University of West Georgia Palliative Care in US and England Comparative Paper The requirement is to compare the health care organizations in the United St

University of West Georgia Palliative Care in US and England Comparative Paper The requirement is to compare the health care organizations in the United States and England through the analysis of the peer review research paper attached to this message. Please, take a careful look at the requirements attached to this message as well, including writing in APA-style and making sure it is not less than 500 words. Instructions
Assignment Name: Healthcare Organizations Online Assignment
Purpose: This assignment will help nursing students to explore how person-centered care is
provided in different types of healthcare organizations around the world (Course Learning
Outcome 2). As the COVID-19 pandemic has demonstrated, nurses of the future will
increasingly have to face global health challenges and will care for patients from all over the
world. It will be helpful for students to have an understanding of some of the ways in which
other countries’ healthcare systems are similar to, and differ from, that of the health care system
in the United States.
Skills: The purpose of this assignment is to help you practice the following skills that are
essential to your success in this course and as a future nurse:
Analyzing aspects of the health care system in the United States and comparing and contrasting
applying this understanding to the provision of patient centered care in different health care
organization(s) around the world.
Knowledge: This assignment will also help you to become familiar with the following
important content knowledge in this discipline: health care organizations, how they differ
both in terms of how they provide patient centered care and nurses’ roles within them.
Task:
Read the chapter titled Health Care Organizations in your Giddens
book. Then, read an article, published in a peer-reviewed journal
within the past 5 years, that describes and/or analyzes a health care
organization in another country. As you’re reading the article, think
about how it relates to what you read about Health Care Organizations
in the United States.
For the assignment, please answer the following questions and submit in a 500
words, Word document. This is not a formal APA paper (you do not need a
running head or title page) but you should follow APA formatting rules for your
citations and the References list.
1. What was the most surprising or important thing you learned from this article?
(This answer should be a paragraph that summarizes what you learned about
health care in another country and compares a healthcare organization in that
country to the system in the United States). Please note: There is no “right” or
“wrong” most relevant, surprising, or important takeaway – I want to know what
was most meaningful to you in the article, and how you can relate it to what you
learned about health care organizations through the assigned Giddens reading.
2. What’s one aspect of health care from another country that might be applied in
or integrated into our healthcare system that might help to reduce costs and/or
improve outcomes? (This answer should be a brief paragraph).
Be sure to cite your Giddens text (the assigned chapter for this module related to
Health Care Organizations) and the article you read at least once within the body
of one of your questions.
References
Giddens, J.F. (2017). Concepts for nursing practice (2nd ed.) St. Louis, Missouri: Elsevier
Mosby.
Seymour, J., & Cassel, B. (2017). Palliative care in the USA and England: a critical analysis of
meaning and implementation towards a public health approach. Mortality, 22(4), 275–
290. https://doi.org/10.1080/13576275.2016.1270262
Mortality, 2017
VOL. 22, NO. 4, 275–290
https://doi.org/10.1080/13576275.2016.1270262
Palliative care in the USA and England: a critical analysis
of meaning and implementation towards a public health
approach
Jane Seymoura and Brian Casselb
a
School of Nursing and Midwifery, the University of Sheffield, Barber House Annex, Sheffield, UK; bCancer
Informatics, Massey Cancer Centre, Virginia Commonwealth University, Richmond, VA, USA
ABSTRACT
Delivering optimal and equitable palliative care is an international
challenge. There are few cross-national comparisons examining
challenges in expanding palliative care along public health lines.
This paper presents a critical review of palliative care in the USA and
England, which share similar challenges but have different contexts
of healthcare. Beyond some obvious differences in the organisation of
palliative care, a set of underlying common issues can be identified. A
key tension in both is balancing attention ‘downstream’ in the dying
phase, as well as ‘upstream’ earlier in the course of serious illness. In
both, the dominant models of palliative care provision have resulted
in excellent care towards the end of life for some patients, but there
remain major deficiencies in care for the majority. England has a
National Strategy for End-of-life care; the US has no equivalent,
although a number of influential agencies have published statements.
Achieving a public health approach in palliative care requires
international consensus on the meaning and target population of
palliative care, replacement of prognosis based understandings
of entitlement to palliative care with a needs-based approach and
development of an evidence base for cost-effective partnerships
between providers across the specialist–generalist divide.
KEYWORDS
Palliative care; public
health, hospice, end-of-life
care; USA; England; policy;
international comparisons
1. Introduction
While there is international consensus about the elements required to deliver optimal palliative care (PC) (World Health Organisation, [WHO], 2014), PC services are organised in different ways internationally and key terms (such as ‘hospice’) mean different things (European
Association for Palliative Care, 2009, 2010). Comparison between nations is necessary to
develop better models of care to address rapid increases in PC needs and address barriers
to innovation (Ferris, Gomez-Batiste, Furst, & Connor, 2007). The uncertain illness trajectories
associated with multiple morbidity and frailty do not fit the classical patterns of ‘terminal
illness’ upon which existing models of PC are predicated(Kimbell, Murray, Macpherson, &
CONTACT Jane Seymour
jane.seymour@sheffield.ac.uk
© 2016 Informa UK Limited, trading as Taylor & Francis Group
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 J. SEYMOUR AND B. CASSEL
Boyd, 2016). Many people consequently fail to receive the PC they need; this is a global
humanitarian and public health issue (Worldwide palliative care alliance, 2014).
In this paper, we examine the meaning and operationalisation of PC in England and the
USA to understand the extent to which each are implementing international recommendations about integrating PC within their health care systems so that more people can access
support. England and the USA have highly developed health care systems with shared histories of PC, arguably making them ‘ideal’ candidates for comparison (Higginson, 2005). In
both, PC emerged in the middle-twentieth century, within the same decade. Innovation was
intially driven by highly charismatic individuals and cross Atlantic exchange, although key
concepts and services later diverged (Clark & Centenos, 2014; Foley, 2014). Both are signatories to the 2014 WHO resolution on PC, which recommends development of public health
policies for PC (WHO, 2014). While England and the USA are ranked first and ninth, respectively, in the widely reported Quality of Death Index reports (Economist Intelligence Unit,
2015), the latter reports have been criticised for assuming ‘… an unambiguous correlation’
(Timm & Vittrup, 2013) between the numbers of specialised PC (SPC) services in any one
country and the quality of PC. This is erroneous, since most people who need PC do not
receive care from specialists, but rather from general staff (community nurses for example),
who may or may not have additional training in PC. The latter reports also do not take sufficient consideration of differences in culture or context. Comparative studies of terminology,
policy and practice are essential to the development of PC internationally (Timm & Vittrup,
2013).
2. Widening access: the public health approach to palliative care
In 2002, in recognition of new needs thrown up by ageing and chronic non-communicable
disease, the WHO revised its original cancer-focused definition of PC referring to all ‘life threatening’ illnesses and making it clear that PC should be provided at an early stage, complementing other forms of care (Sepulveda, Marlin, Yoshida, & Ullrich, 2002; WHO, 1990) (Box 1).
Box 1. The World Health Organization definition of palliative care (2002).
Palliative care is an approach that improves the quality of life of patients and their families facing the
problems associated with life-threatening illness, through the prevention and relief of suffering by means
of early identification and impeccable assessment and treatment of pain and other problems, physical,
psychosocial and spiritual.
Sepulveda, C., Marlin, A., Yoshida, T., & Ullrich, A. (2002). Palliative Care: the World Health Organization’s
global perspective. J Pain Symptom Manage, 24(2), 91-96. Appendix 1.
Since only a minority of people who could benefit come into contact with the relatively
scarce numbers of dedicated or ‘specialist’ PC services, the thrust of international policy is
to try to embed PC principles and skills into mainstream health and social care so that more
people can benefit from what is called variously the PC ‘approach’, ‘primary’ PC or ‘generalist’
PC (Quill & Abernethy, 2013; WHO, 2014). This trend is most clearly demonstrated by the
resolution agreed at the 2014 World Health Assembly calling on member states to integrate
PC more effectively into their health care systems. The resolution calls for national policies
to: (1) support evidence-based service development; (2) expand quality improvement
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initiatives; (3) widen support of family and volunteer caregivers; (4) ensure that the care
workforce receive PC training. This was complemented by a report by the Worldwide Palliative
Care Alliance stating that the scope of PC should include chronic, as well as life-limiting or
life-threatening conditions and that there should be no prognostic limit on its delivery
(Worldwide palliative care alliance, 2014).
Integrating PC into mainstream care is often referred to as the public health approach in
PC (American Public Health Association, 2013; Stjernsward, Foley, & Ferris, 2007) and has
been described as a third evolutionary stage in the development of PC, following clinical
development (stage one) and organisational expansion (stage two) (Singer & Bowman, 2002).
However, the notion of PC as a public health issue is associated with ambivalence (Singer &
Bowman, 2002), reflected in the lack of agreement about whether PC is a field of specialty
practice, a philosophy of care or a system for delivering care (Pastrana, Junger, Ostgathe,
Elsner, & Radbruch, 2008). There is a lack of consistent definition of associated terms (Hui et
al., 2013) and a disparity of views about the appropriate target groups and indicators for PC
(Junger, Payne, Brearley, Ploenes, & Radbruch, 2012), all of which have material impacts on
patient care, with many ‘falling between the cracks’ of different categories of perceived
responsibility.
3. Origins of this paper
This paper draws on our observations during exchange visits to England and USA in 2012
and 2014, where we compared the meaning and delivery of PC as a foundation for further
comparative research about barriers and facilitators to the public health approach for PC.
We build on an earlier paper (Seymour, 2013) exploring the evolution of PC in England where
it was noted that the there is an ‘identity crisis’ in this field of care as it struggles to evolve.
4. Methods
The paper is based on a narrative synthesis of information from three sources: (1) observations made during our exchange visits to England and USA in 2012 and 2014, where we each
spent 4–6 months evaluating the challenges associated with developing PC along public
health lines in our host country; (2) informal interviews recorded by handwritten notes with
key stakeholders, who included policy-makers, practitioners, researchers and field leaders
(n = 25 in the USA and n = 35 in England). The latter were ‘off the record’ and so we do not
use direct quotes, but the interviews informed our interpretation and analysis; (3) a review
of published articles and policy documents, sourced via expert advice from stakeholders
and using our own knowledge. This was complemented by a scoping review conducted in
2014 to identify existing comparative research on the health care systems and PC in the USA
and England. We shared our interpretations at major conferences during 2015, thus giving
many key informants an opportunity to comment.
Our observations are presented in four sections. The first compares the health care systems
and the recent health care reforms in both. The second compares differences in SPC services,
while the third looks at gaps in general PC coverage beyond the provision of SPC, focusing
especially on older people, the largest group in need of PC. The last section addresses PC
policy, highlighting commonalities and differences. We conclude with observations relevant
to PC development internationally.
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 J. SEYMOUR AND B. CASSEL
Table 1. Key terms compared.
Hospice (England)
‘Hospice care seeks to improve the quality of life and
wellbeing of adults and children with a life-limiting or
terminal illness … it aspires to be accessible to all who
could benefit and reflect personal preferences and needs
… Hospice care is provided in a wide range of settings,
not just hospice buildings’
(Hospice UK- see www.hospiceuk.org accessed August
10th, 2016)
Palliative care (England)
‘Palliative care is the active, holistic care of patients with
advanced progressive illness. Management of pain and
other symptoms and provision of psychological, social
and spiritual support is paramount. The goal of palliative
care is achievement of the best quality of life for patients
and their families’
(Palliative Care Explained, National Council for Palliative
Care: see: www.ncpc.org accessed August 10th, 2016)
Hospice (USA)
‘… the model for quality compassionate care for people
facing a life limiting illness, hospice provides expert
medical care, pain management and emotional and
spiritual support…in most cases, care is provided in the
patient’s home’
(National Hospice and Palliative Care Organisation- see:
www.nhcpo.org accessed August, 10th, 2016)
Palliative care (USA)
‘Palliative care is specialised medical care for people with
serious illness. It focuses on providing patients with
relief from symptoms and stress of a serious illness. The
goal is to improve quality of life for both the patient and
the family’
(America’s Care of Serious Illness, Centre to Advance Palliative Care and National Palliative Care Research Centre,
see: www.reportcard.capc.org accessed August 10th,
2016)
‘Palliative care is for people living with a terminal illness
‘Palliative care is patient- and family-centred care that
where a cure is no longer possible. It’s also for people who
optimises quality of life by anticipating, preventing, and
have a complex illness and need their symptoms
alleviating suffering throughout the continuum of a
controlled. Palliative care includes caring for people
person’s illness by addressing physical, intellectual,
nearing the end of life’
emotional, social, and spiritual needs and facilitating
Marie Curie, see: www.mariecurie.org accessed August
patient autonomy, access to information, and choice …
10th, 2016).
Palliative care can begin at any point in the disease
progression’
(National Quality Forum- see: http://www.qualityforum.
org/Palliative_and_End-of-Life_Care_Project_2015-2016.aspx accessed August 10th, 2016)
End-of-life care (England)
End-of-life care (USA)
‘Helps all those with advanced, progressive, incurable
‘End-of-life care is comprehensive care that addresses
illness to live as well as possible until they die. It enables
medical, emotional, spiritual, and social needs during
the supportive and palliative care needs of both patient
the last stages of a person’s terminal illness. Much
and family to be identified and met throughout the last
end-of-life care is palliative in nature, when life-prolongphase of life and into bereavement. It includes
ing interventions are no longer be appropriate,
management of pain and other symptoms and provision
effective, or desired’
of psychological, social, spiritual and practical support’
(National Quality Forum- see: http://www.qualityforum.
(National Council for Palliative Care, 2006, cited in the
org/Palliative_and_End-of-Life_Care_Project_
National End-of-life care Strategy, 2008, p47
2015-2016.aspx accessed August 10th, 2016)
…. any palliative care within the last 12 months is regarded
as end-of-life care’. (National Instititute for Health and
Care Excellence (NICE), 2011 (modified 2013)
To help the reader, we provide in Table 1 the various definitions of ‘PC’ and the related
terms of ‘hospice’ and ‘end-of-life care’ in common use in the two countries at the time of
our study.
5. Health care systems in England and the USA
The US and English health care systems are often posited as polar opposites. The USA is
described as having a ‘market maximised entrepreneurial’ system (Roe & Liberman, 2006)
largely based on the purchasing of health insurance by individuals or employers and a ‘fee
for service’ model of payment. Private, employer-sponsored insurance became widespread
after the Second World War. Government-funded insurance programmes have been operative since the 1960s, with Medicaid (50 federal-state partnerships) covering health care
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279
Table 2. Key provisions in the Affordable Care Act (2010).
Quality, affordable health
care for all Americans
The role of public
programmes
Improving the quality and
efficiency of health care
Preventing chronic
disease and improving
public health
Community living
assistance services and
supports
• A mandate to have insurance through a Health Benefit exchange
• New requirements regarding duties to offer coverage to employees
• Insurers obliged to sell policies at fixed rates
• Insurance companies no longer allowed to refuse health insurance to people with
pre-existing conditions
• Medicaid expansion
• Expansion/ preservation of the Children’s Insurance Programme
• Improved community-based care
• Comparative effectiveness research, through a not for profit ‘Patient Centred Outcomes
Research Institute’.
• Development of a National Quality Improvement Strategy
• Reformation of Medicaid: drug costs; bundled payments for episodes of care beginning
3 days prior to hospitalisation and extending to 30 days following discharge
• Independence at home demonstration programme
• Expansion of access to primary care
• Coordination of Medicare and Medicaid benefits
• Reform Medicare and Medicaid to encourage uptake of preventive interventions
• Development of:
• National Prevention, Health Promotion and Public Health Council
• Prevention and Public Health Fund
• Grant programme for public health
• National Strategy for Health
• Wellness programmes at work
• Establish a national voluntary insurance programme for community living assistance
(CLASS programme)
• Introduce reforms to Medicaid to encourage community-based care
• Disclosure of information to consumers about ownership, accounts and standards of
long-term care facilities
Sources: Obama Care Facts- http://obamacarefacts.com/obamacare-facts/ (accessed August 10th, 2016); Reeve M et al. The
Impacts of the Affordable Care Act on Preparedness, Resources and Programmes: Workshop Summary. National Academies Press 2014, available at: http://www.nap.edu/catalogue.php?record_id = 18,755 (Accessed August, 8th, 2016).
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