Chapter

Research to Improve End-of-Life Care in the United States: Toward a More Behavioral and Ecological Paradigm

Russell K. Portenoy and Eduardo Bruera

in Issues in Palliative Care Research

Published in print September 2003 | ISBN: 9780195130652
Published online November 2011 | e-ISBN: 9780199999842 | DOI: http://dx.doi.org/10.1093/acprof:oso/9780195130652.003.0018
Research to Improve End-of-Life Care in the United States: Toward a More Behavioral and Ecological Paradigm

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This chapter starts with a brief historical overview of the way in which end-of-life care has been conceptualized by policy makers, bioethicists, and researchers in the United States. It then takes up the question of how best to design and evaluate intervention studies aimed at improving end-of-life care. It offers two related arguments. The bioethical focus on case-based clinical ethics coupled with emphasis in the United States on patient self-determination created a bias toward research focused predominantly on decision making about the use or withdrawal of life-sustaining treatments. Reliance on a strictly biomedical model of research has constrained improvement efforts and should be expanded to include methods drawn from the social sciences and from the specialized fields of physician behavior change, organizational development, and continuous quality improvement. The chapter concludes with a call for a more behavioral and ecological model of research rather than a strictly biomedical model.

Keywords: United States; bioethicists; end-of-life care; social sciences; physician behavior; life-sustaining treatments; self-determination

Chapter.  7660 words. 

Subjects: Palliative Medicine

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