• providing in-service training for local hospice staff in new pallia tive care techniques.

Recommendation 2: NCI should add the requirement of research in pallia tive care and symptom control for recognition as a “Comprehensive Can cer Center.”

Practices and policies that govern payment for palliative care (in both public and private sectors) hinder delivery of the most appropriate mix of services for patients who could benefit from palliative care during the course of their illness and treatments.

Recommendation 3: The Health Care Financing Administration (HCFA) should fund demonstration projects for service delivery and reimburse ment that integrate palliative care and potentially life-prolonging treat ments throughout the course of disease.

Recommendation 4: Private insurers should provide adequate compensa tion for end-of-life care. The special circumstances of dying children— particularly the need for extended communication with children and par ents, as well as health care team conferences—should be taken into account in setting reimbursement levels and in actually paying claims for these services when providers bill for them.

Information on palliative and end-of-life care is largely absent from materials developed for the public about cancer treatment. In addition, reliable information about survival from different types and stages of cancer is not routinely included with treatment information.

Recommendation 5: Organizations that provide information about cancer treatment (NCI, the American Cancer Society, and other patient-oriented organizations [e.g., disease-specific groups]; health insurers; and pharma ceutical companies) should revise their inventories of patient-oriented material, as appropriate, to provide comprehensive, accurate information about palliative care throughout the course of disease. Patients would also be helped by having reliable information on survival by type and stage of cancer easily accessible. Attention should be paid to cultural relevance and special populations (e.g., children).

Practice guidelines for palliative care and for other end-of-life issues are in comparatively early stages of development, and quality indicators are even more embryonic. Progress toward their further development and implementation requires continued encouragement by professional societies, funding bodies, and payers of care.

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