Death is Certain, Strategy Isn't

This study evaluates a 20-year initiative of the Robert Wood Johnson Foundation (RWJF) to improve end-of-life care in the United States. RWJF commissioned over 300 grants in the field of end-of-life care over two decades beginning in 1986. This review was created in 2006 to provide insight into how the Foundation developed and executed grantmaking strategies.

The original end-of-life grantmaking strategy focused on improving the capacity of health care providers to provide medical care to the dying, changing public and institutional policies and engaging the public in efforts to improve care for patients at the end of life.

Key Findings:

  • The RWJF-funded study SUPPORT provided broad and vital knowledge about how people die in the United States. Findings from SUPPORT helped buoy the movement to improve end-of-life care throughout the country.
  • RWJF grants helped to promote the integration of palliative care into licensing standards for physicians and nurses and the development of the palliative care subspecialty for physicians. Similar efforts aided the Joint Commission in its revision of standards for pain treatment.
  • The Center to Advance Palliative Care at the Mt. Sinai School of Medicine was instrumental in improving palliative care in hospitals.
  • RWJF grants resulted in a proliferation of research and knowledge on end-of-life and palliative care issues.

Patrizi writes: "The grantmaking under end of life was extraordinary...The work helped produce a body of knowledge, leading practitioners, standards for practice, ways to assess quality, and changes in how pain is assessed and treated...palliative care now has a meaning within medicine and its institutions that didn't exist before."