Time for Better Care at the End of Life

With more chronic conditions and an ageing population, a growing share of the population will need end-of-life care, reaching close to 10 million people by 2050. While end-of-life care services help improve quality of life through relieving pain and other symptoms, currently, there are substantial gaps in the provision of services. More than half of deaths still occur in hospital across OECD countries, despite home generally being the preferred place of death, because of lack of appropriate services and poor care co-ordination. There are marked inequalities in access with people from higher education twice as likely to receive end-of-life care services than those with low education. Planning, recording of wishes and shared decision-making fall short of what is desirable, with only one-quarter of wishes being recorded in the form of advance directives. People at the end of life do not always receive appropriate symptom relief, while others suffer from overtreatment. This report suggests avenues to improve care for the dying by enhancing measurement and monitoring of quality and rethinking funding and governance models of care. End-of-life care could also be improved by increasing knowledge among health care staff across different care settings, and making communication around the topic more person-centred.

Available from February 07, 2023

In series:OECD Health Policy Studiesview more titles

TABLE OF CONTENTS

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Foreword	Read PDF
Executive summary	Read PDF
Assessment and recommendations	Read PDF
Removing barriers to access end‑of‑life care	Read PDF
Making end-of-life care more people‑centred	Read PDF
Renewing focus on high-quality end-of-life care	Read PDF
Ensuring that end-of-life care is appropriately financed	Read PDF
Strengthening governance and evidence‑based design for end‑of‑life care	Read PDF

LAUNCH EVENT

The OECD report was launched on February 7, 2023 through an online event to highlight the growing priority of improving end-of-life care as well as discuss the way forward in terms of policies in the areas of workforce, quality, funding and governance. It brought together experts, practitioners and representatives of civil society.
Watch the event
Download the presentation for the launch

Policy Highlights

The report finds that end-of-life care does not always reflect the wishes of the patient and that, across OECD countries, hospitals are the predominant place of death, accounting for more than 50% of deaths. Key findings of the report are that:

Too many people receive sub-par care in their last days or months of life. Access to services is often insufficient and unequal, especially at home
Professionals often fail to discuss choices that provide people a dignified end of life, and their care preferences are rarely recorded
Care provided at the end of life often fails to alleviate people-suffering and limit unnecessary treatments
Costs at the end of life are high for both the public purse and families, while not necessarily delivering quality of life, and there are questions about which different care models could improve outcomes for patients while reducing costs
Putting end-of-life care higher in the policy agenda and implementing a more comprehensive set of policies would make the end of life a more meaningful and humane experience for people and their relatives, and improve the outcomes achieved for the resources invested

Mean percentage of people using palliative care of hospice for the deceased who died at age 65 or over, by country
Share of people who used hospice or palliative care before dying at age 65 or older, 2017-2019

Hospice or palliative care use

Note: Weighted using cross-sectional weight from last core interview.
Source: Survey of Health, Ageing and Retirement in Europe (SHARE - Waves 7-8), Health and Retirement Study (HRS - Wave 14).

Santé

Time for Better Care at the End of Life

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