Time for Better Care at the End of Life

image of Time for Better Care at the End of Life

With more chronic conditions and an ageing population, a growing share of the population will need end-of-life care, reaching close to 10 million people by 2050. While end-of-life care services help improve quality of life through relieving pain and other symptoms, currently, there are substantial gaps in the provision of services. More than half of deaths still occur in hospital across OECD countries, despite home generally being the preferred place of death, because of lack of appropriate services and poor care co-ordination. There are marked inequalities in access with people from higher education twice as likely to receive end-of-life care services than those with low education. Planning, recording of wishes and shared decision-making fall short of what is desirable, with only one-quarter of wishes being recorded in the form of advance directives. People at the end of life do not always receive appropriate symptom relief, while others suffer from overtreatment. This report suggests avenues to improve care for the dying by enhancing measurement and monitoring of quality and rethinking funding and governance models of care. End-of-life care could also be improved by increasing knowledge among health care staff across different care settings, and making communication around the topic more person-centred.


Making end-of-life care more people‑centred

This chapter discusses people‑centredness of end-of-life care (EOLC). It illustrates that information gaps among the general population and health care professionals lead to stigma and hamper conversation and shared decision making. Efforts to involve patients in decision-making are rising but fall short. Evidence shows that gender, age, diagnoses, ethnic and cultural background influence people’s experience at the end of life. The chapter suggests pathways towards more people‑centred EOLC which include raising awareness around death and fostering the voice of patients and communities. Training and guidelines can support health care workers to undertake difficult EOLC conversations to align care to people’s wishes, while patient reported measures can help monitoring people’s satisfaction with EOLC. Finally, multidisciplinary EOLC conversations involving all relevant stakeholders can facilitate co‑ordination and improve theend-of-life care experience.


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