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This Week in PubHub: Palliative/End of Life Care

June 03, 2011

(Kyoko Uchida manages PubHub, the Foundation Center's online catalog of foundation-sponsored publications. In her previous post, she looked at four reports that examine how structural racism, environmental conditions, and inadequate health inputs reinforce one another, perpetuating racial/ethnic disparities in health outcomes.)

For the final week of our month-long focus on health-related topics, we're highlighting four reports that explore issues involved in palliative and end-of-life care. Earlier studies showing that a majority of patients would rather die at home than in a hospital have resulted in calls for increased access to palliative and hospice care as well as more open discussion of patient preferences.

In Trends and Variation in End-of-Life Care for Medicare Beneficiaries With Severe Chronic Illness (44 pages, PDF), the Dartmouth Institute for Health Policy & Clinical Practice documents how Medicare beneficiaries with chronic illnesses spent fewer days in the hospital, were less likely to die there, and were more likely to receive hospice care in 2007 than in 2003. The report also found that hospitalized patients saw more specialists and spent more days in intensive care units, and that the pace of health system change varies greatly by region and by hospital. Funded by the Robert Wood Johnson Foundation, the report emphasizes how local healthcare delivery systems shape the care patients receive more than patient population characteristics or preferences.

So what are some of the promising developments in the palliative and end-of-life care field? Improving Care at the End of Life (42 pages, PDF) offers a retrospective analysis of the Robert Wood Johnson Foundation's investments in and impact on the field between 1991 and 2005. Lessons learned include the need to articulate a strategy and objectives that integrate an entire body of work, tie strategy to policy changes and incentives, link communications and evaluation synergistically, and leverage and collaborate with other change agents.

According to the California HealthCare Foundation report Be Prepared: Reducing Nursing Home Transfers Near End of Life (10 pages, PDF), a relatively easy way to improve end-of-life care is to reduce needless transfers of nursing home residents to hospitals. The report describes a regional initiative in which clinicians educated nursing home staff about reducing such transfers, and while the project resulted in a statistically significant increase in the number of patients at the end of life cared for in nursing homes, barriers to change remain. These include a financial incentive system that rewards patient transfers, lack of administrative and physician support, and inadequate staff training.

As described in the report Easing the Pain: Successes and Challenges in International Palliative Care (96 pages, PDF), the Open Society Foundations' International Palliative Care Initiative (IPCI) focused on treating "total pain by treating the total person." Using examples from the initiative, the authors illustrate the need to reform national drug policies, build out the regulatory palliative care infrastructure, support public and professional education, and push palliative care as an essential component of public health systems, including advocating for such care as a human right. The report lists a number of priorities, including putting palliative care on international donors' agendas, coordinating funding for palliative care efforts, promoting and improving clinical training, supporting World Health Organization efforts to develop policy guidelines, and fostering patient advocacy.

What's your take on the issue? Do you know of any promising strategies or practices for improving end-of-life and palliative care, in the U.S. or developing countries? Feel free to share your thoughts in the comments section. And don't forget to visit PubHub, where you can browse more than eighteen hundred reports on health-related topics.

-- Kyoko Uchida

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