that extends from the moment of diagnosis throughout the course of the illness.” The statement goes on, “In addition to appropriate anticancer treatment, this includes symptom control and psychosocial support during all phases of care, including those during the last phase of life.”

Also in 1998, ASCO surveyed its membership in the first nationwide inquiry into end-of-life practices. The survey asked about education and training, current practice, perceived barriers to the delivery of care, decisionmaking vignettes about the management of patients, and individual experiences with terminal patients. The results, which have been presented at meetings and have begun to appear in print, confirm many of the deficiencies that have been recognized in caring for dying patients, but coming from the oncology community, they have hit with added force (see Box 1-4 for key survey findings).

For the long term, ASCO has placed high priority on developing its program called “Optimizing Cancer Care: The Importance of Symptom Management.” The curriculum consists of 32 modules covering specific symptoms and symptom control issues (e.g., ascites, breaking bad news, depression, lymphedema). Modules are designed to get information into manageable pieces for practicing oncologists in a way that is concise and information-dense. The program has been featured at national ASCO meetings and will be featured at all yearly state ASCO meetings. ASCO plans to make it available on CD-ROM, on-line, and in print.

The Joint Commission on the Accreditation of Healthcare Organizations is the first national accrediting body to develop mandatory standards for pain assessment and management. JCAHO, which accredits the majority of hospitals and other health care organizations (including hospices), will begin evaluating the hospitals, home care agencies, nursing homes, behavioral health facilities, outpatient clinics, and health plans it inspects for compliance with the new standards in 2001. The organizations will be required to

  • recognize the right of patients to appropriate assessment and management of pain;

  • assess the existence and, if so, the nature and intensity of pain in all patients;

  • record the results of the assessment in a way that facilitates regular reassessment and follow-up;

  • determine and ensure staff competency in pain assessment and management, and address pain assessment and management in the orientation of all new staff;

  • establish policies and procedures that support the appropriate prescription or ordering of effective pain medications;

  • educate patients and their families about effective pain management; and



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