Hospital palliative care services: Three models in three countries

Abstract

There is an increasing trend toward providing palliative care services within general hospitals. The history and work of three hospital palliative care teams is reviewed, one in New York, one in London, and one in Ontario, Canada. The evolution, leadership, structure, functioning, and financing of the teams is discussed. Indicators of success and survival, principally financial support, leadership, and acceptability within hospitals, are considered. It is recommended that the service traditionally limited to oncology patients be extended to other patient groups. It is also recommended that, taking into account cultural and institutional differences, standardized mechanisms be adopted so that services can be systematically audited and changes implemented. Research and education will become increasingly important if services within hospitals are to survive.

Palliative and supportive care: At the frontier of medical omnipotence

“…Palliative and supportive care is now conceptualized and implemented in different forms and is no longer restricted to cancer patients. Depending on local circumstances, palliative and supportive care services are established as home care services [7], hospital-based consultation services [8], as hospital-based inpatient units [9] or as independent hospices [10]. Some of these services are also accessible to patients with AIDS, end-stage renal disease and other medical conditions [11].…”

“…However, there are considerable differences in such services with respect to form and number. In the United Kingdom, for example, where the terms 'palliative care', 'continuing care', 'hospice', and 'terminal care' are often used interchangeably, over 130 hospices were counted in 1992 [8,10]. In the United States, 'hospice' now refers to the discreet form of certified terminal care provided at home or within institutions that is strictly defined, administered, and reimbursed according to a uniform set of procedures set by the government [12].…”

“…In the United States, 'hospice' now refers to the discreet form of certified terminal care provided at home or within institutions that is strictly defined, administered, and reimbursed according to a uniform set of procedures set by the government [12]. In Canada, where there are only two freestanding hospice inpatient units, 'hospice' most commonly refers to a community-based volunteer program for the terminally ill [8]. Some of the hospital-based palliative and supportive care services were first established as consultation services (e.g., at St. Luke's Hospital, New York, in 1974) and later expanded to incorporate an inpatient unit [8].…”

“…In Canada, where there are only two freestanding hospice inpatient units, 'hospice' most commonly refers to a community-based volunteer program for the terminally ill [8]. Some of the hospital-based palliative and supportive care services were first established as consultation services (e.g., at St. Luke's Hospital, New York, in 1974) and later expanded to incorporate an inpatient unit [8]. Others began by establishing an inpatient unit [9].…”

“…The first attitude denies the success that centers with palliative or supportive care programmes have achieved in ameliorating their cancer patients' quality of life [15,16]. It denies the fact that palliative and supportive care services have gained considerable recognition in recent years and are an expanding and evolving part of the medical services in most of the developed countries [8,10,11,17]. Denial is the result of a threat.…”