Be part of a cancer center, not just an add-on.
Don’t focus only on end-of-life care; palliative care is needed to soothe the emotional crisis at diagnosis.
Be supportive of the institutions’ other missions—e.g., education and research.

Necessary Steps

Good intentions aren’t sufficient; the systematic effort of an interdisciplinary team is needed all the way through the process.
Patients’ greatest concern is that their care is coordinated—that they not fall through the cracks—and that their family is cared for.

What I Wish I’d Known Then . . .

“I wish I had known the resources available from health services researchers—people who know about what we are trying to do because they have been through it before with other types of efforts. The struggles are the same.”

--Frederick J. Meyers, MD

This descriptive summary is based on an interview conducted by Jane Grant Tougas with project staff in January and February 2001.

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Promoting Excellence in End of-Life Care is a National Program Office of The Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit PromotingExcellence.org for more resources.