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Much remains to be done in the USA to improve the care of patients at end-of-life.
A recent review article in Nursing Economics examined the current reality of end-of-life care in the United States. The ideal, of course, is that the American public is well-informed about end-of-life care and embrace palliative care for their loved ones (and themselves) when the time comes. However, in reality, there are many barriers to access to palliative care and hospice services. Access includes awareness of palliative and hospice services, payment and financial coverage for those benefits, and acceptance of benefits from a cultural or religious perspective.
Geographic disparities in accessing palliative and hospice care are well documented. Analysis of Medicare data found that overall, 29% of patients with advanced cancer died in a hospital. The hospitalization percentages, though, ranged from 7% in Mason City, Iowa to 47% in New York City. This statistic may say more about our culture rather than availability of services as I imagine that New York City has any number of palliative/hospice services, organizations, and facilities. Another reality is that hospice has increasingly been used by people with chronic medical conditions other than cancer.
The author of the review makes the point that discussions about quality of care, health policy, and disparity must occur and cannot be dismissed due to the fact that these conversations are difficult to have from an ethical and legal perspective. All healthcare professionals should strive to create an environment for patients where the philosophy of palliative care and hospice is understood. Goals include increased knowledge about hospice and palliative care, greater symptom control for patients with end-stage diseases, improved advance care planning, better quality of life, and ultimately less money spent on achieving better outcomes for patients facing end-of-life illness and disease.
Giovanni, LA. End-of-life care in the United States: Current reality and future promise—A policy review. Nursing Economics. 2012; 30(3): 125-126.