• Philip Kinghorn and Joanna Coast.
• 1 Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, Edgbaston, UK.
• Palliat Med. 2019 Jul 1; 33 (7): 823-831.

BackgroundThe use of quality-adjusted life years rests on the assertion that the objective of the health care system is to improve health.AimTo elicit the views of expert stakeholders on the purpose and evaluation of supportive end of life care, and explore how different purposes of end of life care imply the need for different evaluative frameworks.DesignSemi-structured qualitative interviews, analysed through an economic lens using a constant comparative approach.ParticipantsTwenty professionals working in or visiting the United Kingdom or Republic of Ireland, with clinical experience and/or working as academics in health-related disciplines.ResultsFour purposes of end of life care were identified from and are critiqued with the aid of the qualitative data: to improve health, to enable patients to die in their preferred place, to enable the patient to experience a good death, and to enable the patient to experience a good death, and those who are close to the patient to have an experience which is as free as possible from fear, stress and distress.ConclusionManaging symptoms and reducing anxiety were considered to be core objectives of end of life care and fit with the wider health service objective of improving/maximising health. A single objective across the entire health system ensures consistency in the way that resource allocation is informed across that entire system. However, the purpose of care at the end of life is more complex, encompassing diverse and patient-centred objectives which we have interpreted as enabling the patient to experience a good death.

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