End of Life Care and Public Health: Integrative

Models

Existing Integrative Models of End of Life Care at the International Level

Mostly implemented at local or regional levels of the different countries

Mostly addressing palliative care

Differences in use of terms “end of life care” and “palliative care”

Influenced by funding issues and cultural variations

Addressing the population perspective of end of lifeThe WHO PHS model

England’s approach to end of life care

WHO’s Definition of Palliative Care(http://www.who.int/cancer/media/FINAL-PalliativeCareModule.pdf)

provides relief from pain and other distressing symptoms;

affirms life and regards dying as a normal process;

intends neither to hasten nor to postpone death;

integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible

until death;

offers a support system to help the family cope during the patient’s illness and in their own bereavement;

uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;

will enhance quality of life, and may also positively influence the course of illness;

is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy;

includes the investigations needed to better understand and manage distressing clinical complications.

The WHO PHS Model for Palliative Care(http://www.who.int/cancer/media/FINAL-PalliativeCareModule.pdf)

Public Health Approach to End of Life Care:

Protect and improve health and quality of life of the community

Evidence based, cost effective interventions

Available to the population

The model addresses:

Appropriate policies

Adequate Drug Availability

Education of policy makers, health care workers and the public

Implementation of palliative care services at all levels throughout the society

England: A Comprehensive Approach to End of Life Care 2010. Public Health England (PHE) establishes the National End

of Life Care Intelligence Network http://www.endoflifecare-intelligence.org.uk/home Goal: Improve data and intelligence available to support

delivery of quality end of life care Provide national co-ordination to create a national

repository of diverse sources of data related to end of life care

Present and disseminate information Promote efficient and effective data collection Bring together stakeholders

Along with partners, designed and implemented end of life care modeling tools http://www.endoflifecare-intelligence.org.uk/view?rid=158

References Bingley A, Clark D. 1. (2009). A comparative review of palliative care development in six

countries represented by the Middle East Cancer Consortium (MECC). Journal of Pain and Symptom Management, 37(3).

Daher, M., Estephan, E., Abu-Saad Huijer, H., Naja, Z. (2008) Implementation of palliative care in Lebanon: past, present, and future. J Med Liban. Apr-Jun; 56(2).

Herrera, E., Rocafort, J., De Lima, L., Bruera, E., García-Peña F, Fernández-Vara, G. (2007) Regional palliative care program in Extremadura: An effective public health care model in a sparsely populated region. Journal of Pain and Symptom Management, 33(5)

Kaasa, S., Jordhøy, MS., Haugen, DF. (2007) Palliative care in Norway: A National Public Health Model. Journal of Pain and Symptom Management, 33(5).

Krakauer, EL, Cham, NT., Khue LN. (2010) Vietnam's palliative care initiative: successes and challenges in the first five years. Journal of Pain and Symptom Management, 40(1).

National End of Life Care Intelligence Network: http://www.endoflifecare-intelligence.org.uk/home

Stjernswärd, J., Foley, KM., Ferris FD. (2007) The public health strategy for palliative care Journal of Pain and Symptom Management, 33(5)

Wenk, R, Bertolino, M. (2007) Palliative care development in South America: a focus on Argentina. J Pain Symptom Management. 33(5)

WHO PHS Model of Palliative Care: http://www.who.int/cancer/media/FINAL-PalliativeCareModule.pdf