The Project on Death in America (PDIA) (www.soros.org/death) has committed $30 million to improving end-of-life care through its Faculty Scholars Program, grant programs, and special initiatives. The 70 or so faculty scholars that have been funded by PDIA serve as role models and clinical researchers in academic medical centers around the United States (and a few in Canada). About one-third of them are oncologists involved in direct patient care and directing palliative care programs.
The Nathan Cummings Foundation, together with the Commonwealth Fund, supported a major study of nearly 1,000 dying patients (most with cancer, heart disease, or chronic lung disease) and their caregivers. This is one of eight major research projects designed to expand the nation’s understanding of the dying experience and find ways to improve it.
The Milbank Foundation (www.milbank.org) sponsored the development and publication of Principles for Care of Patients at the End of Life: An Emerging Consensus Among the Specialties of Medicine (Cassel and Foley, 1999), a document now signed onto by at least 17 health professional societies that have agreed to incorporate its principles into their professional education activities and residency training programs.
Another milestone was the 1997 report Approaching Death: Improving Care at the End of Life from the Institute of Medicine (IOM, 1997). This was the first major national report covering the range of end-of-life issues, with evidence-based recommendations (see Box 1-3). It received widespread national attention and continues to be cited as a reference and source of guidance for improving end-of-life care. This report builds on the earlier report and its recommendations. (The reader is referred to the 1997 report for a thorough review of issues up to that time.) The 1999 National Cancer Policy Board report Ensuring Quality Cancer Care (IOM, 1999) has already been mentioned.
The 1997–1998 report of the President’s Cancer Panel1 (PCP) was entitled Cancer Care Issues in the United States: Quality of Care, Quality of Life, with a major focus on the need for NCI to fund research and training