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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.

Commentary

Let People Make Their Own End-of-Life Decisions

Major advances in health technology have helped people to live longer, but not necessarily better, lives. Medicare recently announced plans to reimburse providers for time spent counseling patients and their caregivers about the kind of care patients would want to receive near the end of their lives.

Jul 15, 2015
Dissertation

Go Gentle into That Good Night: The Past, Present, and Future of End-of-Life Care

Examines the past, present, and future of end-of-life care in order to shed light on the most effective ways to organize and deliver it.

May 26, 2015
Commentary

He Lived Cautiously, and Then Died Suddenly

After his father's unexpected death, RAND's Jeffrey Wasserman questions his instinct to always play it safe, and decides what risks in life are worth taking.

May 15, 2015
Journal Article

The Frequency and Cost of Treatment Perceived to Be Futile in Critical Care

Physicians often perceive as futile intensive care interventions that prolong life without achieving an effect that the patient can appreciate as a benefit.

Apr 29, 2015
Journal Article

Factors Associated with Palliative Withdrawal of Mechanical Ventilation and Time to Death After Withdrawal

In imminently dying patients, mechanical ventilation withdrawal is often a comfort measure and avoids prolonging the dying process.

Apr 29, 2015
Journal Article

The Opportunity Cost of Futile Treatment in the ICU

Futile critical care was associated with delays in care to other patients.

Apr 28, 2015
Journal Article

Measuring Experience with End-of-Life Care: A Systematic Literature Review

We conducted a systematic review of PubMed, PsycINFO, and PsycTESTS for all English-language articles published after 1990 using instruments to measure adult patient, family, or informal caregiver experiences with end-of-life care.

Mar 15, 2015
Journal Article

Symptom Trends in the Last Year of Life from 1998 to 2010: A Cohort Study

The authors describe changes in pain intensity and symptom prevalence during the last year of life from 1998 to 2010.

Feb 11, 2015
Journal Article

The Invisible Homebound: Setting Quality-of-Care Standards for Home-Based Primary and Palliative Care

This article describes the current status of home-based medical care in the United States and offers a brief narrative of a fictional homebound patient and the health events and fragmented care she faces.

Jan 8, 2015
Report

Hospice Experience of Care Survey: Development and Field Test

This report describes development of the Hospice Experience of Care Survey, field test design, procedures, analytic methods and findings, and the final survey for national implementation by the Centers for Medicare & Medicaid Services.

Aug 8, 2014
Journal Article

Transforming Nurse Home Culture: Evidence for Practice and Policy

The nursing home culture change movement aims to improve resident quality of life and quality of care by emphasizing the deinstitutionalization of nursing home culture and focusing on person-centered care.

Feb 1, 2014
Brochure

Assessing Patients' Experiences with Care

Understanding how patients experience care can encourage delivery of high-quality services. It also helps payers, including the Centers for Medicare & Medicaid Services, ensure that they pay for effective and efficient care.

Jun 26, 2013
Blog

When CPR Is the Wrong Call: Mistaking Medical Treatment for Care

If a medical treatment worked only a fraction of the time and resulted in bad outcomes more often than not, practitioners would not make this treatment the default approach. Yet that is exactly what has happened when it comes to CPR for individuals 85 years and older who suffer cardiac arrest in a community setting.

Mar 14, 2013
Journal Article

Care Experiences of Managed Care Medicare Enrollees Near the End of Life

Research based primarily on reports from an individual's surviving relatives often suggests that end-of-life care experiences are particularly poor. However, this examination of reports from patients found that those who died within a year of being surveyed reported slightly better experiences than other enrollees.

Feb 4, 2013
Commentary

Should We Ration End-of-Life Care?

It's remarkable how often primary care doctors never get around to talking with their patients about an advance care plan before that fateful day arrives. So my colleagues and I end up having the conversation in an ER conference room or the patient's bedside at 2 o'clock in the morning, writes Art Kellermann.

Oct 30, 2012
Blog

Kellermann Debates Rationing of End of Life Care

Despite remarkable progress in medical science, the global death rate is still 100 percent. So the question is not whether we will live, or die. The question is where and how we'll die, and who will be with us when we do.

Oct 17, 2012
Journal Article

Patients Value Metastatic Cancer Therapy More Highly Than Is Typically Shown Through Traditional Estimates

There is a growing emphasis on promoting medical treatments that provide the most benefits relative to their costs.

Apr 1, 2012
Journal Article

Development of a Prognostic Model for Six-Month Mortality in Older Adults with Declining Health

Estimation of six-month prognosis is essential in hospice referral decisions, but accurate, evidence-based tools to assist in this task are lacking.

Mar 1, 2012
Journal Article

Quality of End-of-Life Care for Patients with Advanced Cancer in an Academic Medical Center

Cancer Quality-ASSIST indicators are useful for practical quality assessment of cancer end-of-life care in an academic medical center.

Apr 1, 2011
Journal Article

Missed Opportunities: Use of an End-of-Life Symptom Management Order Protocol Among Inpatients Dying Expected Deaths

Evaluation of implementation of a standardized order set can identify areas for quality improvement and missed opportunities for use.

Mar 31, 2011

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RAND Topic:
End of Life Care

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

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