Cover image for Approaching death : improving care at the end of life
Approaching death : improving care at the end of life
Field, Marilyn J. (Marilyn Jane)
Publication Information:
Washington, D.C. : National Academy Press, 1997.
Physical Description:
xvii, 437 pages : illustrations ; 24 cm
Format :


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R726.8 .A68 1997 Adult Non-Fiction Central Closed Stacks

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Reviews what we know about care at the end of life, what we have yet to learn, and what we know but don't adequately apply, seeking to build an understanding of what constitutes good care for the dying and offering recommendations that address barriers to good care. Discusses the process of determin

Table of Contents

Summaryp. 1
1 Introductionp. 14
The Need for Consensus and Actionp. 17
Initiatives to Improve Care at the End of Lifep. 18
Overview of Reportp. 21
Guiding Principlesp. 22
Concepts and Definitionsp. 23
Conclusionp. 32
2 A Profile of Death and Dying in Americap. 33
When People Die: The Aging of Americap. 34
Why People Die: Causes of Deathp. 37
Where People Die: Death in Institutions and Residencesp. 39
How People Die: Symptoms of Impending Deathp. 42
Attitudes Toward Dying and Deathp. 44
Conclusionp. 46
3 Caring at the End of Lifep. 50
Differences in Dying Pathways: Illustrative Casesp. 52
Determining and Communicating Diagnosis and Prognosisp. 59
Establishing Goals and Plansp. 64
Fitting Care to Goals and Circumstancesp. 72
Conclusionp. 86
4 The Health Care System and the Dying Patientp. 87
Characterizing Care Systemsp. 88
Illustrative Case Historiesp. 90
Settings for End-of-Life Carep. 95
Coordinating Care Within and Across Settingsp. 107
Revisiting the Care System at the Community and National Levelsp. 116
Conclusionp. 118
Addendump. 119
5 Accountability and Quality in End-of-Life Carep. 122
Concepts of Accountability and Qualityp. 123
Evidence of Quality Problems in End-of-Life Carep. 126
Dimensions of Quality in Care at the End of Lifep. 135
Measurement Instruments and Issuesp. 139
Guidelines for Clinical Practicep. 149
Conclusionp. 152
6 Financial and Economic Issues in End-of-Life Carep. 154
Who Pays for Care at the End of Life?p. 155
What Is Spent for Care at the End of Life?p. 156
Do Financing Mechanisms Impede Good End-of-Life Care?p. 160
What About Proposals to Reduce the Cost of End-of-Life Care?p. 173
Conclusionp. 184
Addendump. 185
7 Legal Issuesp. 188
Prescription Laws and Barriers to Pain Reliefp. 190
Informed Consent and Advance Care Planningp. 198
Physician-Assisted Suicidep. 203
Conclusionp. 206
8 Educating Clinicians and Other Professionalsp. 207
Core Components of Professional Preparation for Care at the End of Lifep. 209
Physician Educationp. 210
Nursing, Social Work, and Other Professionsp. 227
Continuing Professional Educationp. 231
Conclusionp. 232
9 Directions for Research to Improve Care at the End of Lifep. 235
A Symptom-Based Strategy for Biomedical Researchp. 236
Social, Behavioral, and Health Services Researchp. 244
Ethical Issues in Research on Dying Patientsp. 251
Research Leadershipp. 253
Conclusionp. 258
10 Conclusions and Recommendationsp. 259
Today and Tomorrowp. 260
Findings and Recommendationsp. 263
Concluding Thoughtsp. 271
Referencesp. 272
A Institute of Medicine Feasibility Study on Care at the End of Life August 1993-Feburary 1994p. 315
B Institute of Medicine Committee on Care at the End of Life Public Meetingsp. 321
C Examples of Initiatives to Improve Care at the End of Lifep. 327
D Prognosis and Clinical Predictive Models for Critically Ill Patientsp. 358
E Cultural Diversity in Decisionmaking About Care at the End of Lifep. 363
F Measuring Care at the End of Lifep. 383
G Excerpts from Medical Guidelines for Determining Prognosis in Selected NonCancer Diseasesp. 400
H American Board of Internal Medicine Clinical Competence in End-of-Life Carep. 405
I Examples of Medical Education Curriculap. 407
J Committee Biographiesp. 413
Indexp. 419