Using the closure model to spark a social movement around care at the end-of-life: What can we learn from the birthing movement about change

Many patients in America experience prolonged, painful deaths after receiving treatments that are costly, invasive and unwanted (SUPPORT Principal Investigators, 1995). Patients and families in general are disappointed with the dying process. In the 2006 Pennsylvania End-of-Life Background Report, families reported dissatisfaction with the dying process of their loved ones, particularly in the areas of pain management, social and financial burdens, and limited access to palliative and hospice services. Contributing to this dissatisfaction is a dearth of easily accessible information on end-of-life.

To address these issues, the Jewish Healthcare Foundation launched an education, planning and community outreach effort around end-of-life called Closure. The goal of Closure is to change expectations around end-of-life and ultimately spark a social movement to improve the care for people approaching end-of-life. This initiative has two connected components: Closure Community Conversations, which bring together a group of interdisciplinary community stakeholders over a six session series to consider issues healthcare professionals, individuals and families face when planning for and approaching end-of-life care; and Closure 101, a multi-part, interactive modular curriculum designed for both online and face-to-face use. Both components provide easy-to-access, simple-to-understand information and resources that patients, their families and healthcare providers can use to make informed decisions. The project, which has been disseminated nationally, is anchored by the website Closure.org, through which participants can access information, participate in an online community, and acquire tools to take action in their community. To date, Closure has connected with hundreds of individuals through face-to-face programs and several thousand online.