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.


Assessment and recommendations

This chapter provides a definition of end-of-life care (EOLC), introduces the OECD framework for assessing EOLC, summarises key challenges in the provision of EOLC and policy options to improve them. It shows that while the need for EOLC is growing, access to care is still limited and unequal across and within countries. The lack of awareness around death and dying among professionals and patients hampers the provision of people‑centred services. Furthermore, people at the end of life would benefit from high-quality EOLC that addresses all symptoms and avoids under- or over‑treatment. While services have proven cost-effective, particularly in community settings, public financing is often partial and geared towards hospital settings. Informal or family caregivers would also benefit from more public support. The governance of EOLC shows room for improvement, as the pandemic has recently highlighted. Improving research, data and quality indicators would inform policy making and align EOLC services with people’s needs.


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