Abstract
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In 1986 June Dahl, a pharmacology professor at the University of Wisconsin—Madison, was the Chair of the Wisconsin State Controlled Substances Board (CSB). The Wisconsin legislature asked the CSB whether Wisconsin should move to legalize heroin for cancer pain. June, together with David Jornanson, MSW, determined heroin was not needed, since existing drugs were sufficient to manage pain. However, they had the insight to determine that rather than a pharmacological deficit, it was a wide range of professional, regulatory, educational, and societal barriers that prevented optimal pain management. June and David spoke with local and national leaders in pain management and convened a state strategy meeting in December 1986, where the Wisconsin Cancer Pain Initiative (WCPI) was formally inaugurated to address the barriers to pain management. Rather than the traditional education approach to practice change of engaging just health professionals, the WCPI reached out to involve community leaders, patients, and the public. The WCPI was quickly designated a World Health Organization Demonstration Project for improving pain management, thus giving it immediate legitimacy.
I had the great good fortune to attend the 1986 WCPI kick-off meeting and became energized by the opportunity to become involved in this truly grass-roots, all-volunteer effort. I had recently moved to Wisconsin as a fledging medical oncologist to start a brain tumor program at the Medical College of Wisconsin. But June Dahl’s encouragement of my interest in physician education made me rethink my career path. Work with WCPI led me to start “cancer pain rounds” at my hospital, then to receive grant funding for the Cancer Pain Role Model Program with June, where over 10 years we “took our show on the road,” working with teams of health professionals from 25 states to start systems change programs in their clinical setting. As part of the role model grant, I received funds to hire an advance practice nurse, and together, we started a hospital palliative care consultation service in 1993, and the rest, as they say, is history.
Like a wildfire, the embers lit in Wisconsin rapidly spread so that within 10 years most states had copied the WCPI model and started their own statewide or regional cancer pain initiatives. As an early adopter of the systems-change approach to improving pain management, June encouraged other state pain initiatives to assess all the barriers to pain, not just the need for health professional education.
The linkage between the pain initiative movement and palliative care was obvious. Both movements recognized that education alone would not change practice patterns—in that way, the pain initiative movement was an early testing ground for future palliative care efforts that included the core systems change principles of developing standards of care, writing policies and procedures, developing quality monitoring programs, and finally, educational efforts geared to health professionals, patients, and the public. Thus, it is not surprising that many palliative care “pioneers” were involved in their state cancer pain initiatives.
Besides leading the WCPI and serving as a consultant to other states, June was front and center in the national initiatives to have pain assessed as part of routine care, establish pain standards for JCAHO, and develop professional training standards for nurses and other health professionals. Every time I go to see a doctor and get asked my pain score, I think of June.
June spent the remainder of her highly productive career at the University of Wisconsin—Madison leading the charge for improved pain relief on a local, state, and national level. Her passion, vision, and dedication to improving pain relief inspired hundreds of health professionals and community leaders. To me, June was a colleague, role model, mentor, and friend; I will miss her dearly.