lower the barriers to excellent palliative care for people with cancer today and for those who will develop it in years to come. The recommendations describe a series of initiatives directed largely—though not exclusively—at the federal government, which should be playing a more powerful role than it has done.

The recommendations are not laid out in parallel to the barriers, as earlier in this chapter. They have been consolidated as “packages” for particular organizations and entities, and some address more than one barrier. Recommendation 1, in particular, which focuses on the role of NCI-designated cancer centers, contains elements that address all the barriers.

Recommendation 1: NCI should designate certain cancer centers, as well as some community cancer centers, as centers of excellence in symptom control and palliative care for both adults and children. The centers will deliver the best available care, as well as carrying out research, training, and treatment aimed at developing portable model programs that can be adopted by other cancer centers and hospitals. Activities should include, but not be limited to, the following:

• formal testing and evaluation of new and existing practice guide lines for palliative and end-of-life care;

• pilot testing “quality indicators” for assessing end-of-life care at the level of the patient and the institution;

• incorporating the best palliative care into NCI-sponsored clinical trials;

• innovating in the delivery of palliative and end-of-life care, includ ing collaboration with local hospice organizations;

• disseminating information about how to improve end-of-life care to other cancer centers and hospitals through a variety of media;

• uncovering the determinants of disparities in access to care by mi nority populations that should be served by the center and developing specific programs and initiatives to increase access; these might include educational activities for health care providers and the community, setting up outreach programs, and so forth;

• providing clinical and research training fellowships in medical and surgical oncology in end-of-life care for adult and pediatric patients;

• creating faculty development programs in oncology, nursing, and social work; and