Project safe conduct integrates palliative goals into comprehensive cancer care.

Abstract

Project Safe Conduct, a collaborative venture between Hospice of the Western Reserve and the Ireland Cancer Center at Case Western Reserve University and University Hospitals of Cleveland, is one of four winners of the 2002 Circle of Life Award. Project Safe Conduct exemplifies a successful collaboration between staff at a National Cancer Institute comprehensive cancer center and a freestanding, community-based hospice in response to a common desire to provide seamless, exemplary patient and family care. One of the key goals of this project is to make palliative care accessible to persons suffering from advanced lung cancer even as they may be pursuing life-prolonging treatments. Persons with advanced lung cancer have not been traditionally well served in terms of timely referral to hospice. The often rapid course of lung cancer and the curative focus of cancer research centers has meant that curative and life-prolonging treatments have often taken precedence over attention to psychosocial and spiritual concerns, and active pain and symptom management in these settings. This project began as a demonstration project and research study, inspired by an awareness that these challenges need not be dichotomous and a wish to integrate these goals of life-prolonging treatment and palliative care. By so doing, the innovators hoped to simplify the journey through the labyrinth of treatments and services for patients with lung cancer and their families. The funded demonstration project research project is now over (1998–2001), but the interdisciplinary team continues as the new standard of care at Ireland Cancer Center. This project represents one effort to provide patients facing life-threatening illness with the mixed management model of care advocated by the Institute of Medicine report, Approaching Death.1 The 2002 Circle of Life Award is conferred by the American Hospital Association in conjunction with the American Medical Association, the American Association of Homes and Services for the Aging, and the National Hospice and Palliative Care Organization, and funded by The Robert Wood Johnson Foundation. In addition, Project Safe Conduct received the 2002 Award of Excellence in Education in the category of Educational Program Designed to Increase Access to Hospice and Palliative Care at the National Hospice and Palliative Care Organization’s Management and Leadership Conference held September 11, 2002 in Washington, D.C. Elizabeth Ford Pitorak, director of the Hospice Institute of Hospice of the Western Reserve and Meri Beckham Armour, vice president for the Ireland Cancer Center, describe the collaborative process of designing and implementing Project Safe Conduct. The project derives its name from Avery Weisman’s book, Coping with Cancer, in which he defines safe conduct as “the dimension of care that guides a patient through a maze of uncertain, perplexing, and distressing events.”2 In this interview with Innovations Staff Editor, Holly D. Sivec, these innovators describe the process of creating an interagency, interdisciplinary team (that includes the oncologist) to supplement the care of patients suffering from stages IIIb and IV lung cancer and their families. The team’s care emphasizes state-of-the-art symptom management, psychosocial, emotional, and spiritual support. These leaders depict the challenges of working across two distinct cultures of care, and the nec-