UICC World Cancer Congress 2006

Objective: End-of-life (EOL) issues (e.g. palliative care, death with dignity) are emerging societal concerns meriting public health involvement. Data indicate that as many as 50% of dying individuals, particularly those with cancer, experience unrelieved suffering in their final days. EOL care is also associated with considerable financial impact for families and society. A recent project to define public health priorities for EOL recommends incorporating EOL principles in all state/territory/tribe Comprehensive Cancer Control (CCC) plans. We assessed the degree to which EOL principles are currently included in CCC Plans.

Methods: Data collection and analysis proceeded in 4 steps: 1) identifying completed plans (i.e., adopted by the state/territory/tribe coalition), 2) reviewing and abstracting EOL information (keywords, topics), 3) determining inter-rater reliability, and 4) analyzing and reporting descriptive results.

Results: Thirty-eight states and 1 tribal organization had eligible plans. Overall, 34 CCC Plans (87%) included the phrase “end-of-life” (excluding definitions) and 22 (56%) had an EOL-related (EOL, palliative care, hospice) section. Fifteen (38%) plans included state-specific EOL data, most frequently on use of hospice or duration in hospice. EOL goals were most often categorized as access to care, use of care, and awareness of EOL principles among providers. The top EOL strategies were research, quality improvements, and provider education. We found that CCC planners are beginning to address EOL in the spectrum of cancer care and planning. This initial characterization of EOL should result in improved assistance in future CCC planning efforts.