1. End of Life Care and Public Health: Integrative Models

2. 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

3. Addressing the population perspective of end of life  The WHO PHS model  England’s approach to end of life care

4. 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.

5. 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

6. 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/homehttp://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 http://www.endoflifecare-intelligence.org.uk/view?rid=158

7. 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/homehttp://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.pdfhttp://www.who.int/cancer/media/FINAL-PalliativeCareModule.pdf