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
