Abstract
Background: The use of quality-adjusted life years rests on the assertion that the objective of the healthcare system is to improve health.
Aim: To elicit the views of expert stakeholders on the purpose and evaluation of supportive end of life care, and explore how different purposes of end of life care imply the need for different evaluative frameworks.
Design: Semi-structured qualitative interviews, analysed through an economic lens using a constant comparative approach.
Participants: .20 professionals working in or visiting the UK or Republic of Ireland, with clinical experience and/or working as academics in health-related disciplines.
Results: Four purposes of end of life care were identified from and are critiqued with the aid of the qualitative data: to improve health; to enable patients to die in their preferred place; to enable the patient to experience a good death; to enable the patient to experience a good death, and those who are close to the patient to have an experience which is as free as possible from fear, stress and distress.
Conclusion: Managing symptoms and reducing anxiety were considered to be core objectives of end of life care and fit with the wider health service objective of improving/maximising health. A single objective across the entire health system ensures consistency in the way that resource allocation is informed across that entire system. However, the purpose of care at the end of life is more complex, encompassing diverse and patient-centred objectives which we have interpreted as enabling the patient to experience a good death.
Aim: To elicit the views of expert stakeholders on the purpose and evaluation of supportive end of life care, and explore how different purposes of end of life care imply the need for different evaluative frameworks.
Design: Semi-structured qualitative interviews, analysed through an economic lens using a constant comparative approach.
Participants: .20 professionals working in or visiting the UK or Republic of Ireland, with clinical experience and/or working as academics in health-related disciplines.
Results: Four purposes of end of life care were identified from and are critiqued with the aid of the qualitative data: to improve health; to enable patients to die in their preferred place; to enable the patient to experience a good death; to enable the patient to experience a good death, and those who are close to the patient to have an experience which is as free as possible from fear, stress and distress.
Conclusion: Managing symptoms and reducing anxiety were considered to be core objectives of end of life care and fit with the wider health service objective of improving/maximising health. A single objective across the entire health system ensures consistency in the way that resource allocation is informed across that entire system. However, the purpose of care at the end of life is more complex, encompassing diverse and patient-centred objectives which we have interpreted as enabling the patient to experience a good death.
| Original language | English |
|---|---|
| Pages (from-to) | 823-831 |
| Number of pages | 9 |
| Journal | Palliative Medicine |
| Volume | 33 |
| Issue number | 7 |
| Early online date | 27 Mar 2019 |
| DOIs | |
| Publication status | Published - 1 Jul 2019 |
Keywords
- Palliative care
- terminal care
- economic evaluation
- place of death
- a good death
- quality-adjusted life years