From the Book - Regular Print
Need for Consensus and Action 17 --
Initiatives to Improve Care at the End of Life 18 --
2 A Profile of Death and Dying in America 33 --
When People Die: The Aging of America 34 --
Why People Die: Causes of Death 37 --
Where People Die: Death in Institutions and Residences 39 --
How People Die: Symptoms of Impending Death 42 --
Attitudes Toward Dying and Death 44 --
3 Caring at the End of Life 50 --
Differences in Dying Pathways: Illustrative Cases 52 --
Determining and Communicating Diagnosis and Prognosis 59 --
Establishing Goals and Plans 64 --
Fitting Care to Goals and Circumstances 72 --
4 Health Care System and the Dying Patient 87 --
Characterizing Care Systems 88 --
Illustrative Case Histories 90 --
Settings for End-of-Life Care 95 --
Coordinating Care Within and Across Settings 107 --
Revisiting the Care System at the Community and National Levels 116 --
5 Accountability and Quality in End-of-Life Care 122 --
Concepts of Accountability and Quality 123 --
Evidence of Quality Problems in End-of-Life Care 126 --
Dimensions of Quality in Care at the End of Life 135 --
Measurement Instruments and Issues 139 --
Guidelines for Clinical Practice 149 --
6 Financial and Economic Issues in End-of-Life Care 154 --
Who Pays for Care at the End of Life? 155 --
What Is Spent for Care at the End of Life? 156 --
Do Financing Mechanisms Impede Good End-of-Life Care? 160 --
What About Proposals to Reduce the Cost of End-of-Life Care? 173 --
Prescription Laws and Barriers to Pain Relief 190 --
Informed Consent and Advance Care Planning 198 --
Physician-Assisted Suicide 203 --
8 Educating Clinicians and Other Professionals 207 --
Core Components of Professional Preparation for Care at the End of Life 209 --
Physician Education 210 --
Nursing, Social Work, and Other Professions 227 --
Continuing Professional Education 231 --
9 Directions for Research to Improve Care at the End of Life 235 --
A Symptom-Based Strategy for Biomedical Research 236 --
Social, Behavioral, and Health Services Research 244 --
Ethical Issues in Research on Dying Patients 251 --
Research Leadership 253 --
Today and Tomorrow 260 --
Findings and Recommendations 263 --
A Institute of Medicine Feasibility Study on Care at the End of Life August 1993-Feburary 1994 315 --
B Institute of Medicine Committee on Care at the End of Life Public Meetings 321 --
C Examples of Initiatives to Improve Care at the End of Life 327 --
D Prognosis and Clinical Predictive Models for Critically Ill Patients 358 --
E Cultural Diversity in Decisionmaking About Care at the End of Life 363 --
F Measuring Care at the End of Life 383 --
G Excerpts from Medical Guidelines for Determining Prognosis in Selected NonCancer Diseases 400 --
H American Board of Internal Medicine Clinical Competence in End-of-Life Care 405 --
I Examples of Medical Education Curricula 407.