End-of-life care: improving quality of life at the end of life.

Purpose/objectives: The purpose of this article is to identify barriers and interventions that influence quality of life at the end of life. PRIMARY PRACTICE SETTINGS(S): Primary care, acute inpatient care, case management, and end-of-life care settings.

Findings/conclusion: Death and dying affects the whole family, not just the individual who is dying. Early identification and recognition of end-of-life care choices heavily influence the quality of life an individual experiences during the dying process. Unfortunately, delaying end-of-life care plans is common. Over the years, the social structure and family structure have changed leaving many patients and families searching for viable end-of-life care options. Advancements in technology have affected the way medical professionals approach the end of life making a difficult decision for patients and families even more difficult by offering medical interventions that may not be necessary. To steer end-of-life care toward evidence-based practice standards, there needs to be additional research on the effectiveness of the various types of care available. Because case managers are often on the front lines of communicating and arranging end-of-life care, case managers need a clearer understanding of end-of-life care choices and how to communicate these choices to patients and families. The hospice and palliative care movements have been instrumental in increasing the understanding of end-of-life care and in providing patients alternatives to dying in the hospital.

Implications For Case Management Practice: * Only 25% of patients eligible for hospice actually enter hospice programs.* The average time spent in hospice is 3 weeks.* The most significant barrier in coordinating and providing end-of-life care is inadequate communication.* Early discussion of prognosis and end-of-life care options helps facilitate earlier entry into hospice and palliative care programs.* The nursing profession needs additional research to determine the effectiveness of the various types of end-of-life care available and steer end-of-life care toward evidence-based practice standards.