To Accelerate Hospice Growth, It’s Time to Embrace ‘The Social Determinants of Death’

Hospice News | By Jim Parker 

As U.S. hospices care for the dying and compete for referrals, a vast contingent of terminally ill Americans die in places they don’t want to be, receiving treatments that will not save them.

Turning this tide will require more than effective marketing. At some point, we as a society need to reconsider how we think about death – and hospices will have a critical role in that discussion.

A commission convened by the United Kingdom-based research journal The Lancet has called on the global medical community and the public to reconsider societal attitudes about death and the care that precedes it. Among the recommendations is a rethink of the over-medicalization of death and greater emphasis on hospice and palliative care.

The commission of Lancet editors and academic scholars outlined principles to guide this process, including what they call “the social determinants of death,” as well as reassessment of cultural attitudes about the end of life and strengthening networks of care for the dying and the bereaved.

A key obstacle to this kind of change is simple to name but difficult to overcome: We don’t want to talk about it.

“Conversations about death and dying can be difficult. Doctors, patients, or family members may find it easier to avoid them altogether and continue treatment, leading to inappropriate treatment at the end of life,” the commission wrote. “Palliative care can provide better outcomes for patients and careers at the end of life, leading to improved quality of life, often at a lower cost, but attempts to influence mainstream health-care services have had limited success and palliative care broadly remains a service-based response to this social concern.”

These are the questions that the Lancet Commission seeks to unravel.

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