Optimal healing environments in end-of-life care and beyond.

This paper is based on the premise that end-of-life care (EOLC) is the incarnation of an optimal healing environment (OHE). EOLC is characterized by factors that distinguish it from other forms of care or patient populations. These include: (1) formal EOLC did not evolve within the health care "industry," but was a reaction to that industry, created as an OHE; (2) patients nearing the end of life may be cared for in a formal "end-of-life" environment or may be located in other settings or systems; and (3) EOLC has a preordained outcome. Patients die in a variety of settings for medical, cultural, and accessibility reasons, and EOLC principles and practices are only beginning to be integrated into the full range of care settings. This paper proposes and defends the use of a single-question intervention to study the effect of EOLC care on its recipients, and considers the difficulty of establishing meaningful outcome variables. This paper also suggests that the principles of EOLC are well-suited to all phases of health services delivery and recommends the practical application of its elements throughout the medical services arena.