American Cancer Society and NPCRC award $1.8M for palliative care research

The American Cancer Society and the National Palliative Care Research Center (NPCRC) are awarding $1.8 million in research grants to researchers at 12 institutions for studies aimed at reducing suffering for seriously ill patients and their family caregivers. The studies will be conducted over the next two years. Since 2007, a collaborative effort by the organizations has awarded 51 grants totaling almost $7 million. These grants, which are in addition to other grants in this area funded by the American Cancer Society, have brought much-needed research dollars to a field that has become an increasingly important part of patient care, but for which federal funding has been inadequate.

"One of the major barriers to reducing suffering for people living with a serious illness like cancer has been the lack of research funding directed towards palliative care interventions." said NPCRC Director R. Sean Morrison, MD, who is also professor of Palliative Care, Geriatrics and Medicine at Mount School of Medicine. "These grants from the NPCRC and American Cancer Society support research scientists who are advancing the field of palliative care. The research findings from our grantees will help ensure that we eliminate the suffering that is too commonly associated with serious illnesses like cancer."

Palliative care focuses on relieving suffering and supporting the best possible quality of life for adults and children living with serious illness. It is a field comprising doctors, nurses, social workers, and other specialists who care for patients with chronic illnesses, functional impairment, and a high burden of family caregiving responsibilities. Palliative care is provided at the same time as all other appropriate medical treatments.

The collaborative initiative between the American Cancer Society and the National Palliative Care Research Center is designed to support clinician investigators conducting patient-oriented research in palliative care in hopes of bringing more funding from federal agencies, which have supported some research in palliative care, but for whom it is not a priority area. Pilot data results are typically needed before a federal agency will consider funding a research project.

• The Research Institute at Nationwide Children's Hospital and The Ohio State University - Cynthia A. Gerhardt, Ph.D., an associate professor of pediatrics and psychology at The Ohio State University, will examine the feasibility of conducting prospective research with families in pediatric palliative care. She will compare symptom burden and quality of life in children with and without life-limiting illnesses, examine the impact on families, and identify factors related to child and family adjustment near the end of life.
• University of North Carolina - Laura C. Hanson, M.D., M.P.H., an associate professor in the division of geriatric medicine, School of Medicine at the University of North Carolina - Chapel Hill, will use the concepts of shared decision-making to test an innovative decision support intervention for family surrogates who must make health care choices for people with advanced dementia. Family surrogates will see an audiovisual decision aid, and participate in a structured care planning meeting with an interdisciplinary team, to make choices about goals of care and treatment. This approach to goals of care communication will be refined using semi-structured interviews with surrogates, to clarify the links between goals and treatments to meet goals of care in dementia.

• Children's Memorial Hospital, Northwestern University - Kelly Michelson, M.D., M.P.H., an assistant professor and pediatric intensivist at Children's Memorial Hospital, Northwestern University, will use mixed methods to study family conferences in the pediatric intensive care unit. She seeks to develop an understanding of the role and impact of family conference on end-of-life care decision making and ultimately to develop interventions that optimize family-centered communication during family conferences in the pediatric intensive care unit.

• University of Vermont College of Medicine - Renee Stapleton, M.D., M.Sc., an assistant professor of medicine in the division of pulmonary and critical care medicine at the University of Vermont, will study along with her co-investigators Drs. J. Randall Curtis and Dee Ford, an innovative "informed assent" approach toward in-hospital CPR (informing patients that their underlying chronic illness renders outcomes after CPR so poor that CPR is not performed while allowing them to actively disagree) in chronically ill patients with reduced life expectancy.

• Oregon Health and Science University - Lissi Hansen, Ph.D., R.N., an associate professor at Oregon Health & Science University, will conduct a prospective, longitudinal study to describe pain and other symptoms, symptom management strategies, and quality of life from the perspective of both patients with intermediate-advanced or terminal hepatocellular carcinoma (HCC) and family members as patients near the end of life.

• Virginia Commonwealth University Massey Cancer Center- Thomas J. Smith, M.D. F.A.C.P., the Massey Endowed Professor of Palliative Care Research and an esteemed professor of medicine in the division of hematology/oncology and palliative care at the Virginia Commonwealth University - Massey Cancer Center in Richmond. Dr. Smith and team will test if ABH gel, commonly used in hospice patients but for which there is little clinical trial evidence, is absorbed through the skin in sufficient levels to allow symptom relief.

• Children's National Medical Center, Washington, DC - Maureen E. Lyon, Ph.D., A.B.P.P., a licensed clinical psychologist and an associate research professor in pediatrics at George Washington University Medical Center within the Clinical and Community Research Center of the Children's Research Institute at Children's National Medical Center in Washington, D. C. Dr. Lyon will conduct a randomized pilot study to determine the feasibility, acceptability, and safety of a cancer-specific communication model, the Family Centered Advance Care Planning (FACE) intervention, appropriate to the cognitive and emotional maturity of the adolescent, that involves him/her in decision making about their wishes for their end-of-life care.

• Northwestern University, Feinberg School of Medicine - Linda Emanuel, M.D., Ph.D., the Buehler Professor of Geriatric Medicine and Director of the Buehler Center on Aging, Health & Society at Northwestern's Feinberg School of Medicine, will design and test for feasibility a Tailored Implementation of Practice Standards (TIPS) package for rapid-relief pain management in all emergency departments. They will test it among people living with advanced cancer who have uncontrolled pain. Successful completion of this project will prepare for a multi-site test and if successful will then allow them to disseminate the TIPS throughout the nation.

• University of Rochester - Robert Gramling, M.D., D.Sc., an assistant professor of family medicine at the University of Rochester, will use direct observation and epidemiological methods to examine the degree to which palliative care clinician approaches for communicating prognosis are associated with subsequent choices to pursue an exclusively palliative plan of treatment. This work will focus on prognostication behaviors that endorse optimism and hope in the context of advanced illness and will begin to explore how different communication strategies interact with patient race, gender and/or educational attainment in their association to palliative treatment choices.

• University of Pittsburgh - Yael Schenker, M.D., who will begin her position as assistant professor of medicine in the division of general internal medicine at the University of Pittsburgh in August, 2010, will characterize and compare the quality of communication about end-of-life issues with seriously ill African American and Caucasian patients. Dr. Schenker will use direct observation and stimulated recall interviews to identify physician communication behaviors that are consistent or inconsistent with patient preferences.

• University of California, Los Angeles - Anne Walling, M.D., Ph.Dc., an assistant professor of medicine (beginning in July 2010), will study transplant patients as a model for patients with a realistic hope for cure. She will investigate how consideration of organ transplantation affects medical care received, and using qualitative methods, examine barriers and facilitators to patient-physician communication around advance care planning in this population.

• Dana-Farber Cancer Institute/Harvard Medical School - Alexi Wright, M.D., an instructor in medicine at Harvard Medical School and an attending physician in medical oncology at Dana-Farber Cancer Institute focuses her research on patient-oncologist communication, the formation of treatment preferences, and variations in practice patterns. Through her research she hopes to develop an evidence base to guide advanced cancer patients' decision-making in areas where there are currently limited data, e.g., the use of palliative chemotherapy in advanced, platinum-refractory ovarian cancer.

Source: American Cancer Society