Background: As part of a comprehensive national effort to improve care at the end of life, the
Promoting Excellence in End-of-Life Care program of The Robert Wood Johnson Foundation
convened "national peer–professional workgroups" of recognized authorities or leaders to advance
palliative aspects of practice in their respective specialties or fields.
Objective: The conveners' goals were to establish research and practice agendas to integrate
palliative care within selected fields and health care settings, and to expand delivery of palliative
care to special patient populations that have been underserved by palliative care. We
hypothesized that leading professionals within specific fields, chartered to achieve clear goals,
and then provided with sufficient administrative and logistical support, could develop recommendations
for expanding access to, quality of and financing for palliative care within
their disciplines.
Design: Staff at the national program office of Promoting Excellence in End-of-Life Care convened
eight disease-based, specialty-based or issue-based workgroups (the selected workgroup
topics were amyotrophic lateral sclerosis, cost accounting, critical care, end-stage renal
disease, human immunodeficiency virus/acquired immune deficiency syndrome [HIV/AIDS]
disease, Huntington's disease, pediatric care, and surgical palliative care). The national program
office implemented a small group process design in convening the groups, and provided
coordination, oversight and administrative support, along with funds to support meetings
(telephone and in-person). A workgroup "charter" guided groups in determining the
scope of efforts and set specific, time-limited goals. From the outset, the workgroups developed
plans for dissemination of workgroup recommendations to defined stakeholder audiences,
including health care providers, policy-makers, payers, researchers, funders, educators,
professional organizations and patient advocacy groups.
Setting and subjects: Groups averaged 25 members and met for an average of 24 months.
Promoting Excellence leadership chose workgroup topic areas that addressed patient populations
underserved for palliative care, and corresponding professional specialties with demonstrated
interest and readiness to improve education, evidence base, and professional expertise
in palliative aspects of care.
Results: Each workgroup was highly productive and advanced changes in respective fields
through developing and disseminating recommendations to their respective fields regarding
practice, education, clinical and health service research and policy. Beyond their chartered responsibilities,
workgroups also developed educational programs and curricula and a wide array
of resources. The workgroups also authored articles for publication, intended to stimulate
professional discourse and influence clinical norms and culture.
Conclusions: The national peer–professional workgroup model exceeded original expectations
and produced well-considered Recommendations to the Field as well as a body of resources
for professionals in expanding access to and quality of palliative care. Results of this
experimental venture in professional change suggest that the workgroup model may be a useful,
cost-effective, rapid-change strategy for quality improvement in other areas of professional
practice and service delivery.
