Worldwide Study Quantifies Quality End-of-Life Care

Some of the richest countries fail to provide quality end-of-life care for patients.

If a good death comes at a cost, why isn’t one of the richest nations making the grade? The United States spends more on healthcare than any other nation in the world. In 2018, the U.S. paid $365 billion for end-of-life care for millions of Americans, including palliative and hospice services. But the U.S. ranks only 43^rd in a worldwide appraisal of 81 countries on their ability to provide quality end-of-life care for terminally ill patients.

“The Cross Country Comparison of Expert Assessments of the Quality of Death and Dying” study was conducted by Duke-National University of Singapore Medical School (Duke-NUS). Researchers surveyed more than 1,200 caregivers who lost a loved one. They determined the most essential factors associated with quality end-of-life care — what patients and families valued most at end of life. Pain management, clear and timely information, and quality of life-extending treatments are a few of the 13 key elements identified. Nearly 200 international palliative care experts graded their countries’ healthcare infrastructure in relation to these indicators.

More than 40% of countries received a grade of D or F in ability to provide a good death.

Only a handful of countries are considered a grade A place to die: United Kingdom, Ireland, Taiwan, Australia, Republic of Korea, and Costa Rica. Nineteen countries, including Brazil, Portugal, and Haiti failed altogether, while 15 others received a D grade. The United States earned only a C average, barely surpassing Mexico. The U.S. only slightly outranks Thailand, Denmark, Romania, and Columbia.

All the grade A countries are high-income areas aside from Costa Rica, which is an upper-middle income society. Czech Republic and Portugal are also high-income areas, but only rank respectively at numbers 66 and 75 on the list. Researchers suggest these statistics are evidence that even higher functioning health systems often fail to deliver quality end-of-life care.

The study was headed by Eric Finkelstein, executive director of the Lien Centre for Palliative Care at the Duke-National University of Singapore Medical School (Duke-NUS), as well as the Duke Global Health Institute. He commented on the overall failure to meet patient end-of-life care needs in a recent interview with “Health Day.”

“Many individuals in both the developed and developing world die very badly — not at their place of choice, without dignity, or compassion, with a limited understanding about their illness, after spending down much of their savings, and often with regret about their course of treatment.

More efforts must be made to support quality end-of-life care for patients everywhere.

The study further revealed positive correlations between quality end-of-life care and government strategies or healthcare laws that support palliative policies and services. Researchers hope the data will provide a solid framework for future efforts to improve end-of-life care for patients and families across the globe.