Gearing health services for the needs of the dying
16/03/2007
Doctors writing to the British Medical Journal have called for urgent reforms to improve the health needs of people in the last phase of life. Sydney Dy and Joanne Lynn, two palliative care doctors, point out that only a few per cent of people in developed countries die suddenly, but traditional hospital and surgical services no longer match most patients’ serious chronic illnesses - a fact that calls for substantial restructuring.
Both doctors argue that developed countries build health care systems as if disability and ill health were aberrations, rather than a foreseeable phase that lasts months or years nearer the end of most of our lives. And since the number of people living with serious chronic conditions in old age will double within the next two decades, finding sustainable ways to improve comfort and meaningfulness in this last phase of life has become a priority.
Patients coming to the end of life generally tend to follow one of three patterns, with different priorities and needs, they explain. For example, patients with a short period of decline need continuity of care and aggressive symptom management, such as expert pain relief. Those with chronic organ system failure need disease management and advance planning, while those with long-term dementia or frailty need support services rather than intensive treatment.
They say that care services need to be customised and redesigned to match the needs, rhythms, and situations of these three basic patterns, offering a promising way to improve outcomes for patients sick enough to die. And if communities can build care systems that reliably serve patients in each of the three patterns in their area, then almost everyone living there could count on good care in the last phase of life.
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