EFTA01149129.pdf

Templeton Foundation LOI Project Information Please answer the questions below in the space provided. If you are invited to submit a Full Proposal. you will be given the opportunity to provide more detailed responses. Project title: Impact of the Zen Chaplaincy Program on Quality of Life. Symptom Control, and Costs of Care in Patients Hospitalized for Cancer Please provide us with a descriptive project title. Please limit your response to 150 characters, including spaces and punctuation. Executive Summary: Please provide an executive summary of your proposal. The summary should highlight the strategic problem or opportunity you intend to address, the main activities of your proposed project, including any innovative approaches, and the anticipated concrete outputs and outcomes. Please limit your response to 1.300 characters, including spaces and punctuation. Co-investigators Dr. Ben Kligler and Dr. Roberta Lee are both published experts in the field of integrative medicine and physicians at Beth Israel Medical Center, whose Department of Integrative Care is one of the leading in-patient programs in the country . They will design and lead a groundbreaking study to evaluate the impact of New York Zen Center for Contemplative Care chaplains on patients hospitalized for cancer-related diagnoses at Beth Israel in New York City. Founded in 2007, NYZCCC has trained over a hundred students, who have touched the lives of over 30,000 patients, providers and caregivers at its partner organizations, such as Beth Israel Medical Center. The two-year research study will measure the palliative effects of contemplative care on patient quality of life and psycho-emotional state, as well as examine the cost-effectiveness of the intervention, by comparing length of stay and use of medications for cancer-related symptoms in the intervention group as compared to a control group, who will not be exposed to the Zen chaplains. We will publish the results of the two-year, $150,000 study in a peer-reviewed journal and disburse the findings widely in an attempt to create a health care system that is more responsive to patient need and health care outcomes. Project Description: EFTA01149129 Please describe the program or project for which you are seeking support. What activities are involved in the project? Who will be involved (as co-investigators, co-organizers, speakers at a conference, judges, etc.)? What core questions or hypotheses do you plan to explore, including any possible "Big Questions"? Please limit your response to 4,000 characters, including spaces and punctuation. Although pastoral care is widely integrated into the care of patients hospitalized for cancer, and although anecdotal reports of the importance of such services abound, to date very little research exists systematically documenting the impact of this care on the experiences of hospitalized patients and on the costs of care. Co-Investigators Dr. Ben Kligler and Dr. Roberta Lee will use a methodology already tested in their study of the Urban Zen Initiative at Beth Israel to evaluate the impact of the New York Zen Center for Contemplative Care chaplains on patients hospitalized for cancer-related diagnoses at Beth Israel Medical Center in New York City. NYZCCC is a New York City-based non-profit that utilizes contemplative care to transform the experience of illness and suffering. Since 2007, NYZCCC has trained over a hundred students, who have touched the lives of over 30,000 patients, providers and caregivers at its partner organizations, Beth Israel Medical Center, Visiting Nurse Service of New York Hospice, New York Presbyterian, and Robert Mapplethorpe Residential Treatment Facility. Dr. Benjamin Kligler is Vice Chair of the Department of Integrative Medicine, Beth Israel Medical Center. He is Associate Professor of Family and Social Medicine at Albert Einstein College of Medicine and Research Director of the Continuum Center for Health and Healing, an integrative medicine practice which opened in May 2000. Dr. Kligler led the Urban Zen study and has been principal investigator on a number of clinical trials, both privately and NIH-funded, over the past several years. Roberta Lee, MD is Vice Chair of the Department of Integrative Medicine at Beth Israel Medical Center. She is formerly Medical Director at Beth Israel's Center for Health and Healing and is current responsible for overseeing development, implementation, and evaluation of inpatient integrative medicine programs at Beth Israel, including the contemplative care program. Koshin Paley Ellison is co-Director of the NYZCCC and intimately involved with the Zen Chaplaincy training program at Beth Israel. He will be responsible for overseeing the pastoral care intervention we are evaluating in this project. Using the Profile of Mood States and the EQ-5D, two standardized measures that effectively describe psycho-emotional and quality-of-life related states, we will compare a group of hospitalized oncology patients with access to the Zen Chaplaincy Program to a group not offered access. The POMS measures anxiety, depression and other mood states, and the EQ-5D—which is specifically used in cancer populations—adds such 2 EFTA01149130 issues as mobility, energy level and pain. We will compare both the change in these measures from time of admission to time of discharge within the intervention and control groups, as well as the difference in the absolute scores between the groups. This data will be augmented by a brief structured qualitative interview conducted immediately before discharge in a sub-group of the intervention subjects, to capture aspects of their hospital experience that might have been missed by relying on the standardized measures alone and how it was or was not affected by the pastoral care intervention. We will study patients for two nine-month periods. Finally, to examine the cost-effectiveness of the intervention, we will also compare length of stay and use of medications for cancer-related symptoms in the intervention group as compared to controls. In the Urban Zen study we developed a methodology with the Beth Israel Decision Support data management team that allowed us to extract cost data regarding medication use from the hospital billing system after patient discharge. If the Zen Chaplaincy program helps patients with symptoms such as pain, anxiety, insomnia and nausea, we hope to see these changes reflected in decreased medication costs in the intervention group. Strategic Promise: * Why is the proposed project important relative to the current state of knowledge in your field or across fields? Please limit your response to 1,000 characters, including spaces and punctuation. Pastoral care services are widely utilized in patient settings in the United States, but we lack any clear information on the service's impact, in particular novel approaches like the NYZCCC chaplaincy, which has not been evaluated to help understand its impact on patients. The proposed study will fill a void in human knowledge on what we have seen to be a valuable intervention for patients, their families, their caregivers, including medical staff, medical institutions and the public, which ultimately bears the financial burden for health care provision. This intervention will become more widely utilized as the population ages and the prevalence of the diseases of aging, like cancer, increase, and the society as whole embraces new ways of dealing with illness, death and dying. A study that documents the efficacy of contemplative care will propel the use of this cost- effective therapy and support the much-needed adoption and expansion of integrative medicine in health care institutions. Capacity for Success: * Please explain how you (the applicant, the project team, and/or the organization(s) connected to the proposed project) are positioned to carry out the proposed activities with distinction and a high standard of excellence. Please limit your response to 1,000 characters, including spaces and punctuation. We are uniquely positioned for success given two major factors. (1) Beth Israel 3 EFTA01149131 Hospital's Department of Integrative Care is one of the leading in-patient programs in the country in terms of integrating the entire spectrum of therapeutic approaches, including spiritual and contemplative care. Our staff and faculty are recognized experts in this emerging field of both research and practice. (2) We have already funded, completed and published research evaluating innovative programs such as NYZCCC's on patient quality of life and cost of patient care. Our study on the Urban Zen Initiative to create a holistic healing environment for cancer patients at Beth Israel's 24-bed in-patient oncology unit was published in the Journal of Alternative and Complimentary Medicine. "Impact of the Urban Zen Initiative on Patients' Experience of Admission to an Inpatient Oncology Floor: A Mixed-Methods Analysis" was published in August 2011, with Dr. Kligler as the lead investigator. Expected Outputs: * Outputs are the specific, quantifiable work products that you will create during the project. Examples include but are not limited to: academic papers submitted for publication, book manuscripts, conference proceedings, training sessions, curricula, prize competitions, films, events, and publicity campaigns. Please describe the expected outputs of your project. Please limit your response to 1,000 characters, including spaces and punctuation. We intend to publish the study's findings in a major peer-reviewed academic journal and also promote in abstracts published at national and international research conferences. We will widely disburse a press release announcing our findings and publicize the study online, including placement on multiple organization websites. Expected Outcomes: Outcomes are the realistic and measurable differences that you believe will result from your project's outputs. Examples include but are not limited to: significant new lines of inquiry that might develop if your research hypotheses are confirmed, and measurable changes that your work might bring about in the actions or attitudes of your target audience. Please specify the audiences that your project seeks to reach, as well as the specific outcomes that you expect will result. Please limit your response to 1,000 characters, including spaces and punctuation. 4 EFTA01149132 Positive research findings will encourage many hospitals to implement similar models incorporating contemplative care to better serve both patients and their caregivers. Enduring Impact: * The Foundation is very interested to learn about your hopes for this project. Describe your vision of the realistic and beneficial long-term changes that could result from your work. Please limit your response to 1.000 characters, including spaces and punctuation. Proving the efficacy of contemplative care is one small step in transforming a health care system that currently employs a demoralizing and antiquated approach to patient care. We expect permanent and substantial incorporation of spiritual approaches to patient care into all levels of the health care system, and we expect a health care system that more effectively addresses patients' psychological and spiritual needs. Currency: * Please select the currency of your funding request. The Foundation awards grants in US dollars, euros, and British pounds. 0 US dollars 0 Euros 0 British pounds Request Amount: $150,000 over two years Please provide us with the amount of funding you am requesting from the Foundation. Please round to the nearest dollar, euro, or pound. and do not use symbols or punctuation. Total Project Amount: $150,000 Please provide the total amount of funding necessary for the implementation and completion of the project. This amount may be equal to or greater than the amount of funding you are requesting from the Foundation. Please round to the nearest dollar. euro, or pound. and do not use symbols or punctuation. 5 EFTA01149133 Proposed Project Start Date: ■ 7/1/2012 The Foundation will not find a project for longer than three years except in exceptional circumstances, and in no case for more than five years. Ordinarily grants must be completely closed within three years. These constraints are required by the philanthropic principles laid down by Sir John Templeton in his Charter for the Foundation. Exceptions, including "no-cost extensions" beyond 36 months, will not generally be granted. A grant is only "closed" when the final payment is made (typically 10% of the total budget). Because the final payment is contingent on the submission and approval of final narrative and financial reports, which can take many weeks to process, all contractually required final reports are due to the Foundation at least three months before the end of a 36-month grant. Applicants should take this requirement into account when designing the Project Timeline. Proposed Project End Date: 6/30/2014 The Foundation will not fund a project for longer than three years except in exceptional circumstances, and in no case for more than five years. Ordinarily grants must be completely closed within three years. These constraints are required by the philanthropic principles laid down by Sir John Templeton in his Charter for the Foundation. Exceptions, including "no-cost extensions" beyond 36 months, will not generally be granted. A grant is only "closed" when the final payment is made (typically 10% of the total budget). Because the final payment is contingent on the submission and approval of final narrative and financial reports, which can take many weeks to process, all contractually required final reports are due to the Foundation at least three months before the end of a 36-month grant. Applicants should take this requirement into account when designing the Project Timeline. Relation to Sir John Templeton's Donor Intent: We recognize that our high aspirations can be achieved only through the vision, passion, and action of extraordinary grantees. At the same time, we are legally and ethically bound by Sir John Templeton's charter to fund only those proposed projects that have the capacity to advance his philanthropic vision. We nvite you to describe how your vision for the proposed project aligns with Sir John's Donor Intent. Please imit your response to 1,000 characters, including spaces and punctuation. 1000 characters remaining This timely study will document the impact of an ancient spiritual tradition — contemplative care — on the 21s' century health care system, where it is being pioneered at several of the nation's leading hospital by a newly formed group of practitioners, the New York Zen Center for Contemplative Care. The beauty of this approach is that it extends over all religions and cultures, bringing palliative care to people of all faiths, or 6 EFTA01149134 no faith tradition. The practice of contemplative care offers new possibilities for spiritual awareness and growth that have previously been rejected, ignored or overlooked. A scientific study of the efficacy of this practice is required to change minds, open doors and reform the way that patient care is conceived and delivered in the United States and around the world, offering a new path for human being through illness, death and dying. 7 EFTA01149135