Approaching Death: Improving Care at the End of Life

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National Academies Press, Oct 16, 1997 - Medical - 456 pages
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When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening.
Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care.
This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life:

  • Determining diagnosis and prognosis and communicating these to patient and family.
  • Establishing clinical and personal goals.
  • Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."


 

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Contents

SUMMARY
1
INTRODUCTION
14
A PROFILE OF DEATH AND DYING IN AMERICA
33
CARING AT THE END OF LIFE
50
4
87
5
122
6
154
7
188
APPENDIXES
313
B Institute of Medicine Committee on Care at the End of Life
321
Examples of Initiatives to Improve Care at the End of Life
327
Prognosis and Clinical Predictive Models for Critically
358
F Measuring Care at the End of Life
383
G Excerpts from Medical Guidelines for Determining Prognosis
400
Examples of Medical Education Curricula
407
J Committee Biographies
413

8
207
CONCLUSIONS AND RECOMMENDATIONS
259
REFERENCES
272

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