Dialysis professionals report significant unmet supportive care needs and barriers in their centers with only a small minority rating themselves as competently providing supportive care. There is an urgent need for education of dialysis professionals about available supportive care resources to provide quality supportive care to dialysis patients.

Minority access to and utilization of hospice services is gaining increasing attention in the field of health care delivery systems. This case study describes the 1997 ethnic and racial make-up of a large metropolitan hospice facility located in Arlington, Virginia and compares its composition with the regional community. Demographic data; aggregate physical and psychosocial problems; utilization of services; and admission, discharge, and mortality data were collected and summarized by race and ethnicity. The state provided 1997 regional mortality data by race and ethnicity. When hospice deaths were compared with regional deaths, the hospice provided service to 30% of Caucasians decedents, 20% of Asian decedents, 19% of Hispanic decedents, and 18% of African-American decedents. By using mortality data rather than census data, the discrepancy between minority and Caucasian populations is not as large as has been reported in previous research.

Deficiencies in palliative and end-of-life care have been well documented by the Institute of Medicine. The National Cancer Institute (NCI), in partnership with Northwestern University, developed an educational curriculum for clinicians who deal with end-of-life issues, the Education in Palliative and End-of-Life Care for Oncology. A live meeting was held to distribute the curriculum to institutional leaders who could take it back to their organizations for broader distribution. To further distribute the materials and ensure they were available whenever a clinician wanted to view them, NCI collaborated with a leading online medical education provider whose websites are visited by over 1,500,000 physicians per month ( http://cme.medscape.com ) to post one module of the curriculum as an online activity certified for physician and nurse continuing education credit. The module is entitled "Last Hours of Living: Practical Advice for Clinicians." A descriptive analysis of the first 7 months of publication was performed. Twenty thousand sixty-one health professionals completed the activity during this time period and earned continuing education credit. Eighty-four percent completed the post-activity evaluation survey. Satisfaction was very high among participants, and many indicated their intention to incorporate new knowledge into practice. Collaboration with a commonly used online medical education provider such as Medscape is effective at broadly disseminating palliative care education to health professionals.

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