The epidemiology of hospice and palliative care

Hospice and palliative care are terms that are many times linked together. While in many cases this is appropriate, they are nonetheless different enough from each other that their distinctions should be made clear. Hospice is fundamentally a philosophical position and concept, which attempts to respect patients’ wishes regarding type of care, location of care, quantity of care, and, in some sense, quality of care during end-of-life care. The overall goal is to operate in a manner consistent with a person’s individual goals and values. This philosophy is independent of location of care. That is to say, the hospice philosophy is operationalized in private homes (usually the patient’s residence–home hospice care), nursing homes, residential facilities, facilities dedicated to hospice care (e.g., an inpatient facility), and acute care hospitals. It is important that the provider and patient discuss the various options that a patient has and determine the best facility for the patient and their family. This decision for care may be influenced by cultural or religious beliefs and cost or availability of resources. The unifying theme regardless of location is the central role of the patient in making decisions regarding the care they wish to receive in their end stages of life. Palliative care, in the traditional sense, is generally directed at relieving pain and discomfort without the intent of curing the patient. The absence of cure is a distinction with merit as palliative care focuses directly on symptoms and not etiology of disease per se. It is not directed at any particular stage of life; it is rather directed at conditions that are consequences of diseases, trauma, or other illnesses. Palliative remedies delivered in a hospice setting that is consistent with a patient’s wishes tie the concepts together. Both hospice care and palliative care share the intent of their efforts and do not focus on curing the patient. The terms hospice care and palliative care will be used throughout this chapter to describe those who are–or will be–eligible for services. Generally speaking, hospice care and palliative care underscore the patient, the loved ones, and the patients’ families. Both use interdisciplinary teams to deliver care. Teams can consist of physicians (primary care and specialists), nurses, social workers, bereavement counselors, therapists, clergy, volunteers, and home health personnel (visiting nurses, volunteers, and