Indeed, the consistency of end-of-life choices with the patient’s wishes is given only a minor relevance. Another result that is worth discussing is the small relevance given to being in control of oneself (i.e. C3). Only one third of the documents refers to this item, whereas it is one of the most important elements

of end-of-life care present in the literature [59]. This might be due to the fact that the maintenance of control is a multifaceted and a selleckchem patient centred issue, which can only with difficulty be addressed Inhibitors,research,lifescience,medical by policy statements on palliative and end-of-life care. The same conclusion may be suggested for completion and meaningfulness at the end of life (i.e. D1), which is given a minor relevance in the documents, while several qualitative studies on patients, families and caregivers account for this item [12,17,23,56,60,62]. On the other hand, there seems to be no persuasive explanation to the fact that minimising the burden of caring on the family is hardly covered in the statements. While,

according to the literature, freedom from financial and physical Inhibitors,research,lifescience,medical burden is considered by patients and caregivers as one Inhibitors,research,lifescience,medical of the most important component of a end-of-life care [17,56,58,59,61] only a few documents address this issue. It might be suggested that, in general, the statements tend to consider “financial and physical” support to the family as less relevant than “emotional” support. In fact, a great number of documents consider emotional support to the family (i.e. B2) as reasonably important. Nevertheless, this consideration does not prevent from observing that minimizing the burden of care is generally underestimated in Inhibitors,research,lifescience,medical the documents. Finally, it is worth noting that a definition of quality of life at the end Inhibitors,research,lifescience,medical of life is lacking, whereas this issue is widely covered by the documents. Of course, the concept of quality of life is highly individual and fluid, and it might be difficult to give a precise definition of this notion. However, several studies have already proved the possibility of developing instruments

to assess both the quality of life for dying patients and the quality of care at the end of life [52,57,59,63,64]. Therefore, it might be observed that the documents generally fail to address the issue of quality of life in a consistent GSK-3 and precise manner. Conclusions This work demonstrates that all the dimensions of end-of-life care stemming from the literature are reflected in the official documents by the most representative organizations committed to the definition of guidelines for the care of the dying patients. A few additional items emerged from the analysis of the documents, thus completing the framework which was formerly taken from the literature. The resulting grid (see Table ​Table2:2: New thematic grid) consists of a more comprehensive framework, which might facilitate the assessment of the high quality palliative care process.