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Meeting end-of-life care needs for people with chronic disease: palliative care is not enough

. . . but what should a system that successfuly combines interventional and palliative approaches look like?

Considerable efforts have been made, both nationally and internationally, to address the growing “epidemic” of chronic disease. Chronic disease accounts for more than half of all Australian deaths,1 treatment of chronic disease in Australia accounts for almost 70% of total health expenditure2 and hospitalisations associated with chronic disease are a major component of this expenditure (see the Box for a definition of chronic disease as used in the context of this article). Systematic processes to prevent and manage chronic disease have been developed, and all incorporate the concept of a continuum of care from prevention and early intervention, through disease management to the end of life.2 While there is a strong focus on systematic care, health education, chronic disease self-management and regular review, comparatively scant attention is paid to the actual care required as people approach the end of their life.

In Australia, to date, the need for end-of-life care for people with advanced chronic disease has…