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End-of-Life Care

Individuals with a terminal illness, and the caregivers in their families, face many challenging questions, and the health care they receive can vary widely. For practitioners and policymakers seeking to better understand end-of-life care concerns, RAND researchers address a range of pertinent topics, including quality of care, costs, patient preferences, pain management, best practices, treatment disparities, and access requirements.

Journal Article

Hospice Care Experiences Among Cancer Patients and Their Caregivers

Opportunities exist to improve hospice care for symptom palliation and training for caregivers when their family members are at home or in an ALF setting. Efforts to improve care for cancer patients in the NH and ALF setting are especially needed.

Feb 26, 2021
Journal Article

End-of-Life Cost Trajectories in Cancer Patients Treated by Medicare Versus the Veterans Health Administration

To evaluate differences in end-of-life cost trajectories for cancer patients treated through Medicare versus by the Veterans Health Administration (VA).

Dec 30, 2020
Journal Article

Negotiating the 'Buffet' of Choice: Advances in Technology and End-of-Life Decision-Making in the Intensive Care Unit Setting

This article explores medical decision-making in the setting of the intensive care unit (ICU) drawing on ethnographic data of ICUs as well as interviews with family members of critically ill patients as and clinicians.

Sep 3, 2020
Journal Article

Beyond the Hour of Death: Family Experiences of Grief and Bereavement Following an End-of-Life Hospitalization in the Intensive Care Unit

This article examines bereaved family members' experiences of grief by examining three aspects from the end-of-life hospitalization and decision-making in the ICU that informed their subsequent bereavement experiences.

Sep 3, 2020
Journal Article

Quality Of End-Of-Life Care Is Higher In The VA Compared To Care Paid For By Traditional Medicare

The Medicare-reliant veterans were significantly more likely to receive high-intensity care, in the form of chemotherapy, hospital stays, admission to the intensive care unit, more days spent in the hospital, and death in the hospital. However, they were significantly less likely than VA-reliant patients to have multiple emergency department visits. Higher-intensity end-of-life care may be driven by financial incentives present in fee-for-service Medicare but not in the VA's integrated system.

Aug 5, 2020
Journal Article

Dyadic Model of Adaptation to Life-Limiting Illness

This review of the scholarly and empirical literature as well as a growing body of research examining adjustment to the prospect of the end of life support the concept of dyads, where one member of a mutual partnership is experiencing losses in the context of life-threatening illness while the other member goes through adjustments.

Jun 26, 2020
Journal Article

Differences in Caregiver Reports of the Quality of Hospice Care Across Settings

Important opportunities exist to improve quality of hospice care in nursing homes and assisted-living facilities. Quality improvement and regulatory interventions targeting these settings are needed to ensure that all hospice decedents and their family receive high-quality, patient- and family-centered hospice care.

Jun 25, 2020
Journal Article

Characteristics of Hospices Providing High-Quality Care

Hospice characteristics associated with strong performance on Hospice Item Set measures differ from those associated with strong performance on CAHPS measures. Providing professional staff visits in the last two days of life is associated with high performance in both quality domains.

Jun 25, 2020
Commentary

COVID-19 and End-of-Life Decisions

Resuscitative efforts do not typically save a life. In anticipation of the pandemic surge, hospitals are discussing blanket do-not-resuscitate orders for patients dying from the coronavirus. It's time to discuss the limits of CPR so patients stricken with COVID-19 can make informed end-of-life decisions.

Apr 30, 2020
Journal Article

Palliative Care and Infection Management at End of Life in Nursing Homes: A Descriptive Survey

The aim of this study was to describe the current status of how nursing homes integrates palliative care and infection management at end of life across the nation.

Mar 19, 2020
Journal Article

Health System and Beneficiary Costs Associated With Intensive End-of-Life Medical Services

The objective of this paper is to quantify expected beneficiary and health system costs incurred in association with receipt of intensive medical services in the last month of life.

Mar 11, 2020
Blog

Ink Tank: At RAND, Tattoos Sometimes Reflect the Research

Three RAND experts and one Pardee RAND student explain how their tattoos reflect their research on the problems Marines face, end-of-life care, migration-related issues, and the changing needs of the labor force.

Jan 10, 2020
News Release

Growing Evidence Supports Best Practices in Palliative Care

A rapidly aging U.S. population with complex care needs will likely accelerate emphasis on palliative care services. A review of palliative care research found substantial evidence to support clinical practice guidelines and was incorporated into the new edition of the guidelines.

Oct 31, 2018
Periodical

RAND Review: March-April 2018

This issue features a Q&A with Michael Rich, Soledad O'Brien, and Francis Fukuyama on the perils of truth decay, and a story on the trend toward unretirement among U.S. workers. The Voices column features Gulrez Shah Azhar on environmental refugees.

Mar 5, 2018
Journal Article

Black and Hispanic Patients Receive Hospice Care Similar to That of White Patients When in the Same Hospices

Black and Hispanic patients received care from poorer quality hospices than white patients.

Aug 1, 2017
Journal Article

Medicare Beneficiaries With Advanced Lung Cancer Experience Diverse Patterns Of Care From Diagnosis To Death

The substantial variations across sites in patterns of end-of-life care for patients with cancer should be factored in to efforts to improve care.

Aug 1, 2017
Journal Article

End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported

Spending in the last year of life accounts for about 10% of overall costs, but spending in the last three years of life can be as high as 25% of total costs, suggesting the need to reduce the costs of caring for people with chronic conditions.

Jul 27, 2017
Journal Article

End-of-Life Care Planning in Accountable Care Organizations: Associations with Organizational Characteristics and Capabilities

About 60 % of Accountable Care Organizations (ACOs) have some kind of end-of-life care planning processes in place, but only about 20% have established advanced planning processes.

Jul 18, 2017
News Release

Black and Hispanic Patients More Likely to Use Lower-Quality Hospices

Black and Hispanic patients are more likely to receive care from poorer-quality hospices. And their family caregivers are less likely to receive the right amount of emotional and religious support in hospice care. However, caregivers of black and Hispanic patients report similar or better experiences than caregivers of white patients within a given hospice.

Jul 5, 2017
Journal Article

Development and Feasibility of a Structured Goals of Care Communication Guide

Studies demonstrate the benefits of discussing goals of care and advance care planning, yet many patients with serious illness do not engage in such discussions with healthcare providers.

May 30, 2017

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RAND Topic:
End of Life Care

Topic Synonyms:
End-of-Life Care;
EOL;
Terminal Care

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