Statewide efforts in promoting palliative care.

Background: In 2002, Means to a Better End: A Report of Dying in America Today, a Robert Wood Johnson Foundation (RWJF) report, was issued that included grades for each state on their ability to provide end-of-life care. Most states, including California, rated as mediocre and the report called for extensive efforts at a state level to improve the quality of palliative care.

Objective: The purpose of this paper is to describe implementation and evaluation of a comprehensive statewide effort to improve end-of-life care education for 350 California nurses as an example of state-level change as recommended by the RWJF report.

Design: Funded by the Archstone Foundation (Long Beach, CA), this effort was based on the End-of-Life Nursing Education Consortium (ELNEC) "Train the Trainer" project, a national educational initiative to improve end-of-life care by providing training to nurses (www.aacn.nche.edu/ELNEC). ELNEC is a partnership between City of Hope, Duarte, California, and the American Association of Colleges of Nursing, Inc., Washington D.C.

Setting/subjects: Three courses were held from October 2005 through March 2007 in which 350 nurses from various clinical settings across California applied and participated in the training program. MEASUREMENTS/RESULTS/CONCLUSION: In order to be accepted in the course, participants agreed to follow-up for 12 months postcourse in order to evaluate the impact of their attendance on their institutions' commitment to palliative care. This paper reports findings from this California effort as an example of a state-intensive effort and to encourage other statewide palliative care initiatives in order to improve care for the dying.