• address patient needs for symptom management in the discharge planning process.

The standards were developed collaboratively with the University of Wisconsin-Madison Medical School, as part of a project funded by RWJF to make pain assessment and management a priority in the nation’s health care system (JCAHO Web site, http://www.jcaho.org/news/nb207.html).


The National Institutes of Health responded to recommendations in the IOM (1997) report and to the widely publicized SUPPORT findings with an initiative in symptom control and palliative care at a meeting in November 1997. This was by no means NIH’s first recognition of research needs in palliative care. A prominent earlier effort was a 1979 interdisciplinary meeting on pain, which provided some of the stimulus for advances in pain control in the 1980s and 1990s, and a follow-up meeting in the early 1990s. Despite these activities, no standing program was ever developed.

The main event of the 1997 effort was a workshop that was cosponsored by the National Institute of Nursing Research (NINR), the Division of AIDS Research of the National Institute of Allergy and Infectious Diseases (NIAID), NCI, and the Office of Alternative Medicine to target research needs in palliative care. The research workshop “Symptoms in Terminal Illness” had three principal goals:

  1. to summarize the current state of knowledge concerning the most common symptoms associated with terminal illness;

  2. to identify important needs and opportunities for research that would be appropriate for NIH funding; and

  3. to initiate a process for enhancing interdisciplinary collaboration and interagency collaboration in research in palliative care.

The workshop was organized into four topic sessions that focused on specific symptom areas: pain, dyspnea, cognitive disturbances, and cachexia and wasting. A research agenda was developed from the workshop report (http://www.nih.gov/ninr/end-of-life.htm), and in 1998, the collaborating institutes issued a program announcement “Management of Symptoms at the End of Life,” with a call for proposals addressing the following objectives:

  • managing the transition to palliative care;

  • understanding and managing pain and other symptoms, such as nausea and depression in the context of end-stage illness;

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