Friday, July 30, 2010

Your Death-Venture Will Begin Shortly

[I would like to introduce a new contributor to Pallimed, Holly Yang, MD  from San Diego Hospice and The Institute for Palliative Medicine. I have been courting Holly for a while to get her to blog for us, so I am glad to see her debut today! You can also find this web- and ocean-surfing doctor on Twitter by the handle @hollyby.  As with all of our contributrs all posts are her own and not the opinion of her employers.  Please welcome her with a few comments - Sinclair, ed. ]

As one of the comments on the Economist website said, “What the heck do they want to promote now – Death Tourism?” As much as I love traveling, I’m not packing my bags just yet. But, I will give you the low-down on the 39-page Quality of Death (QOD) report by the Economist Intelligence Unit and commissioned by the Lien Foundation, which ranks end-of-life care across 40 countries.  Go get your travel kit ready... here we go!




The 40 countries that were chosen to be a part of the report were rated in 4 sub-categories:
  • Basic End-of-Life Healthcare Environment
  • Availability of End-of-Life Care
  • Cost of End-of-life Care
  • Quality of End-of-Life Care
The 24 indicators in those 4 categories included quantitative (e.g. life expectancy), qualitative (e.g. doctor-patient transparency), and status indicators (e.g. existence of a government-led national palliative care strategy).


While not perfect (the report stated that U.S. patients have to give up curative therapy to get palliative care), it is an interesting read. There are some illustrative examples of the many things that go into providing good end-of-life care (or don’t) in different countries, which help to paint a picture of the global situation out there for those who have only entertained the WHO Public Health Strategy for Palliative Care in theory.
  • Cultural taboos around death and dying in China, India, Uganda, Canada and the U.S.
  • Debate on euthanasia and physician-assisted suicide in the U.K., U.S., and Australia
  • Public awareness in China, Hong Kong, the U.S., and the U.K.
  • Funding models in Spain, the U.K., Ireland, Romania, South Africa, Uganda, Singapore, Taiwan, the U.S., Australia and India
  • Non-cancer patients extending length of stay in Spain, the U.K, and the U.S.
  • Government recognition of the importance of palliative care in the U.K., Australia, New Zealand, Canada, the U.S., and Hungary
  • Opioid availability in India, China, Taiwan, Romania, and Uganda
  • Integration into main-stream healthcare in Australia, the U.K., South Africa, Poland, and Uganda
  • Capacity building for home-based care in Singapore, Germany, Uganda, Taiwan, and the U.S.
  • Palliative care training in Uganda, Canada, China, and India

The key findings of the report were:
  • The UK leads the world in quality of death; many developed nations must work to catch up.
  • Combating perceptions of death, and cultural taboos, is crucial to improving palliative care.
  • Public debates about euthanasia and physician-assisted suicide may raise awareness, but relate to only a small minority of deaths.
  • Drug availability is the most important practical issue.
  • State funding of end-of-life care is limited and often prioritizes conventional treatment.
  • More palliative care may mean less health spending.
  • High-level policy recognition and support is crucial.
  • Palliative care need not mean institutional care, but more training is needed.

Whew! All that being said, little information was given on how some of the rankings were reached, or the basis for the weighting of the indicators. However, bottom line for all you competitive folks out there, the U.S. tied Canada for 9th. (Aargh! … as if the World Cup losses weren’t enough!) Our cost of end-of-life care rating, 31st out of 40, pulled us down in the overall rankings. The U.K. was ranked #1, but the Brits shouldn’t toot their horn too much just yet. They still came in 28th in the sub-category of Basic End-of-Life Healthcare Environment. To sum it all up, the rankings and the criteria are interesting as a frame of reference, a place to measure our successes and see where our opportunities for improvement may be, but even #1 U.K. has work to do to reach pallitopia.


“Now where,” you might ask, “is MY death-venture?” On the Life Before Death website, of course. Complete with a creepy voice and morbidly funny illustrations, you too can choose your funeral music, make your bucket list, say those things you haven’t said yet (and post them on Facebook)... you get the idea.  Check out Christian's post from July 15 for more details, and check out the website too for the cliff notes version of the report.


List (of the non-bucket variety) of links of potential interest:
Huffington Post pics of the 15 best places to die.
WSJ Health blog on QOD index.
Cultural Issues in End of Life Care blog from Europe.

Related in name, not in info, but interesting:
WBUR Inside Out website on radio documentary on the Quality of Death in America (2009)

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