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Issues in Palliative Care Research$
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Russell K. Portenoy and Eduardo Bruera

Print publication date: 2003

Print ISBN-13: 9780195130652

Published to Oxford Scholarship Online: November 2011

DOI: 10.1093/acprof:oso/9780195130652.001.0001

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

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

Chapter:
(p.275) 18 Research to Improve End-of-Life Care in the United States: Toward a More Behavioral and Ecological Paradigm
Source:
Issues in Palliative Care Research
Author(s):

Russell K. Portenoy

Eduardo Bruera

Publisher:
Oxford University Press
DOI:10.1093/acprof:oso/9780195130652.003.0018

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

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