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, etc.;

  • 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

  • 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-

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