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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

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

Communication with Families Facing Life-Threatening Illness: A Research-Based Model for Family Conferences

Communication is an ongoing challenge for clinicians working with people facing life-threatening illnesses and end of life. Family conferences offer patient-focused, family-oriented care that brings together patients, family members, and health care providers.

Apr 1, 2011
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.

Apr 1, 2011
Journal Article

Evaluating a Palliative Care Intervention for Veterans: Challenges and Lessons Learned in a Longitudinal Study of Patients with Serious Illness

Longitudinal studies examining care for seriously ill patients are needed to understand patients' experience of illness, evaluate interventions, and improve quality of care.

Mar 14, 2011
Journal Article

Hospital Spending and Inpatient Mortality: Evidence from California: An Observational Study

High Medicare spending is not associated with better health outcomes at a regional level, but patients admitted to California hospitals from 1999 to 2008 had lower inpatient mortality in those hospitals that spent more on end of life care.

Feb 1, 2011
Journal Article

Comparing the Costs of Alternative Models of End-of-Life Care

The authors estimated at pounds 1.8 billion the cost to the taxpayer of care for the 127,000 patients dying from cancer in 2006. The equivalent cost for the 30,000 people dying from organ failure was pounds 553 million. Resources of pounds 16 to pounds 171 million could be released for cancer.

Jan 2, 2011
Multimedia

The Quality of Care for Patients Dying in the Hospital: Areas for Improvement Suggest Fundamental Problem in U.S. Health Care

In this September 2010 Congressional Briefing, Neil Wenger describes a yearlong study on improving end-of-life care that can help policymakers address payment systems and other issues pertaining to quality of care for critically ill patients.

Sep 13, 2010
Journal Article

End-of-Life Care in Teaching Hospital Is Generally Good, but More Family Communication Is Needed

Patients admitted to a teaching hospital for an end-of-life illness generally receive high-quality medical care, but there is a need for better communication about family expectations and for timely efforts to keep patients comfortable.

Jan 1, 2010

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RAND Topic:
End of Life Care

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

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