) While a great deal of support has been given to training physicians in therapies designed to eradicate cancer, fewer experts have been trained to manage the symptoms of patients either at diagnosis or in the terminal phases of their disease. Moreover, since increasing numbers of oncology patients will be managed by family and primary care physicians, more generalists will need to develop expertise in symptom management and palliative care. This proposal describes a one year palliative care fellowship to be offered by the Hematology/Oncology Section at the Philadelphia Veteran's Affairs Medical Center (PVAMC) and the University of Pennsylvania Cancer Center. The fellowship will consist of multidisciplinary training in the palliative care and will be designed to impart the required attitudes, knowledge and skills to internists, family physicians, geriatricians, oncologists, or hematologists who wish to become practitioners and educators in the area of palliative care. The fellows will: 1) Demonstrate the attitudes, knowledge and skills needed to assess and manage the symptoms of patients with cancer, and the problems that develop in the families of cancer patients at all stages of the disease (i.e. diagnosis to death); 2) Demonstrate expertise in working with a multidisciplinary team of clinicians; and 3) Demonstrate mastery of the educational techniques needed to teach colleagues, patients, and their families by implementing an educational program. Training will include service throughout the year on an inpatient Hospice Consultation Team, and responsibility for the inpatient and outpatient management of the symptoms of patients in the PVAMC Lung Cancer Clinic. The fellow will also have the opportunity to learn psychosocial assessment and counseling skills using this clinic population, will participate in the clinic's bereavement program and will learn how to evaluate families at high risk for pathological grieving. The fellow will also have a choice of sites of in-home experiences, including a hospice service. Other rotations will include 1) a pain service run by nursing and neurology 2) a pain and symptom management clinic staffed by anesthesia 3) performing consults and attending the monthly meeting of an ethics advisory committee 4) a course entitled """"""""Loss, Grief and Bereavement"""""""" and 5) group or individual therapy sessions for breast cancer or bone marrow transplant patients. Elective rotations include 1) an inpatient hospice 2) a variety of courses offered by the Bioethics Center and 3) an impatient oncology Unit. The Palliative Care Fellowship Committee will monitor the success of the program, its fellows, preceptors and curriculum. The fellows' progress will be monitored both with tools designed to measure attitudes and knowledge, and by the preceptors, who will assess the fellow's attitudes, knowledge and skills. The long term success of the fellows will be assessed by their later completion of a contract prepared during the fellowship.
