We’ve come in at number four in an international study that ranks countries on how well they provide end-of-life care.
Australia has come in at number four in an international study that ranks countries on how well they provide end-of-life care.
Only six of the 81 countries examined in the research, published in the Journal of Pain and Symptom Management, received A grades in the assessment of their end-of-life care. And nearly half of countries received a grade of D or F in the quality of death and dying.
“Most end-of-life patients, even in high income countries, die in pain and after experiencing serious health-related suffering, not at their place of choice, under significant psychological distress, and, prior to death, often express regret about how the last period of their life was spent,” the authors wrote.
“The six countries who received the highest assessment scores and a grade of A [in order] were United Kingdom, Ireland, Taiwan, Australia, Republic of Korea, and Costa Rica. Only Costa Rica [upper middle] is not a high-income country.”
New Zealand was among the 23 countries to receive a B grade, along with Hong Kong, Switzerland, Germany, France, Japan Canada, Singapore, Sweden and Spain. The US scored a C grade, along with 16 other countries.
“Results highlight the large disparities in assessments of the quality of end-of-life care across countries, and especially between the highest income countries and others,” the authors wrote.
The study set out to score, grade, and rank countries on the quality of end-of-life care, based on assessments from country experts using a novel preference-based scoring algorithm. While the number of countries researched made up of only 37% of all countries, they encompassed 81% of the world’s population.
Experts around the world were asked to assess the performance of their country on 13 key indicators of end-of-life care.
These included questions about the places where patients were treated and whether they were able to be cared for and die at the place of their choice; the levels and quality of life extending treatments and whether health care professionals supported patients’ spiritual, religious, and cultural needs; how care was coordinated across difference providers; pain and discomfort control; emotional support and the provision of information to allow patients to make informed decisions; contact was encouraged with friends and family; and whether costs were not a barrier to a patient receiving appropriate care.
Results were combined with preference weights from caregiver-proxies of recently deceased patients to generate a preference-weighted summary score. The scores were then converted to grades (from A–F) and a ranking was created for all included countries.
“The final sample included responses from 181 experts representing 81 countries with two or more experts reporting,” the authors wrote.
China, Vietnam, Russia, India and Greece were among 15 countries to receive a D grade, while Iraq, Ethiopia, South Africa, Nepal, Malaysia were among the remaining 21 to score the lowest with an F grade.
As the results show, living in a country with, or even receiving, specialised palliative care did not guarantee a high-quality end-of-life experience.
“Despite a lack of systematic reporting in most countries, there is overwhelming evidence that even high-functioning health systems often fail to deliver on aspects of end-of-life care that are important to patients with advanced illness and their caregivers,” the authors wrote.
They also provided an additional indicator to allow policymakers to take stock of where they are in terms of end-of-life care delivery.
“This includes increasing access to opioids and other essential medicines to relieve serious health-related suffering, universal health coverage of end-of-life services to avoid medical bankruptcy, education and training programs to increase capacity to deliver high quality EOL care (including by lay health workers), integrated care delivery, and greater oversight to increase quality, including quality of communication,” they said.
Other factors that could indirectly improve end-of-life care delivery, included public education programs, promotion of compassionate communities, and higher investments in research.
Journal of Pain and Symptom Management 2021, online 21 December
