Improving End-of-Life and Palliative Care
A 2002 Foundation-sponsored report by the Last Acts^® coalition, Means to a Better End, evaluated the 50 states and the District of Columbia on their ability to provide care at the end of life. The report, examining practices such as palliative care, advance directives, nurse and physician training, and hospice care, found that no state did better than a mediocre job in providing end-of-life care.

Yet there are also signs of success:

• U.S. News & World Report included palliative care in its rankings of America's Best Hospitals for the first time in 2002.
• The American College of Surgeons will add content on end-of-life care to its board exam.
• Last Acts, the Foundation-supported campaign to improve end-of-life care, now has 1,080 partner organizations, up from 79 when it began in 1997.
• Last Acts introduced a broad set of principles designed to improve end-of-life and palliative care for children and their families in response to a July 2002 Institute of Medicine report that found significant deficiencies in this area.

The Foundation’s Promoting Excellence in End-of-Life Care program has tested several care system improvements. For example, the University of Michigan Cancer Center integrated hospice into care planning even as life-prolonging treatment continued. The project found that patients enjoy a better quality of life when hospice is provided before the final weeks of life, rather than once all treatment options are exhausted.

Although a great number of Americans receive highly skilled, state-of-the-art and sometimes lifesaving care in intensive care units (ICUs), these technologically-focused settings rarely meet the full array of needs of critically ill patients and their families. A new $2.2-million Foundation initiative, Promoting Palliative Care Excellence in Intensive Care, seeks to integrate high-quality palliative care services in ICUs and assess their impact on the quality of care for patients and their families.

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