Foreword
The policy priority attributed to end-of-life care is too low given its impact on society. Care needs are changing with the rise of chronic diseases so that there will be more people dying often after long periods lived with chronic or debilitating diseases such as organ failure, cancer and with dementia (which is rising particularly rapidly). Currently, 80% of deaths happen among those aged 65 and above, and 50% of deaths occur among people aged 80 and above. Close to 7 million people needed end-of-life care in the OECD prior to the COVID-19 pandemic, in 2019, but with the share of people 80 and above doubling by 2050, many of whom living with chronic conditions, this number will rise to 10 million by 2050.
End-of-life care refers to the provision of palliative care in the last stages of life – which entails physical, emotional, social, and spiritual support – while also including curative care provided at the end of life, such as actions intended to sustain or prolong life. Rather than focusing on improving quality of life, life-prolonging measures are sometimes continued near the end of life. This is due among others to a lack of palliative care services, especially at home and in communities, but also to the ethical and other challenges of deciding the appropriate timing to discontinue treatment.
This report reviews end-of-life care policies across OECD countries, along the following policy dimensions: accessibility, people-centredness, quality, financing, and governance. It examines different policy solutions ranging from providing sufficiently trained staff across at the person’s home and in long-term care homes, to improving knowledge of professionals about conducting conversations on care preferences, ensuring quality standards, and strengthening funding models and governance. The 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.