Several activities are needed to improve access to and the quality of palliative and end-of-life care for African Americans and other underserved minority populations. Three activities that can be initiated relatively quickly should be put in place simultaneously across different community settings (urban, inner city, rural, etc.).
Palliative care units should be established in hospitals. In inner-city locations, end-of-life care for the poor could be initiated until hospice care becomes a more realistic and accepted option.
Teams of health care professionals across different settings need to be trained to understand palliative and end-of-life care and be funded to develop programs to provide this care.
Focus groups should be conducted in communities to gain a better understanding of the needs of patients and families.
A model program that incorporates these elements has been started in Harlem, at North General Hospital (NGH), in collaboration with Memorial Sloan-Kettering Cancer Center (MSKCC) (see Box 5-1). NGH was chosen as the site for this model program for three reasons:
There are already existing collaborations between NGH and MSKCC, and in fact, a $5 million gift from the Ralph Lauren Foundation was recently announced to support a collaborative cancer center.
North General Hospital, a 200-bed institution, is of “manageable” size to initiate and evaluate a program of this type. The educational programs and the pre- and post-intervention surveys are more feasible than they would be in the other two, much larger, Harlem hospitals.
NGH is a private hospital (not a part of the New York Health and Hospitals Corporation), and therefore, it will be easier to implement administrative changes and measure their effects in a less bureaucracy-laden system. However, once the effectiveness of these interventions has been documented, the model (or major components of it) could be replicated in public hospitals.
Research is needed to better understand the needs and preferences for end-of-life care of minorities, medically underserved and other vulner-