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End-of-Life Care
Care arrangements in the United States could ensure that people living with eventually fatal chronic illness can count on living as comfortably and meaningfully as possible, in a sustainable care system. Our research focuses on learning how to achieve such arrangements. Some of RAND's end-of-life studies are highlighted below.
Profiles of Current Research
VA Palliative Care Model
A randomized, controlled study of an intervention based on the palliative care model for patients admitted to the Veterans Affairs’ hospital in West Los Angeles who are at high risk of dying over the following year. The palliative care model comprises explicit plans and protocols, adds care elements to support patient needs, attends to patients’ information and self-management needs, provides access to technical expertise, and relies heavily on the VA’s computerized information system.
Contact: Glenn Wagner, PhD (Glenn_Wagner@rand.org)Research on End-of-Life Care
Focus-group study of community views about policies that limit aggressiveness of care toward the end of life for selected patients who are without meaningful chance of recovery. This qualitative study includes patients, family, and clinicians at hospitals around Southern California. The second half of this project is an evaluation of the quality of end-of-life care provided to patients dying in a large Southern California hospital.
Contact: Neil Wenger, MD, MPH (Neil_Wenger@rand.org)Advance Directives
A literature review to evaluate the evidence base for advance directives (ADs)—a legal tool that patients can use to state their treatment preferences and to name a surrogate decisionmaker for end-of-life care—and to identify effective methods to promote the use of ADs among competent adults.
Contact: Neil Wenger, MD, MPH (Neil_Wenger@rand.org) or Lisa Shugarman, PhD (Lisa_Shugarman@rand.org)Study on Quality Indicators
VA pilot of the validity and feasibility of the RAND Cancer Quality Assessing Symptoms Side Effects and Indicators of Supportive Treatment quality indicators in a cohort of several hundred veterans who were receiving chemotherapy, radiation therapy, and palliative care for advanced disease.
Contact: Karl Lorenz, MD, MSHS (Karl_Lorenz@rand.org)
Highlights of Recent Studies
Redefining and Reforming Health Care for the Last Years of Life — 2006
End-of-life care should be organized according to the kinds of services that groups of people need, rather than by disease diagnosis or where the patients receive care.
End-of-Life Care and Outcomes
Evidence concerning interventions to improve palliative and end-of-life care is strongest in cancer care, reflecting the degree to which palliative care has already been integrated into the research agenda and clinical practice of oncology.
Research brief at ahqr.gov
Related Web Sites
RAND Southern California Evidence-Based Practice Center
http://www.rand.org/health/centers/epc
Palliative Care Policy Center
United Hospital Fund, Palliative Care Quality Improvement Initiative
Working with Congress
RAND’s Office of Congressional Relations (OCR) furthers RAND’s mission to provide objective analysis and effective solutions by disseminating research results to Congress and federal agencies. OCR publishes a monthly electronic newsletter featuring current work on health policy. The RAND Health Congressional Newsletter is found at www.rand.org/congress/newsletters.html. Contact: Shirley Ruhe (Shirley_Ruhe@rand.org).
The RAND Health Congressional Newsletter
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