Allan Kellehear's research while affiliated with University of Vermont and other places

Publications (121)

Article
The sporadic occurrence of unusually enhanced mental clarity before death has been documented over time and cultures, and reported in patients with and without neurodegenerative diseases, psychiatric disorders, and other neurocognitive deficits, as well as those with nonterminal and terminal conditions. Using a purposive sampling method via existin...
Article
Bereavement, a specific kind of grief in response to a death, has been embedded in human history, in cultural patterns, with ritual, ceremony, and community kindness being the mainstay of grief support. The advent of professionalised grief counselling has seen the increasing domination of professional support as the best way to support someone bere...
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Background Compassionate communities build on health promoting palliative care that aims to address gaps in access, quality, and continuity of care in the context of dying, death, loss, and grief. While community engagement is a core principle of public health palliative care, it has received little attention in empirical studies of compassionate c...
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Full-text available
Background Compassionate communities build on health promoting palliative care that aims to address gaps in access, quality, and continuity of care in the context of dying, death, loss, and grief. While community engagement is a core principle of public health palliative care, it has received little attention in empirical studies of compassionate c...
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This essay offers a critical assessment and reflection on the field of public health based on policy directions and themes gleaned from the historical story of John Snow and the Broad Street pump in 19th century London and recent international responses to Covid‐19. Dominant public health strategies, especially for infectious disease emergencies, d...
Article
This theoretical paper describes a classification with accompanying analysis of the main forms of social conduct at the end of life that goes beyond our usual understanding of sociological characterisations of dying. A taxonomy of end-of-life conduct is presented that illustrates and categorises past and contemporary sociological studies of end-of-...
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This article presents an interview with lead authors Dr Libby Sallnow and Dr Richard Smith of the ‘Report of the Lancet Commission on the Value of death: bring death back to life’ published in January 2022. The authors are interviewed by Julian Abel, Director of ‘Compassionate Communities UK’, and Allan Kellehear the Co-Editor-in-Chief of ‘Palliati...
Article
Background After significant early interest in aging and dying, recent empirical studies have been few and theoretically fragmented. Objective The aims of this review were to map what is empirically known about the intersections between existential aging (a sense of passing years that evoke a sense of nearness-to-death) and dying identity and to d...
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Background Compassionate communities are rooted in a health promotion approach to palliative care, aiming to support solidarity among community members at the end of life. Hundreds of compassionate communities have been developed internationally in recent years. However, it remains unknown how their implementation on the ground aligns with core str...
Chapter
This chapter introduces the idea of the social ecology of health and links this approach to the social ecology at the end of life. This approach is founded upon a ‘setting’-based, or place-based, set of ideas that links health and illness to characteristics of the physical and social environment. From these frameworks emerge practice methods to dir...
Article
This is a book about the public health approach within palliative care. Often when we think about ‘public health’ it is more usual to think about palliative care as part of the public health system—similar to the hospitals, nursing homes, community clinics but also the broader supports for population health such as sewerage and water purification s...
Chapter
Public health palliative care draws its main ideas and methods from the wider field of the new public health. This chapter outlines the key ideas of the new public health and identifies the main reasons this approach has emerged from earlier historical ideas about public health and healthcare. Three non-palliative care examples (the long-term manag...
Chapter
The first comprehensive and authoritative textbook on the growing specialty of public health palliative care. Written by international leaders in the field. Explores the role of 'new' public health, or health promotion, as the basis for the development of public health palliative care. Looks beyond the traditional symptom-focused view of palliat...
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Access to palliative care is commonly considered as solely a health services challenge rather than a community challenge. Successive healthcare reports continue to pose the question of access and its solution in terms that ask what a service can do rather than what an ally a service can become. However, the question is not what can we do for disadv...
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In the last 100 years, American orphanages have dramatically declined at the same time as nursing homes have seen exponential growth. This paper reviews the common understanding and assumptions about these two distinct histories and asks: why have these national responses been so different when the populations at the center of them are so similar?...
Article
Compassionate Cities programs are civic efforts to contribute to the work of palliative care by providing a variety of supports – educational, interpersonal, policy-oriented – for the end of life care needs for people from all walks of life in the wider society. These programs are public health initiatives that trace their history to the WHO Health...
Article
Background: Reducing emergency admissions to hospital has been a cornerstone of healthcare policy. Little evidence exists to show that systematic interventions across a population have achieved this aim. The authors report the impact of a complex intervention over a 44-month period in Frome, Somerset, on unplanned admissions to hospital. Aim: To...
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Aims: To determine who provides bereavement support in the community, what sources are perceived to be the most or least helpful and for what reason, and to identify the empirical elements for optimal support in developing any future compassionate communities approach in palliative care. Design: A population-based cross-sectional investigation o...
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The UK Palliative Medicine Syllabus is critically evaluated to assess its relationship and relevance to contemporary palliative care policy and direction. Three criteria are employed for this review: (1) relevance to non-cancer dying, ageing, caregivers, and bereaved populations; (2) uptake and adoption of well-being models of public health alongsi...
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Background: If global palliative care is to successfully address challenges of unequal access, continuity of care, and health services reductionism, new practice models to address these issues need to be identified, debated and tested. This paper offers one such practice model based on a public health approach to palliative care that has so far sh...
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Background: A program of Compassionate City or Community (CC) has been designed and developed in the City of Vic (43,964 habitants, Barcelona, Spain), based on The Compassionate City Charter and other public health literature and experiments, with the joint leadership of the City Council and the Chair of Palliative Care at the University of Vic, a...
Chapter
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This chapter briefly outlines the history, key concepts, and main practice methods from public health approaches to end -of -life care. Although linked to psychosocial care approaches, its main methods draw not from psychology or health services inspired approaches but rather from health promotion, community development, and civic engagement. Key m...
Article
Purpose The purpose of this paper is to understand the need and resources firefighters have to deal with death and dying (D&D) that they encounter whilst on duty and to present a curriculum to support D&D issues for firefighters. Design/methodology/approach A qualitative methodology involving focus groups was conducted in two fire stations in Spai...
Article
Background Social isolation is recognised for its substantial impact on mortality, ranking above many established public health threats. The end of life can compound this problem; with escalating acute care costs due to poor social support and rising numbers of deaths, new solutions are needed. Examples of peers providing social support exist withi...
Article
This article makes critical observations about the popular examination of dying and its care, identifies the key challenges to modern dying, and argues for a public health approach to end-of-life care. Only by adopting a global and non-clinical perspective on the human experience of dying can we address people’s concerns where these arise—in their...
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The clinical and social epidemiology of living with a life-threatening or life-limiting illness, frail ageing, long-term caregiving, and grief and bereavement is well documented in the palliative care, psycho-oncology and psychiatric literature but this investigation asks what interest exists from the mainstream public health sector in these health...
Article
The diagnosis of hallucination for unusual perceptions such as deathbed visions, near-death experiences, or visions of the bereaved, is unhelpful in palliative medicine both academically and clinically. This paper reviews the broad prevalence data about unusual perceptions in the general population as background to identifying the more narrow epide...
Article
Palliative care, since its inception over 60 years ago, has set the standard of how to care for people who are dying. Key features among these standards have been the professional development of clinical specialisms such as palliative medicine and palliative nursing; the essential addition of the multidisciplinary team to these two new specialisms...
Article
This article provides an academic and professional context for the articles written for this special issue. It discusses 4 broad questions often asked about the public health approach to palliative care: what is the evidence for the effectiveness of the approach?; will this approach embedded inside palliative care services deliver the kinds of soci...
Chapter
This article supplies an introduction to the epidemiology of death and dying with an emphasis on global patterns of end-of-life decline. The introduction is then followed by an outline of the principles of health promotion and especially health promotion in palliative care. The importance of community development is emphasized. The article closes w...
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For most people, home is the preferred place of care and death. Despite the development of specialist palliative care and primary care models of community based service delivery, people who are dying, and their families/carers, can experience isolation, feel excluded from social circles and distanced from their communities. Loneliness and social is...
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Communities play an increasingly significant role in their own health and social care, and evidence demonstrates the positive impact of this work on a range of health outcomes. Interest is building regarding the application of the principles of the new public health approach to those facing the end of life and their families and communities. To rev...
Book
Compassionate communities are communities that provide assistance for those in need of end of life care, separate from any official heath service provision that may already be available within the community. This idea was developed in 2005 in Allan Kellehear’s seminal volume- Compassionate Cities: Public Health and End of Life Care. In the ensuing...
Article
: This one-hour symposium considers Milford Care Centre's Compassionate Communities Good Neighbour Partnership and it's evaluation by an international team, led by Maynooth University and funded by the All Ireland Institute of Hospice and Palliative Care, The Irish Cancer Society, The Irish Hospice Foundation and Milford Care Centre. The symposium...
Article
The current systems of care for dying persons, the people caring for them, and the bereaved operate in ways that frequently lack sufficient sensitivity to their needs. We describe a new model for dying, death, and loss that adopts a public health approach. Specifically, we describe a deliberative process that resulted in a charter for a public heal...
Article
This article is a review of Robert Kastenbaum's 1979 essay entitled "Healthy dying: A paradoxical quest continues." It begins with a summary of the arguments and challenges in the original essay. This is followed by an evaluation of his original claims in the light of contemporary insights in modern public health history and empirical studies of ne...
Article
In early 2013 an online survey of over 200 UK palliative care services published in the British Medical Journal found that most of these services were prioritizing 'community engagement' initiatives, most commonly adopting a 'compassionate community' model. Later this same year, a report released by the National Council for Palliative Care and the...
Article
This article argues that vigils for the dying owe their origins to traditional wake behavior. By viewing vigils for the dying as wake behavior, the different social conduct observed around vigils for the dying can be viewed more systematically and predictably. Vigils represent so much more than ways to manage loss and grief or to shore up support a...
Article
Once it was difficult to see end of life care beyond conventional medical intervention, but hospice and palliative care introduced a more holistic approach, providing quality of life for the dying and their families. This ground-breaking work takes end-of-life care beyond these palliative boundaries, describing a public health vision that involves...
Article
This paper reports the principle findings of a national, cross-sectional, interview-based study of the experiences of people who cared for a dying family member in the Republic of Moldova. Study data, collected from 102 interviews, covered four broad areas: the experiences of the dying person; family members' own experiences of caring; the practice...
Chapter
This chapter reviews the key social and cultural dimensions that influence family carers, also noting how less recognized influences, such as hidden relationships, might be important influences on family care behaviour. It argues for a public health response to family care that goes beyond direct service provision. It argues that health promotion,...
Article
This is an interview-based study of 102 families and their observations of the last weeks and days of a dying family member. Forty-one families reported hearing about "visions," "hallucinations," or "dreams" from their dying loved one before their death. Of these 41 mixed cases, 37 cases demonstrated classic features of deathbed visions-reports of...
Article
This article outlines key approaches for a health promoting approach to end-of-life care. Although direct service provision for end-of-life care and bereavement are crucial to any public health approach to dying, death and loss, a broader public health approach – one that targets people in good health and outside acute episodes of need – is also vi...
Article
This is an interview-based study of 104 families and their observations of the last weeks and days of a dying family member. Forty families reported "unusual experiences and behaviors" from the dying person in their last period of life. Thirty of these dying persons displayed behavior consistent with deathbed visions-interacting or speaking with de...
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Older people who die alone are commonly portrayed negatively in the academic and popular literature. Dying alone is viewed either as an outcome of anti-social behaviour or the result of family, neighbourhood or social services neglect. The idea that people may be exercising agency, resistance or dissent at the end of life and that they do not want...
Article
This review compares and contrasts the major reoccurring themes in two sources of research literature - social studies of dying and human suffering. The purpose of such a comparison is to employ the major insights of each field as a useful method of critically evaluating the insights of the other. Critical exchanges and comparisons between the rese...
Article
This is a descriptive case study employing a photographic survey of the numerous objects that patients and their social networks bring to a hospice setting. Photographs were taken of all objects kept by the bedside by 31 inpatients in a hospice in the UK county of Durham. These objects ranged from assorted food and drink, greetings cards and magazi...
Article
In November 2006 a joint National Institute for Health and Clinical Excellence (NICE) and Social Care Institute for Excellence (SCIE) guideline to improve the care of people with dementia was released. This influential policy document reflects both a medicalized approach to care (emphasizing pharmacological management and health services) as well a...

Citations

... Abel and Kellehear recently outlined a vision of reimagining public health in this journal. 1 As a patient co-designed care model group consultations support that vision, inherently supporting, developing and maintaining compassionate communities, as well as creating time and space for Lifestyle Medicine. 2 During the challenges of the pandemic, increased virtual networking, training and delivery of virtual group consultations have been a silver lining. ...
... These are complex and hard earned capacities." (15). Practice examples of both compassionate cities and compassionate communities (16) exist across multiple continents (17). Large towns and cities have developed policies and practices of support among businesses, schools, workplaces, local governments, faith groups, and for local prisons or homeless populations. ...
... Close partnerships between clinician communities, patients and their caregivers, and key groups, such as universities, are likely to be key to the successful development and adoption of public health interventions in palliative care (10). Despite this, the focus of partnerships in public health has often included an emphasis on partnerships with community organizations and faith-based groups, as well as members of the public (11). Less emphasis has been placed on partnerships from within the professional healthcare system (e.g., communities of practices inclusive of palliative care service providers), and the involvement of patients, their caregivers, and the public is also often neglected. ...
... The objective of such care teams is to enhance the quality of life of patients and their carers through a range of services, such as symptom management, counseling, arranging psychological support and social assistance, and discussions about the goals of care with the patient and caregivers [11]. Abel et al. (2018) promote the public health approach or health-promotive approach to palliative care as "the new essentials model" to reshape services by coordinating specialist palliative care, generalist palliative care, compassionate communities, and the civic approach to end-of-life care [15]. The Ottawa Charter for Health Promotion, which guides public health palliative care, respects communities' capacity to identify needs and strengths, determine priorities, and formulate goals and strategies [16]. ...
... Compassionate Communities at the end of life have been conceived as a model of social innovation that complements palliative care towards integrated health, social and community care [1][2][3][4]. In addition, compassion has been shown to improve the quadruple aims of improving patient experiences, population health, professional experiences and organizational effectiveness [5]. ...
... Our findings bring into sharp focus the importance of attitudes in influencing opioid accessibility. The Lancet Commission on the Value of Death highlights how unequal deaths follow unequal lives [27]. This is evident, when costs of opioid or of travelling to prescribing centres limit access to treatment [28,29]. ...
... for people with palliative care needs within their networks and neighborhoods (13,14). The identification and harnessing of community-specific assets with recognition of shared concerns may better reflect and serve the needs and wishes of ethnically and socially diverse populations than traditional service responses alone (10). ...
... Cervical cancer is the second most prevalent cancer in women in South Africa. Recent data reveal that 6945 cases of cervical cancer were diagnosed in 2019 being 15.85% of all histologically diagnosed cancers (Cancer Statistics NICD, 2022: https://www.nicd.ac.za), with an estimated mortality of 19.6 per 100,000 population (Global Cancer Observatory, 2022: https://gco.iarc.fr). Therefore, cervical cancer is a public health problem in South Africa. ...
... Potentially relevant studies were retrieved in full, and their citation details imported into the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI; JBI, Adelaide, Australia). 31 The full text of selected citations was assessed in detail against the inclusion criteria by 2 independent reviewer (MI and KM). Reasons for exclusion of full-text studies that did not meet the inclusion criteria were recorded and reported. ...
... what the patient is saying or doing (Callanan and Kelley, 1992;Kellehear, 2020). A universal definition of ELDVs is urgently needed as misinterpretation of ELDVs by healthcare professionals may lead to inappropriate administration of medical interventions which may inhibit the dying persons' ability to communicate meaning at the end of life resulting in an increased sense of isolation (Callanan and Kelley, 1992;Barbato, 2009;Doka, 2020;Kerr and Mardrossian, 2020). ...