The authors tallied the presence of end-of-life information in various ways, including examining tables of contents and indexes for mentions, as well as analyzing each text for the critical content areas. Among the key findings are the following:

  • 1.4 percent of all chapters (24 out of 1,750) and 2 percent of all content (902 out of 45,683 pages) were devoted to any end-of-life topic;

  • 30 percent of the texts had at least one chapter devoted to end-of-life issues (the vast majority were devoted only to pain);

  • the strongest coverage was in the two areas of pain and issues of policy or ethics; end-of-life topics with the poorest coverage were quality of life issues and role and needs of family caregivers; and

  • overall, 74 percent of the prespecified content was absent, 15 percent was present and 11 percent was present and useful or commendable.

The authors also qualitatively analyzed the information that was found in the texts, drawing a number of conclusions, among them:

  • most end-of-life content focused only on cancer and AIDS;

  • although pain was frequently discussed, the text referred mainly to acute or chronic pain, and not pain at the end of life; minimal content was found on pain assessment, neuropathic pain, or pain assessment in the cognitively impaired or nonverbal patient;

  • outdated drug approaches were frequently recommended, and there was virtually no information on pain management at the end of life;

  • minimal information was found on symptoms other than pain at the end of life; and

  • the four pharmacology texts all included erroneous information and lacked information on current approaches to pain and symptom management.

The overarching finding was a lack of content on essential topics for end-of-life care.

Ongoing Programs and Initiatives

As is the case for education programs for physicians, much of support for nursing education comes from private foundations (Table 9-8).


Social workers are central to counseling, case management, and advocacy services for the dying and for bereaved families. With their focus on

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