Original ArticlesPolicy Issues in End-of-Life Care
Section snippets
Background
Since the landmark 1997 Institute of Medicine report about dying in America (Field & Cassel, 1997) that decried the overuse of life-extending treatments, end-of-life care throughout the United States has gradually improved. Palliative care has become a medical and nursing specialty. More hospitals have palliative care specialists (Morrison, Maroney-Galin, Kralovec, & Meier, 2005) and pain management services (Gordon et al., 2005, Sherman et al., 2004). Opioid use has increased dramatically (
Barriers to Delivering Good Care at the End-of-Life
A significant issue impeding improvement in care for the dying is the mismatch between the dominant culture of recovery-focused medicine and the needs of an aging population. “Rescue medicine” is the default mode in American hospitals, although 7 out of 10 deaths today result from life-limiting chronic illnesses that follow a slow and often predictable decline. The misalignment of aggressive-focused acute-care hospitals serving an aging and chronically ill population sometimes results in
Policy Recommendations
End-of-life care has been a flash-point in the current health care reform debate. Although improving care at the end-of-life ranks high for reform, issues can quickly devolve into confusion about the incentives for improving care. Groups such as the elderly and the disabled can misunderstand that effective planning for life's end, intended to enhance respect for patient and family wishes, improve palliation, and reduce unwanted and expensive aggressive treatments, can appear to be otherwise
Implications for Nurses
By training and passion, nurses promote the health and well-being of patients, families, communities, and society. Nurses also have a pivotal role in the formation and evaluation of health policy. Along with patients and families, nurses experience firsthand the disparities in the delivery of end-of-life care and how health policies promote or reduce inequities. As well-educated patient advocates, nurses are highly qualified to communicate patient experiences to state and federal legislators
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Cited by (11)
The expression of ‘policy’ in palliative care: A critical review
2022, Health PolicyCitation Excerpt :Various human-resource related shortfalls were also expressed – like deficits in palliative care education provision [79], an insufficiently skilled workforce [86] and knowledge and skills deficits [57]. Building on these functional issues, deeper “systems-level” antagonisms [90] were also suggested, expressed variously as: the existence of a problematic “dominant biomedical paradigm” [80]; a “bias toward curative care” [36]; health service cultures where death is still a taboo [54]; hostile professional attitudes toward older people [80]; “legal and regulatory constraints” [80]; and “knowledge deficits and misunderstandings about PC” [79]. These narratives tended to be resolved by seeing palliative care as an “urgent policy and practice imperative” [55] and more policy formulation [80]; increased funding [15]; more trained palliative care professionals [91]; and expanded palliative care [83].
Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders’ perceptions
2017, Health PolicyCitation Excerpt :Earlier studies have identified challenges for the provision of palliative care in hospitals [21]. Many view the meanings of the concepts ‘palliative care’ and ‘end of life care’ as unclear [21–23], and the staff have difficulty in identifying patients in need of palliative care [21,24–27]. Lack of adequate training and competency in the field are also described as barriers to good palliative care [24,26,28].
Embedding a palliative approach in nursing care delivery: An integrated knowledge synthesis
2017, Advances in Nursing ScienceNon-beneficial treatments in hospital at the end of life: A systematic review on extent of the problem
2016, International Journal for Quality in Health CareEnhancing Palliative Care for Low-Income Elders with Chronic Disease: Feasibility of a Hospice Consultation Model
2014, Journal of Social Work in End-of-Life and Palliative CareThe Nurse Practitioner and Policy in End-of-Life Care
2014, Nursing Science Quarterly
Portions of this article were originally delivered in the Helen Nahm Research Lecture at the University of California San Francisco School of Nursing on April 16, 2007.