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.


Strengthening governance and evidence‑based design for end‑of‑life care

This chapter focuses on the governance and evidence‑based design of end-of-life care (EOLC) systems. The COVID‑19 crisis has shed a light on the unpreparedness of EOLC services to emergencies, causing disruption in service provision for people at the end of life. Poor governance can also exacerbate fragmentation in the care that people receive at the end of life. It highlights the weakness of EOLC research and data, which hinders benchmarking and prevents best evidence to inform policy making. Countries have already started to promote community care and technology in EOLC during the pandemic, and further efforts could be undertaken. Information sharing and case management can be useful tools to provide more integrated care to people with complex needs approaching death. EOLC would also benefit from better evidence produced through a scale up in research, improvement of data linkages and design of indicators.


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