Palliative Care — A Shifting Paradigm

Palliative care focuses on relieving suffering and achieving the best possible quality of life for patients and their family caregivers. It involves the assessment and treatment of symptoms; support for decision making and assistance in matching treatments to informed patient and family goals; practical aid for patients and their family caregivers; mobilization of community resources to ensure a secure and safe living environment; and collaborative and seamless models of care across a range of care settings (i.e., hospital, home, nursing home, and hospice). Palliative care is provided both within the Medicare hospice benefit (hospice palliative care) and outside it (nonhospice palliative care). Nonhospice palliative care is offered simultaneously with life-prolonging and curative therapies for persons living with serious, complex, and life-threatening illness. Hospice palliative care becomes appropriate when curative treatments are no longer beneficial, when the burdens of these treatments exceed their benefits, or when patients are entering the last weeks to months of life.

Comprehensive palliative care services integrate the expertise of a team of providers from different disciplines to address the complex needs of seriously ill patients and their families. Members of a palliative care team typically include professionals from medicine, nursing, and social work, with additional support from chaplaincy and professionals in nutrition, rehabilitation, pharmacy, and other professional disciplines, as needed. These programs are now available at more than 80% of large U.S. hospitals (those with more than 300 beds), where most Americans receive their care during complex and advanced illness.

Research shifts a long-held paradigm that has limited access to palliative care to patients who were predictably and clearly dying. The new approach recognizes that life-threatening illness, whether it can be cured or controlled, carries with it significant burdens of suffering for patients and their families and that this suffering can be effectively addressed by modern palliative care teams. Perhaps unsurprisingly, reducing patients' misery may help them live longer. We now have both the means and the knowledge to make palliative care an essential and routine component of evidence-based, high-quality care for the management of serious illness.


Amy S. Kelley, M.D., M.S.H.S., and Diane E. Meier, M.D.