Creating healing environments.

In 2004 two organizations, the George Washington Institute for Spirituality and Health, Washington, DC, and the Supportive Care Coalition: Pursuing Excellence in Palliative Care, Portland, OR, collaborated in an experiment seeking antidotes to the depersonalization of health care. Their "Hospital-Based Spirituality Initiative: Creating Healing Environments" was intended to achieve two objectives: First, to develop and test strategies that encourage clinical caregivers to attend to patients' spiritual concerns; and, second, to better understand the organizational values and infrastructure that support increasing the spiritual care that caregivers provide. The initiative was conducted in five faith-based hospitals and two secular hospitals. Evaluation of the data indicated that the initiative was success for patients and caregivers.

Evaluation of a Comprehensive, Adaptable, Life- Affirming, Longitudinal (CALL) palliative care project.

BACKGROUND: Many persons with life-threatening illnesses require services before they begin receiving hospice or hospital-based palliative care. Although health care professionals focus on diagnosis, treatment, and comfort care, patients and families view the illness as it impacts their whole life. OBJECTIVE: Evaluating a Comprehensive, Adaptable, Life-Affirming, Longitudinal (CALL) intervention to patients with life-threatening cancer, cardiac illness, respiratory conditions or dementia. The CALL Care interventions are consistent with the 2004 Clinical Practice Guidelines for Quality Palliative Care. DESIGN: Prospective observational study. SETTING AND SUBJECTS: Eleven sites (1 primary care, 8 acute care, and 2 long term care) located around the United States. Two hundred ninety-five patients and families enrolled in the study; many were enrolled for over 12 months. MEASUREMENTS: Patient self-reported Modified City of Hope Questionnaire addressing physical, psychosocial, emotional, and spiritual status and health care experiences; completed at enrollment and every three months. Family members completed Modified City of Hope Bereaved Family Questionnaire, with contents similar to the patient questionnaire. Sites compiled health care and community services utilization data regularly. RESULTS: Participants reported improved pain and symptom management. Fewer than one third were hospitalized (29%), and 7% had a critical care admission while enrolled. In addition, participants had high use of hospice (48% of those who died), and were likely to die at home (38% of those who died). CONCLUSIONS: CALL Care is an effective interdisciplinary intervention approach to individualize care for people living with life-threatening illness.

A "CALL" for community-focused palliative care.

Providing interdisciplinary coordinated health and social services has a profound positive impact on patients and families facing life-threatening illness. CALL Care is a demonstration project designed to provide this type of care and bridge gaps in the existing palliative care system. The program seeks to provide care that is comprehensive, adaptable, life-affirming, and longitudinal. Hallmarks of the approach include identification and offer of assistance to those facing terminal illness as close to diagnosis as possible, periodic comprehensive assessments of the patient and family situation, coordination of health and social care services made possible by an active interdisciplinary team process with a single care coordinator, and links to community resources. This article describes the CALL Care experience, presents several case studies illustrative of the interventions and their impact, and provides recommendations for those seeking to make a similar commitment to integrated palliative care services.