"I am the voice of one crying in the wilderness, make straight the way of the Lord." --John 1:23
The above summarizes the difficulty of sharing the message of this website with the masses of people in the world. The message is clear and righteous, but few hear the words. The straight path is a basic human right of palliative life care for all, but those who are leading the masses are not on the correct path to acheive this.
Millions of patients around the world are experiencing unnecessary suffering and dying without access to palliative care.
--Jan Stjernsward, MD, PhD, FRCP (Edin), Kathleen M. Foley, MD, and Frank D. Ferris, MD
The above statement is from the article "The Public Health Strategy for Palliative Care" [J Pain Symptom Manage. 2007 May;33(5):486-93. PubMed]. The truth and fact of the matter is--99+% of the patients in the world who should be getting competent and comprehensive palliative care are not getting it!
This is an unfunded and ongoing campaign to help expedite the advancement of palliative life medicine practice by crusading for all health care workers to become certified in palliative life care. Unlike other efforts that are well funded and spearheaded by physicians and nurses, this is not a funded effort and is spearheaded by a respiratory therapist with over 32-years of full time experience in intensive care practice.
Working full time and going to school part time leaves little time to contribute content to this project. Still, much has been accomplished since this website began in May, 2010. An attempt has been made to contact an author involved in every article cited in this website to share details of this project.
ASAP Care first started in 1996 as a letter writing campaign and a website called asap-care.com. The website initially started as a means to help promote my new book titled "Life Support: A family clinical guide," but soon became just an effort to help campaign for helping to advance the awareness about palliative life care. The book was an attempt to help educate people about life support practice so they could make better decisions regarding the use of life support. Back at that time, few people knew what palliative care was, including most physicians and nurses. Actually, this problem continues today! Although there has been further awareness and advancement of palliative life care, there is still a tremendous gap in it's practice and availabiity for millions of patients each day. Moreover, the way that things are progressing it will take 20-years or more to reach realistic goals that could be achieved within 2-years, if my SIMPLE plan was adopted. Basically, it will be 10 years or more for all medical and nursing schools to start graduating students who are educated and trained in palliative care, as well as many years for thousands of clinicians to obtain degrees in palliative care. Many clinicians will also retire or leave their job in health care or education. And what about the millions of clinicians who are already practicing health care and have NO FORMAL EDUCATION in palliative life care? In order to "teach these old dogs new tricks," they will have to be officially certified in palliative life care.
Many claim that palliative life care is now widely available, but the fact is that there are relatively few referrals to hospice and palliative life service. That is, the vast majority of patients who should be provided with palliative life care are not getting it, and for those who are it is mostly provided in a haphazard fashion.
The initial effort with ASAP Care lasted for about 4 years and ended in 2000, mainly because the domain name was not renewed. During the period of initial existence, dozens of letters were written each year and sent to authors (physicians) and editors who had just published articles about life support and terminal care topics. The letters were a personal response directed to the Editor and/or Author(s) of the research that had just been published. Only one of the letters that were written to a journal editor was actually ever published. [The dying experience. Ann Intern Med. 1997 Aug 1;127(3):243. PubMed] Letters were also written to magazine and newspaper editors in response to news stories related to life support and terminal care topics, as well as to government authorities, including President Bill Clinton, and the US Supreme Court (when assisted suicide was debated by them in 1998). President Bill Clinton responded with a signed letter and shortly thereafter used his executive authority to help increase funding for terminal care. A letter to the US Supreme was too late to be included for the assisted-suicide debate.
A poem called "Pull the plug!" was also distributed with some of the letters.
The ASAP Care website was re-started in May, 2010 because there is still a profound need for palliative care in health care practice. Much of the general public is unaware of the problems in end-of-life health care and the urgent need for palliative care. This new website will provide clear and convincing evidence that there is overwhelming need for palliative care in every area of medical practice--and by all personnel involved in providing health care to those with life-limiting conditions or those who are at their end of life. Efforts will then be made to direct people to this site to read the evidence presented here. More letters will be written, editorials will be presented to newspapers and magazines, and government authorities will be contacted.
The strategy is to site comments from articles archived in PubMed. Rather than trying to convey personal opinions about issues, statements made in published articles will be used as the predominant source of opinion. Some personal remarks will be added to help the information to flow more understandably. It is the remarks made in clinical studies that provide credible expert opinion. Medical journals very carefully screen manuscripts before publication, which includes scrutinizing statistics of studies and statements made by authors. In other words, published material is written by medical scientists and their work is critically reviewed before publication, since it will be read by thousands of other highly educated peers who also work in the field and expect information to be as factual as possible. An emphasis will be made upon citing the most recently published articles. Many authors' make statements in their articles that refer to data that was collected some years ago. Old data obviously does not accurately reflect current practice, which may be better or worse than the period it refers to. Health care costs are increasing exponentially and any data about costs that is cited from previous work is likely to have increased substantially (unless it was a study demonstrating how a measure lowered cost).
Millions of people at any given time are living within the last year of their life and can greatly benefit from palliative life care. Cancer is widely accepted as a disease that is beneficial with hospice and palliative life care. Besides cancer, there are even more people--of all ages--who have a life-limiting disease or chronic critical illness that has a morbidity and mortality similar to cancer. These people with other "cancers" die by the thousands each week and have a comparably anguishing death. This concept was revealed in a landmark article titled "Use of intensive care at the end of life in the United States: An epidemiologic study." [Crit Care Med. 2004 Mar;32(3):638-43. PubMed] One part of the article stated that "More than one in five decedents in our cohort died after using intensive care some time during a terminal admission. Nationally, this translates to approximately 540,000 Americans each year. To put this figure in perspective, it is similar to the number of Americans who die of cancer annually." Another point made in the article was "In a country where nine of ten persons polled say they would like to die at home, that 20% will instead die after receiving the most technologically advanced care available is noteworthy." One of their concluding statements was that "One in five Americans die using intensive care services. Therefore, ICU core competencies should include the provision of quality end-of-life care in addition to life-sustaining care."
ASAP Care is [currently] a fictitious name and no funding or support is therefore anticipated. This website will exist for at least 3-years (May 2010 to May 2012). It is anticipated that somewhere along the way this campaign will become adopted by others who have the credibility and funding to accomplish this endeavor. The concern is that those others will settle for a band aide and not fully meet the goals of this endeavor and the needs of patients will remain unfulfilled. Otherwise, the current movement to bring palliative life consulting services and special units into healthcare facilities may become somewhat accomplished sometime within the next 20 years--for trillions of dollars.
Note: Every article mentioned in this website has been read and an e-mail has been sent to the chief author's of each article to inform them of this website/campaign. Copies of all of the articles cited herein have been read and saved in PDF.