Oklahoma’s low ranking in end-of-life care is due to the lack of hospitals offering satisfactory end-of-life care, an OU alumna told an audience Tuesday at the OU College of Public Health.

Linda Edmondson, co-chairwoman of the Attorney General’s Task Force on End-of-Life Care in Oklahoma, spoke to students and citizens about the need to educate the public and to train more health care providers about end-of-life, or palliative, care in Oklahoma.

“What is palliative care? I would not be surprised if you and others in the community don’t know,” Edmondson said. “We don’t have a lot of palliative care in Oklahoma.”

Oklahoma received a failing grade for its end-of-life care last year, according to a state-by-state report card issued by the Center to Advance Palliative Care.

“We need to get rid of [Oklahoma’s] failing grade in palliative care,” Edmondson said.

She said palliative care improves the quality of life for patients and families facing life-threatening illnesses. She also said palliative care prevents and relieves physical, psychological, social and spiritual suffering, and includes assessment and relief of pain and other troublesome symptoms that neither hasten nor postpone death.

Edmondson said improvements in hospice care would greatly improve the quality of Oklahoma’s palliative care.

Hospice medical care is designed to support a patient and a family when there is no longer a possibility of curing a terminal illness, according to the National Hospice and Palliative Care Organization Web site.

“Hospice is the gold standard of palliative care,” Edmondson said.

While Oklahoma has the highest number of hospices per capita, Edmondson said more surveyors are needed to develop innovative ideas for hospices, and patients need to remain in hospices longer.

“The bottom line here is that Oklahomans have lots of hospice access in most areas, but most of them are in hospice, however, for a very short time,” she said. “Increasing the number of patients in Oklahoma that spend more than a week or two in a hospice at the end of life would improve end-of-life care.”

Edmondson also said physicians need to get used to talking about death with terminally ill patients.

“In order to make some of these changes it’s really important that we get more comfortable talking about the end of life,” Edmondson said. “Every part of our culture sets out to tell us that we may eventually need Viagra or arthritis medicine, but lord knows we’re not going to die.”

Edmondson said terminally ill patients or families of terminally ill patients often resist hospice care because they see it as giving up on life.

“There is a bioethical principle that says withholding and withdrawing care is ethically the same,” she said. “And yet mentally we have such an idea that once we start something we can’t stop it.”

Edmondson said almost 40 percent of deaths in the U.S. are under hospice care, which extends survival for about a month over patients who continue with curative care.

“It is ethically appropriate to withdraw care if it’s prolonging dying,” she said.

In states with higher grades of palliative care, patients had more access to palliative care, according to the Center to Advance Palliative Care’s report card. Edmondson said patients in these states are less likely to die in the ICU, have fewer admissions in the last month of life and spend less time in the ICU during the last six months of life.

“Experts consider the lesser time patients spend in the ICU as indicators of improving end-of-life care,” Edmondson said.

According to the report card, Oklahoma was one of three states, along with Alabama and Mississippi, that failed to improve from the last report card issued in 2002.

“Whether you are in public health, in medicine, in nursing, or whether you are a social worker or a student, you have a stake in learning to talk more comfortably about what happens at the end of life, because all of us are going to die one day,” Edmondson said.