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Marie Bakitas, DNSc, NP-C, FAAN - Principal Investigator

American Cancer Society


Bakitas-head-shotFunded by the American Cancer Society, Dr. Marie Bakitas, Professor & Marie O'Koren Endowed Chair and her team will study whether a phone-based palliative care intervention can help reduce access disparities for veterans, minorities and patients from rural areas who have advanced cancer.

 Palliative care focuses on providing patients with relief from the symptoms, pain, and stress of illness. Research studies show that when patients with incurable cancer receive palliative care concurrently with regular cancer treatment, they have a better quality of life, less symptoms and depression, and may live longer. As a result, the American Society of Clinical Oncology recommends “palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden.” However, nearly 60 million US citizens live in rural areas where few palliative care services exist. In response, over the last decade we developed Project ENABLE (Educate, Nurture, Advise, Before Life Ends), a phone-based palliative care intervention. In Project ENABLE, a specially trained nurse practitioner leads patients and their caregivers through a series of structured telephone sessions on topics such as problem solving, communication, and medical decision-making. The patients who underwent this intervention had a better quality of life, less depression, and lived longer than patients who received only regular cancer care.  

Given that advanced cancer patients in rural areas are less likely to benefit from palliative services due to limited access and suboptimal care, it is necessary to find innovative ways for cancer centers in these areas to provide palliative care. The ACS has set a Nationwide Objective to eliminate cancer disparities by 2015. Our proposal aligns well with this objective as we aim to bring our ENABLE model to four communities representing rural geography and/or ethnic and racial diversity: Birmingham, AL, Grand Rapids, MI, Spartanburg, SC, and Bangor, ME.

In phase one of this project, Bakitas and her team will create a community-academic “Learning Collaborative” partnership to assess current palliative care practices thereby allowing them to determine the necessary steps to enhance the integration of palliative care along with usual care.  The team will also measure organizational/system implementation and patient/caregiver effectiveness outcomes, to understand the current care at each site. In phase two, within the “Learning Collaborative”, they will train local providers to deliver the ENABLE model, tailored specifically to their communities. After implementation, they will again measure outcomes, with the research goal of determining the extent to which the cancer centers adopted and followed the model and its impact on patients, caregivers, and the organization.

Their short-term goal is to learn the best way to bring palliative care services to patients and families, improve care, quality of life, and reduce the burden of cancer in the four communities, and develop a “Toolkit” that other cancer centers can use in implementing this model across the country. The long-term goal is to transition this knowledge to other cancer centers. In so doing, they hope to reduce the suffering of patients living with cancer nationwide.

Related Publications

Bakitas, M., Macmartin, M., Trzepkowski, K., Robert, A., Jackson, L., Brown, J. R., . . . Kono, A. (2013). Palliative care consultations for heart failure patients: how many, when, and why? J Card Fail, 19(3), 193-201. doi: 10.1016/j.cardfail.2013.01.011

Williams, AL and Bakitas, M. (2012) Cancer Family Caregivers: A New Direction for Interventions. J Palliat Med. 15(7): 775-783.

Bakitas M, Lyons K, Hegel M, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II Randomized Controlled Trial. JAMA.2009;302(7):741-749.