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 for End 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 for Improving 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