Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

Project Safe Conduct
Ireland Cancer Center at University Hospitals of Cleveland
and Hospice of the Western Reserve
Elizabeth Ford Pitorak, MSN, APRN, CHPN
Former Project Director
11100 Euclid Avenue
Cleveland, Ohio 44106-5065
www.irelandcancercenter.org/PatientCareTeamsICC-thoracic-safeConductTeam.htm

Project Safe Conduct is a collaborative venture between Hospice of the Western Reserve, a large, community-based hospice, and Ireland Cancer Center, a National Cancer Institute comprehensive cancer center. It began as a demonstration project in response to an initiative to support innovative models of end-of-life care, launched by Promoting Excellence in End-of-Life Care, a national program office of The Robert Wood Johnson Foundation in Missoula, Montana. Project Safe Conduct has several elements, but the defining feature is an interdisciplinary palliative care team made up of an advanced practice nurse, a social worker, and a spiritual care counselor. This team interfaces with the oncology team at the Ireland Cancer Center and has access to pain specialists and psychologists for consultation. The team introduced a pain care path and guidelines for pain management as well as a pain flow sheet for tracking pain assessment and management. The program increased continuity of care for these patients through the presence of a team member at every clinic appointment as well as by providing a patient consultation hotline during weekday business hours.

The role of the Safe Conduct Team is to serve as an advocate for the patient regarding his or her care, with a particular focus on helping patients recognize moments that might be key decision points. In order to ensure that patients are receiving the most appropriate care at the right time, the Safe Conduct Team initiates family conferences early in the disease trajectory. Communication is emphasized at all points in the patient’s care; team members work with the patients and family to ensure that the physician understands their concerns and takes the time to be sure patients and family members understand test results and their implications.

The innovation lies in having an external palliative care team housed internally within a cancer center and integrated into its system of care. This project has substantial pre- and post-evaluation data using the short and long forms of the Wisconsin Brief Pain Inventory, the Missoula-VITAS Quality of Life Index, the FACT-L, and the After-Death Inventory. The demonstration project funding has ended, and the team has been integrated into standard practice at Ireland Cancer Center.

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