The first-ever state-by-state analysis of end-of-life care, Means To a Better End: A Report on Dying in America Today, depicts "a nation that is coping poorly with critically ill and dying people right now" and highlights the problems Americans have in finding good care when facing a life-threatening illness.

Funded by The Robert Wood Johnson Foundation and released on November 18, 2002, the report indicates that the situation is no better in Massachusetts. There are about 56,000 deaths in Massachusetts each year. Many of the people who die are in pain and have received treatment that was not consistent with their wishes. Massachusetts does not stand out when it comes to excellent end-of-life care. Too few patients access hospice and palliative care services. Too few professionals are trained in pain management and palliative care. Too few hospitals and nursing homes have programs to deliver this care. Excellent end-of-life care is available in Massachusetts but, as in most other states, excellent end-of-life care is not the norm.

The report is intended to "help every interested American start to understand how disturbing the current situation is and, at the same time, what the elements of good end-of-life care are." This is critical because thinking ahead about the kind of care we want for ourselves and our families is essential to a peaceful end-of-life.

The report highlights the issues that demand attention and provides recommendations for possible action. The report notes that there is progress in improving end-of-life care. Most noteworthy are the partnerships and coalitions in 30 states, including Massachusetts, that are working to improve the quality of care. These coalitions share four main goals of their activities, says the report, which are to improve advance care planning; improve pain management; improve the quality of care and coordination; and increase the demand for, and access to, high quality end-of-life care.

Making death a more compassionate and caring experience for both the patient and the family in every community in America will require the efforts of the general public, health care professionals, educators, nursing home and hospital administrators, and public policymakers.

The full 108 page report is available online at www.rwjf.org/files/publications/other/meansbetterend.pdf, or it may be ordered by email at laxfeedback@partnershipforcaring.org.