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They outline the full benefits can be obtained for patients, family and for the institutions offering the palliative care. There is an introduction in each paper describing the features of the program, the institutions involved, and the history of how palliative care started. This includes also a discussion of the values and objectives that each program has. After this there are graphs and tables showing numbers of patients and staff, and some indications of funding sources. There are demographic details also, showing what kind of patients and staff are involved.
Both authors are involved in the programs they describe and they try to present objective findings, with appropriate factual evidence, to show both the strengths and the weaknesses of their particular situation. On closer reading it is evident that the two cases have similar aims, but are very different in scale and approach. The Walsh article describes a very large facility which usually has 17 in-patient beds , including 2 hospice beds, and an extensive outpatient and home care provision. Specialists in social work and pastoral care are involved in the palliative care programs.
The Meier et al. article describes a much smaller facility with only 4 in-patient beds and no provision for social work and pastoral care. A critical difference is also in the funding of the two initiatives. In the Walsh article much of the funding comes from Medicare, and palliative care is well integrated into the standard medical systems of the facility. Research is undertaken also as part of the wider academic institution. The funding of the provision described by Meier et al. is both smaller and less secure.
Education and training is partly funded by the Project on Death in America (PDIA), and a lot of the patient care is funded by donations from benefactors. The PDIA has been responsible for pushing forward innovative ideas for palliative care in the United States of America in the period 1994-2003. (Clark, 2001, 81). This body made three recommendations: improved training for professionals, a comprehensive funding group, and more hospice availability. (Clark, 2001, 83). Both of the case studies agree with these three priority areas for intervention.
The Walsh study has achieved greater progress in achieving the PDIA aims, and has succeeded in integrating palliative care more thoroughly into general medical provision. The Meier et al case study is making good progress towards these aims, but is at an earlier stage in implementation and faces more resistance from traditional medicine. The Meier et al.case illustrates some of the practical barriers that occur, including “the highly specialized and fragmented nature of tertiary care … and the low priority accorded to palliative care services compared to other clinical services” (Meier et al., 2000) Funding issues are also more acute in this study, and this is perhaps the most critical issue for the people there, since with better funding there might be more support from the more traditional areas of the institution.
There is interesting difference between the two articles in terms of the style in which they are written. Walsh writes in a
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