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This report looks at the state of end of life care since the independent Review of the Liverpool Care Pathway, chaired by Baroness Neuberger. It finds great variation in quality and practice across both acute and community settings. It makes a number of recommendations for improvement, and in particular strongly recommends that social care should be free at the end of life. Other conclusions included that: all clinicians and providers who may care for people at the end of life should be aware of the Five Priorities of Care but in light of the variation in practice a senior named person in each NHS Trust be given responsibility for monitoring how end of life care is being delivered within their organisation; expertise should be more equitably available to people with a non-cancer diagnosis, older people and those with dementia; all staff who provide palliative and end of life care to people with life limiting conditions should receive training in advance care planning, including the different models and forms that are available and their legal status; most people who express a preference would like to die at home but that is made more difficult by the shortfall in community nurses and specialist outreach palliative care; sustainable, long term funding for the hospice sector also needs to be addressed as part of the Government's response to the Palliative Care Funding Review; and bereavement support for families should also be consistently included as part of end of life care

This report examines the scale and quality of end of life care; the current and future approach to commissioning and funding of services; and the capability and capacity of NHS and social care staff to provide such care. In England approximately half a million people die each year. Around three quarters of deaths follow a period of chronic illness, such as cancer or heart disease, where people may need access to end of life care. End of life care services seek to support those with advanced, progressive, incurable illness to live as well as possible until they die. The provision of end of life care is becoming increasingly complex, often requiring a complex mix of health and social care services. End of life care is delivered by many people, including families and friends, specialist palliative care staff, and generalist staff such as doctors, nurses and social workers, for whom end of life care represents a varying proportion of their role. There are no full estimates of the full financial cost of end of life care, but in 2006-07 primary care trusts estimated they spent £245 million on specialist palliative care, delivered by around 5,500 staff with specific training in the management of pain and other symptoms. Most people would prefer not to die in hospital but a lack of NHS and social care support services means that many people do so when there is no clinical need for them to be there. The Department of Health published its End of Life Care Strategy in 2008 which commits additional funding of £286 million over two years, and aims to increase the availability of services in the community and develop the skills of health and social care staff.

When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening. Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care. This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life: Determining diagnosis and prognosis and communicating these to patient and family. Establishing clinical and personal goals. Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."

For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.