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Background: The use of quality-adjusted life years rests on the assertion that the objective of the health care system is to improve health. Aim: To elicit the views of expert stakeholders on the purpose and evaluation of supportive end of life care, and explore how different purposes of end of life care imply the need for different evaluative frameworks. Design: Semi-structured qualitative interviews, analysed through an economic lens using a constant comparative approach. Participants: Twenty professionals working in or visiting the United Kingdom or Republic of Ireland, with clinical experience and/or working as academics in health-related disciplines. Results: Four purposes of end of life care were identified from and are critiqued with the aid of the qualitative data: to improve health, to enable patients to die in their preferred place, to enable the patient to experience a good death, and to enable the patient to experience a good death, and those who are close to the patient to have an experience which is as free as possible from fear, stress and distress. Conclusion: Managing symptoms and reducing anxiety were considered to be core objectives of end of life care and fit with the wider health service objective of improving/maximising health. A single objective across the entire health system ensures consistency in the way that resource allocation is informed across that entire system. However, the purpose of care at the end of life is more complex, encompassing diverse and patient-centred objectives which we have interpreted as enabling the patient to experience a good death. [ABSTRACT FROM AUTHOR]

Family building by bisexual mothers is a neglected area of research, yet this is an important aspect of life course development that may reciprocally influence the sexual identity development of bisexual women and family processes around parenting. Family map drawings (genograms) and interview data were collected from eight cisgender women from the United Kingdom and Republic of Ireland who spoke about their bisexual parenting experience and family relationships. Thematic narrative analysis indicates that participants depict both heteronormative (traditional) extended kinship networks (radiating out from a family core centering on them and their children) and family of choice network features. Nonetheless certain features appear to be more indirectly presented on some participants’ family maps: namely, complex or marginalized (erased) relationships with additional partners that may sustain sexual identity but contradict both heteronormative and homonormative presentations of family life. Our discussion considers the difficult issues bisexual mothers face in maintaining both their family relationships and a marginalized sexual identity. [ABSTRACT FROM AUTHOR]