A Story from Project Safe Conduct

Collaborative Interagency Program to Improve End-of-Life Care for Cancer Patients and Their Families: Case Western Reserve University (Cleveland, Ohio)

Synopsis of Work: From October 1998 to December 2003, with $450,000 from RWJF's Promoting Excellence in End-of-Life Care national program (as well as funding from the Cleveland Foundation, the Elisabeth Severance Prentiss Foundation and Case Western Reserve University [CWRU]) staff at CWRU, in partnership with Hospice of the Western Reserve and the Ireland Cancer Center at University Hospital, created Project Safe Conduct. Safe Conduct was defined as the dimension of care that guides a patient through a maze of uncertain, perplexing and distressing events. Safe Conduct's overarching goal was to eliminate the artificial boundaries separating acute care from end-of-life care by providing "safe conduct" for patients with terminal illnesses. Safe Conduct served 221 patients with advanced lung cancer.

Story Told: A large portion of the Safe Conduct team's efforts takes the form of gentle and persistent probing for problems that patients choose to keep to themselves. Why? Some, says Polly Mazanec, a nurse practitioner who is part of the three-member Safe Conduct team at the Ireland Cancer Center in Cleveland, are afraid that a complaint will lead to no treatment, either because the symptoms they are keeping to themselves will reveal that their case is hopeless, or because they will somehow appear ungrateful for the care they have been receiving.

"I pose it as an open-ended question for patients," says Stephen Adams, an ordained Presbyterian minister and a member of the Safe Conduct team, who has been involved with end-of-life work for almost 14 years. "What is your image of death, and beyond death? Sometimes they say they don't want to talk about it. After, they do. Asking gives them permission. Every individual has to explain to us what is their language, what's safe for them."