Quality and Costs of End-of-Life Care: The Need for Transparency and Accountability

Increasing attention to the quality of end-of-life care for seriously ill, dying adults has included evaluation of the site of death, place of care, and health care transitions¹ with an important concern being whether these patterns of care, especially receipt of aggressive care, is consistent with patient preferences and improved quality of life. Choices involving these and other aspects of end-of-life care, such as for hospice care, are complex decisions that involve patients, their families, and their physicians. However, as elegantly stated by Levine using the metaphor of “Goldilocks and the Three Bears,”² the current dilemma that involves the timing of hospice referral is whether it is too late, too early, or just right.