The dying patient has many unique needs—physical, emotional, and spiritual. Unfortunately these needs are often unmet, leaving dying patients with little or no control over how they die.

The Robert Wood Johnson (RWJ) Center to Advance Palliative Care (CAPC) is trying to change this situation. By assisting hospitals and health systems in the development of palliative care programs, the CAPC hopes to fill the gaps in care for the dying across the nation.

According to Robert D’antuono, M.H.A., deputy director of the CAPC, the center is believed to be the only program in the country that is "focused primarily on improving end-of-life care in hospitals." He added, "Many hospitals are not well organized to provide a full range of services—pain management, symptom control, psychosocial, and spiritual services—to dying patients and their families."

The mission of the CAPC is simple. It strives to instill in palliative care programs a respect for patients’ goals, a system of comprehensive care, support for family and caregivers of the dying patient, and the opportunity for growth at the end of life. Said D’antuono, "In short, we hope to raise the standard of care for those patients who must remain in the hospital setting at the end of life by educating institutional leaders in the planning and implementation of palliative care programs."

These are among the variety of services the center will provide:

• A how-to manual on establishing hospital-based palliative care programs

• A national directory of palliative care programs

• A speaker’s bureau

• Policy papers on financing and other issues affecting palliative care

• Referrals to fellowship and other training opportunities for physicians and nurses seeking hands-on education in palliative care

• A national education conference

The center, which is located at Mount Sinai School of Medicine in New York City, intends to work closely with other national efforts, such as those by Education for Physicians on End-of-Life Program and the American Hospital Association, for example, to encourage the development of palliative care programs.

Also based at Mount Sinai School of Medicine is the Hertzberg Palliative Care Institute, which serves as a model for other palliative care programs. Sean Morrison, M.D., assistant professor and research director of the institute, is a palliative care physician who works with dying patients. On a daily basis he treats pain and other symptoms, sets achievable goals with patients and their families, and works with patients and families after discharge to find the setting that best suits the patients’ needs.

Morrison, who was featured on the recent PBS special, "On Our Own Terms: Moyers on Dying", works with an interdisciplinary team consisting of a palliative care nurse specialist and a fellow or trainee from the geriatric or oncology division at Mount Sinai. Together the team works with the floor nurses, social workers, and medical specialists, including psychiatrists, who have all attended a two-year bimonthly seminar series in palliative care.

"Psychiatry is crucial to palliative care," Morrison told Psychiatric News. "The prevalence of delirium, as well as depression and dysthymia, is extremely high in people approaching the end of their lives." He noted that treatments of these populations are different from what they would be under "normal" circumstances. "Because of the limited life expectancy, patients often do not have three weeks for traditional antidepressants to work. We work intensively with psychiatrists in terms of both ongoing therapy, but also with other medications and psychostimulants so that the patients are able to feel better."

Morrison also noted that mental health care at this crucial point in life helps patients come to terms with their impending death and allows patients and families to confront some of the issues that arise during the dying process.