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Improving the Care of the Dying

The Institute of Medicine's Seven Recommendations

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1. People with advanced, potentially fatal illnesses and those close to them should be able to expect and receive reliable, skillful, and supportive care.

2. Physicians, nurses, social workers, and other health professionals must commit themselves to improving care for dying patients and to using existing knowledge effectively to prevent and relieve pain and other symptoms.

3. Because many problems in care stem from system problems, policymakers, consumer groups, and purchasers of health care should work with health care practitioners, organizations and researchers to:

strengthen methods for measuring the quality of life and other out comes of care for the dying patients and those close to them

develop better tools and strategies for improving the quality of care and holding health care organizations accountable for care at the end of life

revise mechanisms for financing care so that they encourage rather than impede good end-of-life care and sustain rather than frustrate coordinated systems of excellent care

reform drug prescription laws, burdensome regulations and state medical board policies and practices that impede effective use of opioids to relieve pain and suffering.

4. Educators and other health professionals should initiate changes in undergraduate, graduate and continuing education to ensure that practitioners have relevant attitudes, knowledge and skills to care well for dying patients.

5. Palliative care should become, if not a medical specialty, at least a defined area of expertise, education and research.

6. The nation's research establishment should define and implement priorities for strengthening the knowledge base for end-of-life care.

7. A continuing public discussion is essential to develop a better understanding of the modern experience of dying, the options available to patients and families, and the obligations of communities to those approaching death.

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