Palliative and end-of-life care: policy analysis.
OBJECTIVE
To present an overview of policy issues affecting hospice and palliative care focusing on the nursing home and hospital settings and to discuss factors affecting end-of-life care, policy initiatives, recent legislation, and nursing implications.


METHODS
Published articles; technical, advisory, and research reports (from government, professional, and private organizations); newsletters; textbooks; meeting minutes; online references; and legislative documents.


RESULTS
Improvements are needed in end-of-life care, especially with regard to access, delivery, and financing of such services. Legal, organizational, and reimbursement policies, as well as healthcare professional education, have been identified as areas that need improvement. The nursing shortage and variable reimbursement policies for nursing services have a significant impact on access to quality end-of-life care, especially for underserved populations.


CONCLUSIONS
A need exists for further research, including demonstration projects to test new ways to deliver and integrate hospice and palliative care throughout the illness continuum. Education and research are needed regarding symptom management, communication and decision making, caregiver support, and other end-of-life issues. Nursing interventions, palliative care networks, and other models that promote a coordinated approach to care delivery have been shown to decrease costs and improve quality of care.


CONCLUSIONS
Nurses play a key role in advancing improvements in palliative and end-of-life care through their involvement in educational, quality improvement, research, and legislative initiatives. Nursing activities in these areas may contribute to improved access, lower costs, and improved quality of care in advanced illness.
Reb
Anne M
AM
College of Nursing, University of Maryland, Baltimore, MD, USA. amrreb@aol.com
D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D004506:Education, Nursing; D019317:Evidence-Based Medicine; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence; D017051:Hospice Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006801:Humans; D006278:Medicare; D024802:Nurse's Role; D009859:Oncology Nursing / Q000193:education / Q000458:organization & administration* / Q000592:standards; D010166:Palliative Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D011050:Policy Making; D011787:Quality of Health Care / Q000458:organization & administration; D012051:Reimbursement Mechanisms; D013727:Terminal Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D014481:United States