Lynn J. Measuring quality of care at the end of life: a statement of principles. J Am Geriatr Soc. 1997;45:526-527.

Ten principles are presented that guide the measurement of quality of care at the end of life. They range from physical and emotional symptoms to bereavement.

Billings JA. What is palliative care? J Palliat Med. 1998;1:73-81.

Palliative care overlaps with "terminal care," "death and dying," "hospice," "end-of-life care," "thanatology," "comfort care," and "supportive care." The diversity in the definitions of these terms and their unfamiliarity to many people can bewilder patients, family members, and health professionals. This essay provides some clarification.

Christakis N, Escarce J. Survival of Medicare patients after enrollment in hospice programs. N Engl J Med. 1996;335:172-178.

The unadjusted survival after enrollment was shortest for those with renal failure, leukemia or lymphoma, and liver or biliary cancer; it was longest for those with chronic lung disease, dementia, and breast cancer.

Connors AF Jr, Dawson NV, Desbiens NA, et al. A controlled trial to improve care for seriously ill hospitalized patients: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274:1591-1598.

The phase I observation of SUPPORT confirmed substantial shortcomings in care for seriously ill hospitalized adults. To improve the experience of seriously ill and dying patients, greater individual and societal commitment and more proactive and forceful measures may be needed.

Levy MH. Drug therapy: pharmacologic treatment of cancer pain. N Engl J Med. 1996;335: 1124-1132.

Cancer pain can be effectively treated in 85% to 95% of patients with an integrated program of systemic, pharmacologic, and anticancer therapy. Many of the remaining patients can be helped by the appropriate use of invasive procedures. In the final days of life, pain not controlled by therapies aimed at both comfort and function can be relieved by intentional sedation.

Doyle D, Hanks GWC, MacDonald N. Oxford Textbook of Palliative Medicine. 2nd ed. New York, NY: Oxford University Press; 1996.

This second edition remains the "bible" of palliative care. The chapters summarize the history of palliative care, its current status and practice, and its future directions. Topics covered include pain and symptom management, ethical, psychosocial, and spiritual issues in palliative care, and education and training in palliative medicine.

Field MJ, Cassel CK, eds. Approaching Death: Improving Care at the End of Life. Committee on Care at the End of Life, Division of Health Care Services, Institute of Medicine. Washington, DC: National Academy Press; 1997.

Seven recommendations address different decisionmakers and different deficiencies in care at the end of life. Each applies generally to people approaching death, including those for whom death is imminent and those with serious, eventually fatal illnesses who may live for some time. Each is intended to contribute to achieving a compassionate care system that dying people and those close to them can rely on for respectful and effective care.

Dunlop R, ed. Cancer: Palliative Care. New York, NY: Springer; 1998.

This book offers a broad overview of palliative care. It is written for health professionals from all disciplines, particularly doctors and nurses who work with cancer patients but have little or no experience of palliative care.

The goals of this project are to identify and promote physician competency in the care of dying patients during internal medicine residency and subspecialty training.

Jacox A, Carr DB, Payne R, et al. Management of Cancer Pain: Clinical Practice Guideline. Rockville, Md: Agency for Health Care Policy and Research; 1994. US Dept of Health and Human Services publication 94-0592.

The guidelines set out in this volume, developed by an interdisciplinary panel of clinicians, patients, and researchers, are based on expert judgment as well as a review of scientific research. The volume outlines a multimodal approach to the management of cancer pain and emphasizes the need for careful and continuous assessment in order to match interventions to the sources of pain in individual patients.