A Public Health Perspective on End of Life Care

Worldwide, more than 50 million people die each year and it is estimated on the basis of the conditions leading to death that up to 60% of them could benefit from some form of palliative care. It is a public health challenge to ensure that these people can access good palliative or end-of-life care. Pursuing good population health essentially also implies striving for a 'good enough death' and a good quality of care at the end of life. Safeguarding a good quality of the end of life for patient populations for whom it is appropriate requires a public health approach. In most developed countries ageing populations that increasingly die from chronic diseases after a prolonged -often degenerative- dying trajectory make up the public health challenges for palliative care. The very large baby boom generation will soon reach old age and can be expected to pose strong demands regarding the circumstances and care at their end of life. Only by applying a public health approach to palliative care (instead of individual patient perspectives), can societies successfully help to organize and plan end-of-life care in accordance with these aspirations. A Public Health Perspective on End of Life Care presents a synthesis and overview of relevant research and empirical data on the end of life that can bear a basis for a more systematic 'public health of the end of life'. The book focuses on population health, rather than clinical interventions or other aspects of individual health, and discusses studies using different methodologies (not only epidemiological research). The focus is on the quality of the end-of-life of populations, in particular from social sciences, environmental sciences, and humanities perspectives.

PART I: INTRODUCTION. 1. Applying a public health perspective in end-of-life care. PART II: CLINICAL AND SOCIAL CONTEXT OF DEATH AND DYING. 2. Place of death and end-of-life care. 3. Circumstances of death and dying. 4. End-of-life decisions. 5. Economic and health related consequences of individuals caring for terminally ill cancer patients in Canada. PART III: END-OF-LIFE CARE: PROVISION, ACCESS, AND CHARACTERISTICS. 6. Aggressive treatment and palliative care at the end of life. 7. Access to palliative care. 8. Communication between patient and caregiver. PART IV: END-OF-LIFE CARE SETTINGS. 9. Palliative care in primary care. 10. Palliative care in institutional long-term care settings. 11. Palliative care in hospitals. PART V: INEQUALITIES AT THE END OF LIFE: UNDERSERVED GROUPS. 12. Non-cancer patients. 13. Palliative care for the older adult. 14. A public health framework for pediatric palliative and hospice care. 15. End-of-life care for patients with intellectual disabilities. 16. End-of-life care for people who live in rural or remote areas versus those who live in urban areas. 17. Social inequalities at the end of life. PART VI: END-OF-LIFE CARE POLICIES. 18. Design, implementation, and evaluation of palliative care programs and services with a public health who perspective. 19. Public health policy regarding end-of-life care in sub-Saharan Africa. 20. Palliative care in the global context: understanding policies to support end-of-life care. 21. The importance of family carers in end-of-life care: a public health approach. PART VII: Conclusion. 22. Conclusions.