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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

Care Preferences in Physician Orders for Life Sustaining Treatment in California Nursing Homes

Physician Orders for Life-Sustaining Treatment (POLST) facilitates documentation and transition of patients' life-sustaining treatment orders across care settings. We describe the orders within POLST among all nursing home residents in California from 2011 to 2016.

Mar 16, 2022
Journal Article

POLST Completion and Continuity in California Nursing Homes

We used MDS 2011–2016 linked to California Section S to describe POLST completion, cardiopulmonary resuscitation and do not resuscitate orders, invalid POLST documents, and switches in POLST content across the population of California NH residents.

Mar 16, 2022
Journal Article

Association Between Receipt of Emotional Support and Caregivers' Overall Hospice Rating

"Too much emotional support" is not always viewed negatively in consumer ratings of hospice care.

Apr 21, 2021
Journal Article

The Role of Regional and State Initiatives in Nursing Home Advance Care Planning Policies

We examined whether state and regional advance care planning initiatives play a role in the presence of "do not administer antibiotics" orders for nursing home residents at the end of life.

Apr 7, 2021
Journal Article

Improving Care Experiences for Patients and Caregivers at End of Life: A Systematic Review

Previous reviews examined palliative care improvements or available measures but none explicitly on improving care experiences. We reviewed literature on improving patient and/or caregiver end-of-life care experiences.

Apr 7, 2021
Journal Article

Bereaved Family More Likely to Report "Too Little" Care Than "Too Much" Care at the End of Life

Interviews with family members about their loved one's end-of-life care found that a majority thought he or she received the right amount of care. One in six said their family member received too little care.

Mar 31, 2021
Journal Article

Individual, Interpersonal, and Health Care Factors Associated with Informal and Formal Advance Care Planning in a Nationally-Representative Sample of Midlife and Older Adults

This paper examines correlates of advance care planning among midlife and older adults in the U.S., with attention to informal planning (e.g., conversations) and formal planning (e.g., legal documentation) and factors at the individual, interpersonal, and health care levels.

Mar 31, 2021
Periodical

RAND Review: March-April 2021

The cover story highlights research on improving the police response to homelessness; a second feature focuses on the millions of caregivers who provide support services to chronically ill loved ones but are not integrated into health care teams.

Mar 11, 2021
Journal Article

Racial Differences in End-of-Life Care Quality Between Asian Americans and Non-Hispanic Whites in San Francisco Bay Area

Compared with caregivers of non-Hispanic whites, caregivers of Asian decedents reported unmet needs for caregiver support and lack of respect for cultural traditions and religious/spiritual beliefs.

Mar 2, 2021
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

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

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

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

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
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
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

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RAND Topic:
End of Life Care

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

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