Palliative care in the USA and England: a critical analysis of meaning and implementation towards a public health approach

Abstract

Delivering optimal and equitable palliative care is an international challenge. There are few cross-national comparisons examining challenges in expanding palliative care along public health lines. This paper presents a critical review of palliative care in the USA and England, which share similar challenges but have different contexts of healthcare.Beyond some obvious differences in the organisation of palliative care, a set of underlying common issues can be identified. A key tension in both is balancing attention 'downstream' in the dying phase, as well as 'upstream' earlier in the course of serious illness. In both, the dominant models of palliative care provision have resulted in excellent care towards the end of life for some patients, but there remain major deficiencies in care for the majority. England has a National Strategy for Endof-life care; the US has no equivalent, although a number of influential agencies have published statements.Achieving a public health approach in palliative care requires international consensus on the meaning and target population of palliative care, replacement of prognosis based understandings of entitlement to palliative care with a needs based approach, and development of an evidence base for cost effective partnerships between providers across the specialist-generalist divide.

Patient and carer involvement in palliative care research: An integrative qualitative evidence synthesis review

“…119,123 The lack of diversity found among those involved was shown to reflect many of the inequalities found in the wider context of palliative care service provision, where some communities receive limited palliative care services or a poorer quality of care, including patients with non-cancer conditions, people from BAME backgrounds, older people and those living in deprived areas. 124–126 To increase diversity, there needs to be greater emphasis on the process of involvement, to address issues such as access and flexibility, using a variety of involvement methods, adapting or changing them over time. The evidence base for this is gradually developing, with studies in palliative care and other fields beginning to use more innovative approaches.…”

Understanding the organization of hospital-based palliative care in a Nigerian Hospital: An ethnographic study

“…[3] There is also a hospice-based model in the US but largely nondisease-focused treatments rendered in patients' homes, inpatients' hospice facilities, nursing homes, residential facilities, and acute care hospitals. [34] Overall, PC in the UK is organized into specialist and generalist levels. [5] The specialist level provides hospital-based care led by a National Health Services multidisciplinary team and hospice care in which patients do not need to relinquish disease-focused treatment, unlike in the US.…”

“…[5] The specialist level provides hospital-based care led by a National Health Services multidisciplinary team and hospice care in which patients do not need to relinquish disease-focused treatment, unlike in the US. [46] The hospice care model in the UK provides care through inpatient beds, day care, home hospice, and care homes. [7] The generalist level comprises all other health-care professionals but is supported by specialist teams to provide PC services in various care settings.…”

Referral of Patients with Nonmalignant Chronic Diseases to Specialist Palliative Care: A Study in a Teaching Hospital in Ghana

“…Palliative care development in the developed western countries such as the United States of America and the United Kingdom, as well as in East and South Africa, has advanced rapidly [15,16]. However, its development and progress in West Africa has been rather slow [17].…”