Palliative care

Lore & Background

The field of palliative care grew out of the hospice movement, commonly associated with Dame Cicely Saunders, who founded St. Around the same time, Paul Henteleff became director of a new terminal care unit at Saint Boniface Hospital in Winnipeg, but this unit was not directly involved in coining the term. Horvitz Center for Palliative Medicine, designated as a World Health Organization international demonstration project.

Reader's Guide

Palliative care is appropriate for individuals with serious or chronic illnesses across all ages and can be provided as the main goal of care or alongside curative treatment. It is ideally delivered by interdisciplinary teams including physicians, nurses, therapists, psychologists, social workers, chaplains, and dietitians, in settings such as hospitals, outpatient clinics, and homes. Historically focused on incurable cancer, palliative care now applies to diseases including severe heart failure, chronic obstructive pulmonary disease, multiple sclerosis, and other neurodegenerative conditions. The distinction between palliative care and hospice varies globally: in the United States, hospice is a specific federal benefit for those with less than six months to live who forego curative treatments, while outside the U.S. the terms are often synonymous. Evidence shows that palliative care improves symptom control, quality of life, and family satisfaction while reducing healthcare costs. Over 90% of U.S.

Did You Know?

• Only 14% of the 40 million people worldwide who need palliative care each year receive it.
• Providing palliative care alongside standard oncologic care for advanced cancer is associated with lower rates of depression, increased quality of life, and increased length of survival.

Origins and the Patient-Centered Turn

The term palliative care traces back to the Latin word palliare, meaning to cloak — a fitting metaphor for wrapping around a patient's suffering rather than attacking the disease itself. For decades the field operated under a disease-specific lens, with programs organized around particular cancers or conditions. The World Health Organization's formal definition framed it as an approach improving quality of life for patients and families facing life-threatening illness through early identification and treatment of pain and physical, psychosocial, and spiritual problems. However, throughout the 2000s, WHO broadened its stance considerably. It began advocating that palliative principles be applied as early as possible to any chronic, ultimately fatal illness, regardless of diagnosis. This was a deliberate correction: a disease-oriented model, WHO argued, left patients' preferences unmet and neglected dimensions of care like emotional support, social needs, and spiritual well-being. The patient-centered model that emerged prioritizes the individual's experience of suffering and tailors interventions to maximize their quality of life, making the person — not the pathology — the organizing principle of care.

The Interdisciplinary Team and Settings of Care

Palliative care is not a single clinician's responsibility. It is delivered by a multidisciplinary team that may include physicians, nurses, occupational and physical therapists, psychologists, social workers, chaplains, and dietitians working in concert. This breadth reflects the scope of what the field addresses: physical symptom relief, emotional and spiritual distress, caregiver burden, and the practical logistics of navigating complex healthcare systems. The team's work unfolds across a wide range of settings — emergency rooms, inpatient hospital wards, outpatient clinics, hospice facilities, and the patient's own home. Crucially, palliative care is not confined to the final weeks of life. It can be initiated at diagnosis for certain severe conditions and can run alongside curative or life-prolonging treatments. The American Society of Clinical Oncology, for instance, recommends that patients with advanced cancer be referred to interdisciplinary palliative teams within eight weeks of diagnosis, even while active cancer treatment continues. This early, concurrent model is designed to improve symptom control, strengthen communication between patients and physicians, and ensure continuity of care as patients move between hospital, home, and hospice environments.

Expanding Beyond Cancer and the Global Access Crisis

Historically, palliative care services were built around one diagnosis: incurable cancer. That narrow framing has given way to a much wider application. Today the field encompasses severe heart failure, chronic obstructive pulmonary disease, multiple sclerosis, and other neurodegenerative conditions — any serious illness that diminishes daily function, degrades quality of life, or places heavy strain on caregivers. The scale of the need is staggering. An estimated forty million people worldwide each year require palliative care, yet only about fourteen percent actually receive it. The distribution of that access is deeply inequitable: roughly seventy-eight percent of the global population in need lives in low- and middle-income countries, while the majority of those who do receive services are concentrated in high-income nations. This gap has made palliative care a significant public-health priority. The field's overall aim is to improve quality of life through pain and symptom management, identification and support of caregiver needs, and coordinated care across settings. Engaging palliative providers early has been shown to improve symptom control, boost family satisfaction, and reduce overall healthcare costs, making the case for broader investment both ethical and economic.

Palliative Care versus Hospice: A Distinction That Depends on Geography

The relationship between palliative care and hospice care is not uniform around the world. In the United States, hospice carries a specific legal and financial meaning: it is a federal benefit established in 1982 under Medicare. To qualify, a patient typically must be certified by two physicians as having fewer than six months to live and must generally forgo curative treatments, a requirement designed to prevent two clinicians from billing for overlapping services. If a patient lives beyond that six-month window, benefits are not automatically revoked. More than forty percent of dying Americans now receive hospice care, most of it in the home during the final weeks or months, and an overwhelming eighty-six and two-thirds percent rate their experience as excellent. Outside the United States, by contrast, hospice usually simply names a building or institution dedicated to end-of-life and palliative services, and the two terms are often used interchangeably without any funding-based distinction. In 2016, a movement emerged in the U.S. to extend concurrent care to adults who qualify for hospice but are not yet emotionally ready to abandon curative options.

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