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Release: Immediate

NOTE TO EDITORS: This release was provided by the Robert Wood Johnson Foundation

Iowa coalition receives $75,000 grant to promote policy supporting end-of-life care

IOWA CITY, Iowa -- A statewide coalition in Iowa today received a one-year planning grant of $75,000 to create a strategy that will involve health care professionals, policymakers, educators, social service workers and the public in promoting better care at the end of life. The coalition is one of 15 statewide partnerships to receive funding under a new program encouraging state and community groups to reshape public policy to improve end-of-life care.

Through its new grant program, Community-State Partnerships to Improve End-of-Life-Care, the Robert Wood Johnson Foundation will award a total of $11.25 million over three years to up to 25 such coalitions, each of which will receive either a three-year project grant or a one-year planning grant. The grants will support broad-based, multidisciplinary coalitions that tap citizens, health care professionals and policymakers to identify problems, make recommendations and build public support for practical policies, regulations and guidelines to improve care of the dying. Planning grant recipients will have the opportunity to apply for funding later to implement their plans.

The coalitions were selected by the foundation from a highly competitive pool of 51 applicants representing 43 states and the District of Columbia.

The Community-State Partnerships program is based on the belief that the actions and decisions of individual patients, families and professionals regarding end-of-life care can be greatly enhanced if they take place in a supportive policy context. Recent research has shown that many Americans fear pain, abandonment and becoming a burden to their families in their final days of life. The Supreme Court's 1997 ruling on physician-assisted suicide has thrust states into the forefront of determining appropriate end-of-life options. The grant program enables states, the public and health care providers to work together to develop a vision and strategy for improved care that serves diverse communities.

The Iowa program will be carried out by Improving End-of-Life Care in Iowa, an interdisciplinary consortium formed in July 1998 and based at the University of Iowa. Douglas S. Wakefield, Ph.D., UI professor of health management and policy, will lead the project.

The Iowa coalition will develop a statewide end-of-life care policy consortium and local end-of-life care councils. These organizations will develop and deliver continuing education to health professionals, review institutional care guidelines, seek patient and family options about choices in decision making, and suggest ways to coordinate palliative care delivery among local organizations.

Palliative care is an approach that emphasizes physical comfort ­ particularly pain control ­ as well as emotional, social and spiritual well-being. The group will establish an end-of-life resource center at the UI that develops tools for measuring local end-of-life care delivery levels and collects data on topics such as curriculum content and policy issues.

One unique aspect of the Iowa coalition plan is the involvement of dentists and dental hygienists. Traditionally these professionals are not members of palliative care teams, even though studies suggest that more than 75 percent of end-of-life patients have at least one oral symptom requiring treatment. The Iowa coalition plan will pilot a community program to include oral health as part of palliative care in order to develop detailed and comprehensive guidelines for a statewide program.

Mary Christopher, director of the Midwest Bioethics Center in Kansas City, Mo., is also director of the Community-State Partnerships program. "State policies directly affect so many elements of end-of-life care," Christopher said, "including the way physicians prescribe pain medication, the way Medicaid pays for health services and the way medical and nursing schools prepare their students to care for dying patients. Our goal is to open more opportunities for good palliative care and to stimulate a public dialogue that helps citizens both voice concerns and understand their options in the event of a terminal illness."

The Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care. It became a national institution in 1972 with receipt of a bequest from the industrialist whose name it bears and has since made more than $2 billion in grants. The foundation concentrates its grant-making in three areas: to assure that all Americans have access to basic health care at reasonable cost; to improve the way services are organized and provided to people with chronic health conditions; and to reduce the personal, social and economic harm caused by substance abuse --tobacco, alcohol and illicit drugs.