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Tables of Contents for Approaching Death
Chapter/Section Title
Page #
Page Count
SUMMARY
1
13
1 INTRODUCTION
14
19
The Need for Consensus and Action
17
1
Initiatives to Improve Care at the End of Life
18
3
Overview of Report
21
1
Guiding Principles
22
1
Concepts and Definitions
23
9
Conclusion
32
1
2 A PROFILE OF DEATH AND DYING IN AMERICA
33
17
When People Die: The Aging of America
34
3
Why People Die: Causes of Death
37
2
Where People Die: Death in Institutions and Residences
39
3
How People Die: Symptoms of Impending Death
42
2
Attitudes Toward Dying and Death
44
2
Conclusion
46
4
3 CARING AT THE END OF LIFE
50
37
Differences in Dying Pathways: Illustrative Cases
52
7
Determining and Communicating Diagnosis and Prognosis
59
5
Establishing Goals and Plans
64
8
Fitting Care to Goals and Circumstances
72
14
Conclusion
86
1
4 THE HEALTH CARE SYSTEM AND THE DYING PATIENT
87
35
Characterizing Care Systems
88
2
Illustrative Case Histories
90
5
Settings for End-of-Life Care
95
12
Coordinating Care Within and Across Settings
107
9
Revisiting the Care System at the Community and National Levels
116
2
Conclusion
118
1
Addendum
119
3
5 ACCOUNTABILITY AND QUALITY IN END-OF-LIFE CARE
122
32
Concepts of Accountability and Quality
123
3
Evidence of Quality Problems in End-of-Life Care
126
9
Dimensions of Quality in Care at the End of Life
135
4
Measurement Instruments and Issues
139
10
Guidelines for Clinical Practice
149
3
Conclusion
152
2
6 FINANCIAL AND ECONOMIC ISSUES IN END-OF-LIFE CARE
154
34
Who Pays for Care at the End of Life?
155
1
What Is Spent for Care at the End of Life?
156
4
Do Financing Mechanisms Impede Good End-of-Life Care?
160
13
What About Proposals to Reduce the Cost of End-of-Life Care?
173
11
Conclusion
184
1
Addendum
185
3
7 LEGAL ISSUES
188
19
Prescription Laws and Barriers to Pain Relief
190
8
Informed Consent and Advance Care Planning
198
5
Physician-Assisted Suicide
203
3
Conclusion
206
1
8 EDUCATING CLINICIANS AND OTHER PROFESSIONALS
207
28
Core Components of Professional Preparation for Care at the End of Life
209
1
Physician Education
210
17
Nursing, Social Work, and Other Professions
227
4
Continuing Professional Education
231
1
Conclusion
232
3
9 DIRECTIONS FOR RESEARCH TO IMPROVE CARE AT THE END OF LIFE
235
24
A Symptom-Based Strategy for Biomedical Research
236
8
Social, Behavioral, and Health Services Research
244
7
Ethical Issues in Research on Dying Patients
251
2
Research Leadership
253
5
Conclusion
258
1
10 CONCLUSIONS AND RECOMMENDATIONS
259
13
Today and Tomorrow
260
3
Findings and Recommendations
263
8
Concluding Thoughts
271
1
REFERENCES
272
43
APPENDIXES
315
104
A Institute of Medicine Feasibility Study on Care at the End of Life August 1993-February 1994
315
6
B Institute of Medicine Committee on Care at the End of Life Public Meetings
321
6
C Examples of Initiatives to Improve Care at the End of Life
327
31
D Prognosis and Clinical Predictive Models for Critically Ill Patients
358
5
E Cultural Diversity in Decisionmaking About Care at the End of Life
363
20
F Measuring Care at the End of Life
383
17
G Excerpts from Medical Guidelines for Determinging Prognosis in Selected NonCancer Diseases
400
5
H American Board of Internal Medicine Clinical Competence in End-of-Life Care
405
2
I Examples of Medical Education Curricula
407
6
J Committee Biographies
413
6
INDEX
419