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A number of courses have been developed, including the Program in Palliative Care Education and Practice (a two-week intensive course with distance-learning elements, recently provided with additional funding for minority scholarships by the Robert Wood Johnson Foundation and the James Green Family Fund), Practical Aspects of Palliative Medicine, and The Art and Science of Palliative Nursing. Outreach efforts for house officers and other clinicians, including both educational and staff support programs, are partially funded by the Academy at Harvard Medical School and the Donaldson Charitable Trust.
The data collection phase of our National Institute of Nursing Research project with the New England Research Institute and Beth Israel Hospital, New York, has been completed and we are now examining longitudinal (2-year) follow-up of patients with advanced heart and lung disease and their families.
Two new research projects were initiated this year. Selected new patients at the Center for Thoracic Cancers and the Stephen E. and Catherine Pappas Center for Neuro-Oncology will be offered Palliative Care Service evaluation and follow-up at the time of presentation as part of pilot programs to measure the impact of early involvement of a standardized palliative care intervention. Similarly, a Robert Wood Johnson Foundation demonstration project to measure the impact of "merging" palliative care and intensivist cultures in the Medical Intensive Care Unit will begin accruing patient and family subjects. A small study in collaboration with the University Hospital Grosshadern (University of Munich) of the Schedule for the Evaluation of Individual Quality of Life will look at the clinical utility of this research instrument, as funded under the Max Kade German American Project on Palliative Care.
Dr. Nicholas Christakis has employed quantitative epidemiological methods to examine the impact of illness and death upon the health and risk of death of relatives of the deceased. One study examined 200,000 couples and found that delivery of hospice care to a decedent appears to lower the risk of death during bereavement in survivors. Other work has examined the ways in which widowhood affects health care consumption. Dr. Christakis has continued work on the role of prognostication in clinical practice, publishing papers in JAMA and the BMJ, further exploring in a clinically relevant manner his longstanding interest in this topic. Finally, in collaboration with Cancer Center oncologist Dr. Elizabeth Lamont, Dr. Christakis is continuing a set of projects on cancer epidemiology, focusing on the ways in which the occurrence of co-morbid disease before or after cancer diagnosis or therapy provides insight into risk factors for the diseases in question.
Dr. Eric Krakauer is a Project on Death in America Faculty Scholar, and continues work on hospital policies regarding end-of-life care, focusing on such topics as sedation for intractable distress in the dying patient and handling intractable conflict. He has also been funded by the Centers for Disease Control and Prevention to help develop HIV treatment programs in Vietnam, where he has been involved with palliative care program development.
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