VA Selects Six Sites for End-of-Life Fellowships

WASHINGTON – The Department of Veterans Affairs (VA) has selected six health care sites to launch VA’s new program focused on changing the way physicians, social workers, nurses and other caregivers approach end-of-life care.

The initiative, called “VA Interprofessional Fellowship Program in Palliative Care,” will develop health care professionals with vision, knowledge and compassion to lead end-of-life care into the 21^st century.  Although aimed at improving care for veterans, the program will affect how this care – known as “palliative care” in medical circles – is provided throughout the country.

The following VA health care sites were selected from among 21 that applied: Bronx; Los Angeles; Milwaukee; Palo Alto, Calif.; Portland, Ore., and San Antonio.   Each site will have four one-year fellowships or the equivalent part-time positions.  Palo Alto will serve as the hub site and be responsible for coordinating curriculum, program evaluation, educational outreach and recruitment strategies.

“This program is one of the most important developments in the field of palliative care,” said Dr. Susan Block, chief of adult psychosocial oncology, Dana-Farber Cancer Institute at Harvard Medical School and Brigham and Women’s Hospital.  “The fellowships will train a cadre of expert clinicians who will serve as beacons for others interested in improving care at the end of life throughout VA and the country.”

Historically, VA has taken a leadership role in the promotion and development of hospice care and, more recently, in a national pain management initiative.  On March 1, 2001, the palliative care fellowship program was announced and last month a review committee comprised of non-VA and VA specialists in the field reviewed the applications and made its recommendation to VA.

“The training changes the focus of health care providers who are treating the terminally ill,” said Dr. Stephanie Pincus, VA chief officer for Academic Affiliations, when the fellowships were first announced last spring.  “In the past, doctors saw death as a failure, so they consequently focused on medical cures and preventing death at any cost.  We are training medical care staff now to refocus on the patient by jointly managing the patient’s symptoms and the disease.”

The new fellowship program has a large educational component.  Trained clinicians are expected to serve as leaders promoting development and research.  Selected training sites will be required to develop and implement an “Education Dissemination Project” to spread information beyond the training site through conferences, curricula for training programs, patient education materials and clinical demonstration projects.

And, of course, as resident doctors go out into the community, they take their training with them.  More than 130 VA facilities have affiliations with 107 medical schools and 1,200 other schools across the country.  More than half the physicians practicing in the United States have received part of their professional education in the VA health care system.

“VA’s leadership comes at a critical time,” said Dr. Charles F. von Gunten, medical director, Center for Palliative Studies, San Diego Hospice, and associate clinical professor of medicine at the University of California.  “Medical progress has led to more people living longer with illnesses which will ultimately be fatal.  VA is laying the groundwork for making sure that progress in relieving suffering is made clinically available to its veterans and their families.  With sustained funding, this initiative could change the face of health care.”

What does this mean to the chronically ill veteran?  According to Dr. Pincus, it means that the patient will be more comfortable.  It means the veteran might not have to die in an intensive care unit but instead be able to remain in the secure surroundings of his home.  The patient will be treated by a caring, trained partnership of doctors, nurses, chaplains and social workers.  And the veteran’s family will be included in decision-making and care giving.

“There comes a time when all the modern medicine in the world can’t cure the illness.  That’s when treating the pain, communicating with compassion and providing support and counseling become paramount.  And that’s what these fellowships are all about,” said Pincus.

For more information about the program check VA’s Web page at http://www.va.gov/oaa/fellowships.

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