BOX 5-1 Memorial Sloan-Kettering Cancer Center and North General Hospital: Partners in Pain Management and End-of-Life Care in a Minority Community
North General Hospital (NGH) is embarking on an ambitious and definitive series of activities in the area of pain and palliative care. Under the direction of Dr. Harold Freeman, president and Chief Executive Officer of NGH, and Dr. Richard Payne, chief of the Pain and Palliative Care Program at Memorial Sloan-Kettering Cancer Center (MSKCC), NGH has established a new Pain and Palliative Care Program. This program has been an outgrowth of North General’s plan to establish a comprehensive cancer center; that center was recently awarded a $5 million grant from the Ralph Lauren Foundation. Below is a brief description of the current pain and palliative care initiatives at NGH and the collaborating partners. Evaluation of the outcomes of these developing models of care and service delivery will add significantly to our body of knowledge in these areas. 1. The Pain and Palliative Care Service is a comprehensive, multidisciplinary endeavor that opened in June 2000. The center has received support from the Ellen P. Hermanson Foundation, NGH, and MSKCC resources for initial staffing. As part of its mission and operation, the Pain and Palliative Care Service at NGH is training its physician, nursing, and support staff, has revised hospital policy and procedures; and has implemented an inpatient pain management consultative service and a weekly ambulatory clinic. The consultative service on pain management and ambulatory services will be available to North General Hospital patients 24 hours a day. This clinical program serves as a community resource providing expertise in palliative medicine for the greater Harlem area. For example, a series of formal and informal educational programs delivered by staff of the Pain and Palliative Care Service has targeted Harlem physicians and other health care providers. 2. The United Hospital Fund’s Community Oriented Palliative Care Initiative has funded a two-year collaborative program at NGH with MSKCC and the Visiting
able populations. We need to address health policy and financing barriers that prevent the utilization of end-of-life care support that is available. We need to know if demographics (age, social class, and education level) affect the attitudes and practices of these groups at the end of life.
The National Cancer Institute (NCI) should increase efforts to address disparities in access to cancer care, including end-of-life care (including many of the recommendations in the recent Institute of Medicine report The Unequal Burden of Cancer [IOM, 1999]).
NCI-designated cancer centers should provide plans to address equal access to cancer care services (including end-of-life care) in vulnerable populations. Demonstration projects should be funded to develop models of care delivery and evaluated to assess the effectiveness of care.