Research

Precisely because it is a relatively young discipline, palliative care is only now beginning to develop the solid evidence base, research capacity, and standards of excellence through which all other medical disciplines have sustained themselves and gained credibility and acceptance. Up to the very recent past, palliative care has been overlooked in the competition for research funding from the National Institutes of Health (NIH), which is the largest source of health care research funding in the United States. A review of late 1990's funding found that NIH's National Cancer Institute spent less than 1% of its budget on activities related to palliative care.

During the last decade, however, talented researchers in medicine, nursing, the social sciences, and humanities have begun to recognize the importance of palliative care. Research is fundamental to eliminating unnecessary suffering during critical illness and at the end of life. The Institute to Enhance Palliative Care focuses the research capabilities of the University of Pittsburgh on palliative care with a particular emphasis on educational techniques, communication regarding end-of-life issues, clinical trials in palliative medicine, and family and caregiver needs. The Institute's partnership with Family Hospice and Palliative Care widens the research horizon beyond the University to a much broader community-based population. Institute-affiliated researchers are pursuing innovative, rigorous, and culturally sensitive research projects, mobilizing the resources of the University's schools of medicine, nursing, and public health, and are making special efforts to reach subgroups of the population that have been underrepresented up to now in research of this kind.

Past Accomplishments

• Institute-Affiliated Funded Projects:
• Advanced Illness Coordinated Care: A Proposal for a Community Collaboration - Assessment of Project Outcomes
  Principal Investigator: B. Arnold
  Funder: Highmark Foundation, Jewish Healthcare Foundation

  This was an assessment of psychosocial and specialty care coordination and advance planning for people with advanced chronic illness.

• Improving Quality of Life during the End of Life Process
  Principal Investigator: E. Redinbaugh
  Funder: National Institutes of Health

  This project worked with hospice patients at different stages of their illness and their families through one-on-one interventions aimed at improving patient symptom management with the intended goal of managing symptoms and reducing caregiver stress.

Current Programs & Initiatives

• Palliative Care Pilot Research Program: This Institute-funded grant program is designed to provide the necessary research support for preliminary work toward external funding addressing an important issue in palliative care that is likely to lead to future substantive work in the field.
• 2007 - 2008 Award:
  End of Life Surveillance: Test and Incorporation of End of Life Module in 2008 Allegheny County Behavioral Risk Factor Surveillance Survey.
  Principal Investigator: S. Albert
• 2006 - 2007 Award:
  A Pilot Study of Emergency Physician, Hospitalist, and Intensivist Communication Strategies and Decision Making for Critically Ill Elders with End-Stage Cancer
  Principal Investigator: A. Barnato
• 2005 - 2006 Award:
  Examining Renal Provider Understanding of Chronic Hemodialysis Patients' Symptoms: A Pilot Study
  Principal Investigator: S. Weisbord
• Alan Gleitsman Student Research Fund in Palliative Care: This student research fund in Palliative Care provides financial support for a medical student’s summer learning in the Palliative Care Program.
• Task Force on Hospice Research: Composed of Family Hospice and Palliative Care (FHPC) staff and University-based researchers, this task force is working to establish policies and build infrastructure that will facilitate empirical research with community-based hospice patients, while respecting FHPC's primary mission of patient care and family support.
• Institute-Affiliated Funded Projects:
CLINICAL

• Discussing Death with Families of Dying Cancer Patients
  Principal Investigator: R. Hebert
  Funder: National Institute on Aging

  This is a pilot grant for a qualitative study on discussing death with families.

• Enhancing Patient-Oncologist Communication
  Principal Investigator: B. Arnold
  Funder: National Cancer Institute

  The overall goal of this project is to expand the field of oncologist-patient communication by enhancing understanding of how oncologists and patients communicate about the transition to end-of-life care.

• Preparing Caregivers for the Death of Their Loved One
  Principal Investigator: R. Hebert
  Funder: National Institute of Mental Health

  The specific aims of this project are to develop a death and bereavement question prompt sheet that promotes communication between caregivers of the terminally ill and health care providers, to improve the ability of health care providers to address caregivers' questions about death, dying, and bereavement, and to pilot test the feasibility of this intervention in palliative care.

• Ventilator Weaning: Processes of Care and Communication
  Principal Investigator: M.B. Happ
  Funder: National Institutes for Nursing Research

  This project focuses on advanced practice/specialty roles, communication content, and clinician interactions with patients, caregivers, nursing staff, and other health team members in weaning long-term mechanical ventilation patients. In addition, the study will describe perceptions of the weaning process from the perspectives of the patient, family, and clinicians.

• Collaborative multi-site study on the Impact of Palliative Care Consults on Outcomes for Hospitalized Patients with Advanced Cancer
  Principal Investigator: R. Arnold, M.B. Happ
  Funder: National Cancer Institute

  The University of Pittsburgh is one of five sites in a multi-million dollar, multi-site study. It will assess the structure, processes, and clinical outcomes of care among hospitalized persons with advanced cancer that receive palliative care consultation team services, as compared to similar patients receiving usual hospital care.

EDUCATIONAL

• End-of-Life Education in the Third Year of Medical School
  Principal Investigator: D. Barnard
  Funder: National Cancer Institute

  Under the direction of Institute Director David Barnard, Palliative Medicine faculty are utilizing web-based educational technologies to deliver "just-in-time" palliative care learning materials at the bedside to medical students in all required clinical rotations.

• Critical Care Communication (C3): Teaching Intensivists' Communication Skills
  Principal Investigator: B. Arnold
  Funder: National Palliative Care Research Center, Jewish Healthcare Foundation

  This project is working to tailor a skills-based curriculum for Critical Care and Pulmonary fellows for an educational intervention designed to be a pilot study to develop a multifaceted educational program that teaches communication skills in the ICU. The goal is to show how the intervention improves fellows' skills and family-centered outcomes.

HEALTH SERVICES

• Hospital-level Variation in Treatment Intensity
  Principal Investigator: A. Barnato
  Funder: National Institute on Aging

  The aim of this project is to identify and measure hospital-level variation in the use of intensive services at the end of life among elders in Pennsylvania and to quantify costs and outcomes of differing levels of treatment intensity among patients at the highest risk of death on admission.

• Religious/Spirituality, Health, and Health Services
  Principal Investigator: R. Hebert
  Funder: Alzheimer's Association

  The goal of this project is to update literatures relevant to religion, caregiving, and bereavement and to write comprehensive literature reviews in this area. It is anticipated that new hypotheses will emerge in the course of this project that will lead to additional analytic work and empirical papers.

• Trajectories of Serious Illness
  Principal Investigator: B. Arnold
  Funder: National Institute of Nursing Research

  The goal of this project is to follow dying patients and their caregivers prospectively as they traverse the course of illness to death so that effective strategies for care can be achieved.