Maintaining quality of life at the end of life

Despite the successful growth of the hospice movement during the past 30 ye ars in the United States, almost 85% of Americans continue to die in hospit als or nursing homes. While the benefits of palliative care principles are well established, palliative care interventions remain underused in clinica l practice in the settings in which most Americans die. Our premise is that physicians as a group perpetuate end-of-life suffering rather than ease th e transition from life to death. We also believe that maintaining quality o f life (QOL) at the end of life requires a multidimensional approach orches trated by physicians drawing on the full range of available physical, psych ological, social, and spiritual interventions, This article defines the mea ning of QOL at the end of life and then examines the ramifications of faili ng to attend to QOL concerns in dying patients. It reviews strategies that physicians can use to advance palliative care approaches, thereby reducing terminally ill patients' suffering in the institutions in which most die.