Development of Public Health Priorities for End-of-Life Initiatives

Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
American Journal of Preventive Medicine (Impact Factor: 4.53). 01/2006; 29(5):453-60. DOI: 10.1016/j.amepre.2005.08.014
Source: PubMed


Recently, end-of-life (EOL) issues have captured the attention of the public health community. This study reports a project to help state health departments better understand their potential role in addressing EOL issues and develop initial priorities for EOL activities.
The project involved two studies. Study 1 (October 2002 to September 2003) involved a concept mapping process to solicit and organize recommendations from key stakeholders. Concept mapping integrates qualitative group processes with multivariate statistical analysis to represent the ideas of stakeholders visually through maps. A key-informant approach was used to identify stakeholder participants with expertise in aging, cancer, public health, and EOL. In two meetings, stakeholders used the maps to develop short-, intermediate-, and long-term recommendations for EOL initiatives. Study 2 (October 2003 to September 2004) involved a modified Delphi process with three iterations to prioritize recommendations for initial action from among a group of short-term recommendations.
Study 1 resulted in 103 recommendations for EOL initiatives across nine domains. Study 2 resulted in consensus on five initial recommendations from three domains: identifying an EOL point of contact in state health departments, collecting and analyzing data about EOL, incorporating EOL principles into state comprehensive cancer control plans, educating the public about hospice and palliative care, and educating the public about the importance of advance directives.
Diverse perspectives of key public health stakeholders resulted in a series of short- and longer-term recommendations for EOL action. These recommendations can guide future efforts by state health departments and other public health agencies to address EOL issues.

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    • "Several projects have used concept mapping to create logic models (Anderson et al., 2006), prioritize strategies (Rao et al., 2005), and plan and evaluate programs (Rosas, 2005). Project 2, conducted from April to July, 2013, involved a Delphi process. "
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    • "The implementation of a health promoting approach would provide an ideal opportunity for early stage care to be provided to patients who face life-limiting illness through, for example, the provision of education and information about palliative care services/illnesses that may, in turn, challenge personal fears and change attitudes (Scott, 1992). However, Kellehear (2009) warns against merely understanding health promoting palliative care purely as an approach to changing attitudes through awareness raising, education provision and increasing access to services as suggested by Rao et al. (2005). He emphasises the need to work in partnership with communities to stimulate community change and develop community led supports. "
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    Affiliation: Milford Care Centre
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    • "ivity that are directly relevant to the provision of palliative care: • Public education. • Patient, family and caregiver education. • Research, epidemiology and evaluation. • Professional education. • Policy and planning. Importantly, these areas are accompanied by a set of recommendations for action; for example, in the public education cluster, Rao et. al (2005) describe strategies to raise public awareness of palliative care, increase the use of advanced health directives,"
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