End of Life Issues in Cancer Care

“Just as dying is part of the life of an individual,

and part of the life and history of a family,

caring for those among us who are dying

is part of the ongoing life of a community.”

Ira Byock MD

Key Problem Areas in End of Life Care

• Education

• Access to Care

• Research

Problem Area #1:End of Life Education

• Target Populations

• Content Area

Target Populations

Health Care Providers and those in training

Patients and Family Members/Caregivers

Community/Human Service Providers (i.e. clergy, home health aids, social workers, case managers, etc.)

Community At Large

Employers/Insurance Providers

Public Officials

•Recognition of Cultural/Religious Diversity

•End of Life Health Care Options

•End of Life Decision Making (Advance Care Planning)

•Physical, Psychosocial, Spiritual Needs of Patients and Family Members/Caregivers

•Communication Issues/Conflict Resolution

•Bereavement Issues

Content Areas

General Recommendations forEnd of Life Education

• Provider Education– Required initial training– Continuing education

• Community Education– Proactive outreach– Knowledge of resources

Problem Area #2: Improving Access to Care

• Specialized Populations

• Coordination of End of Life Care Services

• Financial coverage of services

Specialized Populations

Pediatric, adult, geriatric

Special needs groups (e.g. developmentally disabled)

Minority populations

Coordination of End of Life Care Services

• Rural/Urban Needs

• Ensuring Continuum of Care

• Access to appropriate place of care

Financial Coverage of End of Life Services

Insurance Coverage of full services throughout the continuum of care

• Burial costs

General Recommendations forImproving Access to Care

• Needs assessment

• Timely referrals

• Palliative care teams

• Providing appropriate sites of care

• New palliative care coverage

• Extension of burial benefits

Problem Area #3: Research

• Quality Assurance

• Health Care Provider Shortage (i.e. Nurses)

• Physical, Psychosocial, and Spiritual Aspects of Care

• Care Giver Issues

• Health Services Systems/Programs

General Recommendations for Research

• Funding

• Coordination and dissemination of research

• Use of CRFP funds