What do hospices do or not do?

Nathan Cherny,
 Norman Levan Chair of Humanistic Medicine; Associate Professor of Medicine (BGU); 
Director, Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Israel.

Professor Nathan Cherny

Professor Nathan Cherny

I was recently contacted by the family of a 70-year-old man with pancreatic cancer who was referred for inpatient palliative care. He had a resolving cholangitis and was on antibiotics. The family was distraught to hear that the hospice did not provide antibiotics, do blood tests, administer blood or even check vital signs. Incredulous, I called to speak with the physician in the hospice who explained that the hospice aims to ensure patients are comfortable and not suffering, but that it does not provide life-supporting therapies (of any sort). 


This philosophy does not seem consistent with providing individualised, goal- focused care. In the end, the patient was transferred to another hospice (60 km away).

The encounter has left me wondering how common is the phenomenon of hospices:

  • not monitoring vital signs (for anyone)
  • not doing blood tests
  • not treating infections
  • not providing tube feeding
  • not providing BiPAP.

Please help me to understand the prevalence of this and the rationale?

Let’s hear your views…
What happens in your hospice or palliative care setting, region or country? Please leave a comment below or contribute a post. Full instructions on preparing and submitting a post are in our Guidelines for Contributors.

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31 Responses to What do hospices do or not do?

  1. pallcare says:

    This discussion depends on how you define hospice and what in your setting is a hospice. This may even depend on economic considerations, as some hospice programmes in the US are quite clear that they do not provide antibiotics nor chemotherapy nor monitoring of vital parameters. This is based in the cost balance background of hospice in the US:Medicare pays for hospice programmes because these programmes save money in other places.
    In Germany, nost palliative care units would do the things you listed, whereas no inpatient hospice would. Hospices would describe their task as care of the dying, though, exactly as you described. This is quite in contrast with UK hospices.
    So I am curious what other experiences and opinions will be reported on this blog post!
    Lukas Radbruch

    • Nathan Cherny says:

      We need to be clear about what we are advertising. Most people seem to equate hospice with long term inpatient palliative care (as distinct to an acute PC inpatient service).
      With all that palliative care ties to promote about individualized goal focused care, I find it difficult to justify hospices providing only terminal care..as per the final days of the Liverpool pathway.
      This whole debate really begs the question of defining standards for the scope of long term inpatient palliative care. In the absence of standards we are left with confused patients and referring doctors who don’t know what they can reasonably expect of our services

      • AS says:

        Specialist palliative care involvement is often delivered alonside palliative oncological treatment – SPC healthcare professionals reviewing patients. However, most of the interventional aspects of palliative treatment such as chemotherapy, chest drains, ascitic taps etc tends to be delivered within an acute hospital setting rather than a hospice – this would seem appropriate given the tests, equipment, scans,etc required to provide these interventions. I am assuming this is what most people are suggesting when they talk about access to appropriate treatments. SPC is also provided within the community – they will liaise with GP’s and oncologists, etc to provide appropriate support and admit to the right setting if needed. In the hospice in – patient setting the care is focused on less interventional therapies – by this stage symptom management with medicines or simple interventions. Should a patient require a more interventional approach more likely to transferred to an acute hospital where RT, etc., on site.
        I would agree that care of the dying as a core value of a hospice happens less these days – sadly I think due to economics as much as anything. As we are encouraged to provide care of the dying patient within the community and support the generalist teams caring for these patients and families so we are likely to see more complex end of life care patients and this will influence what we offer within the hospice setting.

  2. AS says:

    Interesting discussion. One might ask why did this person need an in patient bed at a hospice if resolving cholangitis and on relevant treatment? I would suggest most in patient units in the Uk do not “routinely” do blood tests or measure vital signs. However, if patient was symptomatic these may be done to define the problem. Treatment of infection is assessed and provided on an individual basis. It is not usual to commence tube feeding within the hospice setting but if a patient has a tube insitu then this would be continued and discussed and altered as per the individual circumstances. Use of BiPAP is less likely but not impossible.
    I guess the other question is to define the difference between hospice and palliative care unit – the above comment seems to suggest a difference in what is provided, however, to me they are one and the same thing. I would suggest that hospice care in the Uk provides less care of the dying person and more symptom control – the patient is then discharged to an appropriate setting, home, Nursing Home, etc.

  3. Rohan Vora says:

    From Australia. There is enormous variation. When I first started where I now currently am Director the service was obviously a “Terminal Care” service where “palliative sedation” was a frequent event. It was very unsafe for patients who were mobile, enjoying life and had several months of an active life ahead of them if they were actively managed for their current infection, dehydration, hypercalcaemia, anemia etc. Observation schedules were considered too burdensome and over a weekend patients could deteriorate and little notice was taken as it was considered to be consistent with dying. To turn all this around has been a mammoth cultural change. We now have patients on observations schedules consistent with transparently documented and agreed on “goals-of-care”: and adapted “Adult Detection of Deterioration” schedule, an obs schedule from the Care-of-the-Dying Pathway or a full Care-of-the-Dying Pathway (where death is expected in the next 7-10 days). We now have many patients who are actively managed with simple acute medicine interventions, who go on to live active lives for several months, we do time limited trials of active rehabilitation, send patients for radiotherapy and have interventional pain management as a much more frequent addition to our symptommanagement assessment and treatement regimens.
    We are now able to promote a Supportive & Palliative Care approach in the last 12 months of life and are hoping to move towards early referral and seamless transition into our service from acute medicine for chronic and advanced disease. Patient safety has become an integral feature of our service now and is reported on regularly. Palliative Sedation is much less frequent now down to about 5-10%.

    • Nathan Cherny says:

      This is a great articulation of the problem I would like us to start to a adress.

      • Rohan Vora says:

        Happy to provide copies of our adapted observation schedules (ADDS, CDP Obs or CDP) as they are linked to the outcome of discussions we have with patients, families/carers and amongst the multidisciplinary team. “Goals-of-Care” (based on a realistic discussion of prognosis and harm vs benefit of various options) are “shared goals” determined largely by the patient or surrogate decision maker if the patient is no longer competent. The Phase is determined and also clearly documented (stable, unstable, deteriorating or terminal). We also have a statewide “Acute Resuscitation Plan” document that we fill out in detail documenting the patient’s wishes very clearly about likely treatments that they may or may not want e.g. IV antibiotics, IV Rehydration, Blood Transfusions, Palliative Chemotherapy, Radiotherapy, PEG or BiPAP etc. as well as CPR or no CPR

  4. Nagesh Simha Medical Director Karunashraya Hospice Bangalore India says:

    A very important issue has been raised, one which we have grappled with for many years. Ours is a free standing cancer hospice providing free palliative care to patients in Bangalore South India. We do give antibiotics, blood transfusion and oxygen in select cases, where we feel that there is a reasonable chance of a good quality of life. We do not have facilities for ventilation. We have sent patients for palliative surgery (colostomy, tracheostomy and PEG) to a neighbouring medical college hospital. Blood tests, X rays and ultrasound scans are done when it is deemed necessary. Tube feeding is done quite often considering the high incidence of head and neck cancers. We have also sent our patients for emergency radiation when we suspect impending cord compression.

    All this has been possible with our networking with other hospitals

    I agree with some of the comments; let us make sure what we would like to offer in our hospices. If a patient needs acute care which we cannot offer, there must be a place where we can send them for that care. It is unrealistic to convert a hospice into a hospital

  5. In our hospice in Rotterdam, The Netherlands, we also provide medical care in as far this is beneficial for the situation the patient is in, and within the limits of our possibilities. Bloodtransfusions i.e. are given in the local hospital, as a day admission. Likewise we admit patients for changing stents, radiotherapy, etc, just tailored to the costs and comfort it brings to the patient. It might be more helpful to solve the problem which causes the discomfort than just trying to suppress is. So we do bloodtests on demand, monitor vital signs, use observation scales (i.e. for delirium), and in special cases we can handle BiPAP. We use the Pathway-of-the-dying frequently. Also we involve the fysiotherapist or occupational therapist if this adds to the wellbeing of the patient.

  6. In the hospice in South Africa where I work, we do home care, but have partnerships with clinics, private sector GPs and specialists, hospitals etc. We encourage early referral, therefore our patients have access to treatment such as chemo, radiotherapy, surgery, blood transfusions, ARVs etc. A good inital and ongoing assessments (including the wishes and aims of the patient and family) are vital to facilitating access to appropriate treatment.

  7. In Badalona, Catalonia, Spain, we can provide medical care without limits in our palliative care unit. We can do active rehabilitation, blood tests, x rays, oxigen, tube feeding, monitor vital signs 24 hours 7/7 days, parenteral antibiotic therapy or epidural catheter care.
    Our patients have acces to chemotherapy, radiotherapy, surgery and control with the Department of Medical Oncology and Department of Radiation Oncology.

  8. John Weru says:

    An interesting ongoing discussion. In my current working station, a University Hospital’s
    Oncology unit palliative care service, all patients have their vital signs taken regularly,
    put on medication as need arises and access palliative chemotherapy and radiotherapy as
    indications present. My previous station was different as we only provided supportive care
    with the above being overlooked.

    It is my strong feelings that being hospice or palliative service, does not disconnect from the
    medical needs of the patient, the only difference would be being less aggressive in these situations.
    For example, currently we have a patient with brain mets of cancer of the breast in semi comatose
    state, overweight with good renal functions. We have put the patient on small doses of prophylactic
    anticoagulation to prevent any thromboembolic event, but would we rather have foregone this?
    I dont think so and at the end of it all it is the individualistic approach that is important.

  9. Ellen Üblagger says:

    In the hospice in Salzburg, Austria we provide medical care as far it is a benefit for the patient. For a palliative chemotherapy, radiation therapy or blood transfusion the patient is send to the oncology near by. We do blood tests on demand, or when we assume, that an alteration of he therapy brings a relief for the patient. In rare cases we used CPAP, tube feeding(PEG) is provided. We use oxygen and give antibiotics in selected cases when we see the possibilty to imporve the wellbeing oft he patient. The basis of the treatment is an individualised goal-focused care. We also offer physiotherapy, musictherapy, therapeutic touching health therapy and these therapies improve the wellbeing of the patients. The experiences of the last years show that the cases become more complex and patients come to the hospice earlier

  10. Dr. Ofra Fried says:

    Palliative care is patient-and-family centred care and it is patients and families who miss out when health care providers are confused about what they are offering. We often find that they are frightened about the transition to palliative care, believing that they will be abandoned without treatment, until we work out with them their ‘goals of care’, which may require active managment of some problems. This approach ensures we can tailor care to to changing needs and engenders trust, as well as taking advantage of the new and improved therapies or approaches that the development of our discipline has enabled. The major problem that arises with a blanket approach to care using very narrow criteria is that we limit referrals to and takeup of assistance for people who would otherwise benefit from a palliative approach to care – a situation that in Australia we have been working to change around for 30 years! Years ago, when I told a taxi driver what I did for a living, they didn’t know what I meant, and they shuddered when I told them. Now, everyone has an aunty or someone who has benefited by excellent palliative care, and all the taxi drivers have a story to share. The major problem that arises from a broader approach is that we can over-medicalise dying and lose sight of the valuable and somewhat revolutionary insights developed by contemporary palliative care. We should continually return to the basic principles including the ‘patient centred approach’. Here in Australia these are clearly articulated in 13 ‘Standards for providing Quality Palliative Care for all Australians’ (Palliative Care Australia 2005). Thank you for raising this topic.

  11. Nathan Cherny says:

    Regarding standards of care
    there are very few standards of care that have been published and none are specific for inpatient hopsices.
    All of the standards that have been published emphasise goal setting (in agreement with the patient) and goal focussed care. .. which is not consistent with a dogmatic radical de-medicalisation regarding all patients as imminently dying and regarding even basic medical interventions as innapropriate for hospice care.

    Given that, are these radicaly demedicalised approaches indeed a violation of contemporary standards of palliative care that need to be rectified?

    • Interesting discussion – strikes me as lots of apples & oranges. Sounds like it is important to consider venue, staffing skill set & resources, expectations of funder, achievable standards, bthen define what business one is in – hospice, longterm inpt palliative care, acute palliative care unit are three terms used in this discussion, likely meaning different things to each of us – thus importance of being clear in one’s own setting about which population one is trying to address. If one’s own unit is intentionally limited in scope, then does seem important to ensure access to interventions/other units for patients who may benefit meaningfully – one does not have to be all things to all people, but patients need to get the appropriate care somewhere.

  12. There are many factors to be considered on this subject; the type of health care system and providers, the level of knowledge of professionals, not only in palliative care, bioethics, anthropology, philosophy, etc. In addition we must consider the type of social affairs of each country.

    I am a physician working in Spain. My responsibility is Medical Coordinator for a small and successful hospice, CUDECA which was founded in 1992. For the past 20 years we have been working in the field of offering end of life care, and at the present time there are now others involved who specialise in palliative care for patients facing an end of life.

    How many others have followed the example of Cicely Saunders? Is it taking too long? I do not think so. I would like to transmit that it will take a long time to imbue our “normal” visions in this field. I never heard a word about end of life care during my undergraduate period – I had to look for training in this field…..now it is different in Spain. We are seeing changes in educational issues about end of life, a national strategy……..something is moving forward.

    About social affairs, I must say that we are receiving more euthanasia wishes than in former years (but not so many as you would expect). Social movements to defend euthanasia as a right are growing, our experience is that many times when we ask a colleague located in a hospital to perform a “special” diagnosis technique such as a scan or therapeutics as a transfusion, we are looked upon as professionals that perform therapeutic “Obstinacy” with our patients and then the magic words appear…”but if he/she is dying ? “

    The main reason to understand this problem is the lack of knowledge of the main issues about end of life care.

    I feel much calmer after reading your article. It is always a good idea to consider other opinions and to share concerns with colleagues with the same strong views.

  13. I am working in ‘Arodafnousa’ hospice in Nicosia as a palliative care physician for 13 years now.
    The hospice operates since 1976, at the beggining with patients at the end of their life. But in the last 15 years the philosophy of the hospice changed to palliative care and end of life care.
    The patients and their families is our focus of care. The policy of the hospice for admission is: pain and symptom management, respite care for the carer, blood transfusion, rehydration,physiotherapy, intravenous treatment for any kind of infections (it is an opportunity to improve their quality of life), accomodation(if they live far away from the oncology centre and they live alone) and caring during their treatments (radiotherapy and chemotherapy) at the oncology centre, caring and rehabiltation after an operation relating to cancer.
    During their addmision they have every day monitoring of the vital signs (incudIng pain), blood tests if it is necessary, treating the infections, providing tube feeding if they come with it, and the patient and the family would like to keep it longer, rehydration if they need it and it is going to improve their quality of life. Any other need of the patient is always under the consideration and assessment of the multiprofessional team.
    Our multiprofessional team work together with the patient and the family to cover their needs and we try to individualised every case who comes to our hospice.

  14. In Italy, ANT Foundation assists every day more than 3,600 cancer patients in advanced stages of disease, free of charge, to their home, through supportive/palliative care.
    Physicians, psychologists and nurses work in the name of Eubiosia (from Ancient Greek “good life”), that comprises a set of qualities that bring dignity of life from the first breath to the last.
    That is why we, in full compliance with the standards of clinical appropriateness shared, provide our patients with all medical interventions (basic and specialized) that can be useful at any stage of the disease. In fact, in addition to pain control, we also provide for interventions like transfusion, nutrition, and overall management of symptoms.

  15. Nathan Cherny says:

    It seems that there is a very strong consesnus here.
    Does anyone want to advocate for hopsices being places for terminal care only?

  16. pallcare says:

    Well, as commented before: in Germany, inpatient hospices would define themselves as places for terminal care only. There is a clear division of tasks between inpatient hospices and palliative care units, as well as different reimbursement systems. So there are settings where your consensus has to be challenged.

    I also noticed that most comments were from people working in palliative care units, not hospices.

    This is a very interesting discussion though

    • Nathan Cherny says:

      Are you there suggesting that hospices not advertise themselves as providing inpatient palliative care (rather terminal care only)?

      World wide “palliative care” is generally the preferred term to hospice care and indeed many Hospices (such as St Christopher’s) provide palliative care for patient not imminently dying?

      Where in Germany are patients needing long term inpatient palliative care cared for?

      Do we need international consistancy regarding the use of these terms?

  17. pallcare says:

    Inpatient hospices in Germany would advertise themselves as places of care for those patients who cannot be cared for at home, for example because the social setting does not provide enough support.
    Long-term palliative care would be delivered at home, or at whatever place the patient has been care for until now (i.e. he may call his home). There are specialised palliative home care services (with reimbursement from the health care system) that support the GP and other health care staff and may even take on the palliative care support completely for patients who need that. We are caring for patients with MND who are living in some sort of assisted housing arrangements, with a nursing service that runs this assisted housing (1-2 nurses around the clock in the flat), and we are supporting them with counselling, coordination and sometimes direct care.
    Some patients stay for prolonged periods of time in inpatient palliative care units if need be.

    I agree that consistency for the use of terms would be good. EAPC has tried to do exactly that in the white paper on standards and norms (http://www.eapcnet.eu/LinkClick.aspx?fileticket=f63pXXzVNEY%3D&tabid=735). However, we did find no definition of hospice care that was agreed on throughout Europe, and indeed found a wide range of settings (and goals) of hospice care in different countries. EAPC tries to foster a consenual understanding of the underlying philosophy as well as of the terminology of palliative care (and hospice care), for example with the many translations of the white paper that are available on the EAPC website.

    I am afraid that we have to accept that with the different health care systems and cultural background, as well as with the different roots that the hospice and palliative care units have grown out of, it will be hard or indeed impossible to achieve complete consensus.

  18. cathymillernz says:

    Here in New Zealand we have grappled with this. Recently there has been an attempt to come up with a nationally acceptable framework for palliative care services/hospices, incorporating definitions of what specialist palliative care is, what it is not (i.e. in what way could we expect ALL health professionals such as GPs, all nurses wherever they are working etc to contribute to dealing with the palliative care needs of their patients?)

    Such a framework was to have come up with a description of what hospices ought to provide (they are partly government funded therefore accountable to the taxpayer as well as to their own communities who help raise funds) and so on.

    This attempt is ongoing and it may take a very long time to finalise, if it ever is completed.

    One suggestion was that there be different “levels” of hospice – (just as we have secondary and tertiary care hospitals, so we could have primary secondary and tertiary care hospices). The problem is how many “levels” do you have and what should each level provide? I understand that in Australia there are different “levels” of hospice, with requirements to provide a certain set of services in order to qualify for the label of level 1 2 3 etc.

    The outcome of the NZ discussion was the consensus that ALL palliative care providers need to ensure that their patients have access to the services they need, and if unable to provide the service within their organisation then it must be provided through linkages with others. In other words the goal is that all patients have access to all the services they need (within the resource constraints of this country to provide them) in order to have their palliative care needs met. Just the fact of having a palliative diagnosis does not preclude having IV fluids, antibiotics, bisphosphonates etc, however not all hospices are able to provide all these interventional treatments and will transfer patients to hospitals for certain services. What individual hospices are able to do depends to a large extent on the facilities and level of expertise of their employees. For example we have excellent community based hospices that do not have their own inpatient unit, but care for patients wherever they live. These patients may be admitted to hospice or a hospice inpatient unit if required.

    The underlying principal of the consensus that was reached is to define the goals of care for that patient. If the goals of care are to no longer have any active treatments, then that is respected and readily provided for in most hospices. If the goal of care includes active care possibly even up to resuscitation, possible even including CPR, then that too is respected, and dependent on the hospice, may or may not be available. Some services will never be provided for in hospices (for example, as far as I know, no stand alone hospice in NZ has the capacity to provide high flow oxygen for example in excess of 10 litres, so patients requiring this for control of symptoms will always be managed in hospital)

    Here in NZ no two hospices look quite alike, and they probably never will.

  19. Nathan Cherny says:

    The EAPC consesus starement defines hospice care ” Hospice care is for the whole person, aiming
    to meet all needs – physical, emotional, social and spiritual. At home, in day care and in the
    hospice, they care for the person who is facing the end of life and for those who love them.
    Staff and volunteers work in multiprofessional teams to provide care based on individual need and personal choice, striving to offer freedom from pain, dignity, peace and calm.”

    While I appreciate that there are hospices who define their purview of care to a VERY limitted scope.. ie comfort care only.. this is not consistant with standrads that EAPC advocates and which are incopportaed in the definition of PC.

    There seems to be a fundimental problem of non enforcement of standards and a political decion not to advocate for instituional reforms to bring these limitted scope hospices into complience with conteporary standards of palliative care.

    I am concerned that these arrangements and the decision not to advocate for reform (for various political considerations) undermines the credibility of palliative care and of the EAPC as an organization that promotes complience with standards of care.

    Could we possibly bring this to discussion at an EAPC conference, possibly in the form of an interctive debate over a point of controversy.

    • AS says:

      So far we have discussed, hospice care, acute palliative care, oncological care, palliative care, terminal care all under the umbrella of “hospice care”. Hospice being the building where the care is provided. Teams that provide palliative care as per the EAPC standards or definitions do so in a variety of places and environments – if we are looking at in patient hospice care specifically then we may have to accept that some countires provide some aspects of palliative care as in patient care – and that might be end of life care or it may be acute palliative intervention care or both – and they may provide other aspects of palliative care by other means – perhaps community care.
      However, is the discussion “what specifically should be provided under the guise of palliative care”? If there are interventional therapies such as bisphosphante infusions or spinal analgesia techniques that will improve the QOL for our patients is it our duty to provide this or to ensure it is available for our patients? I believe we have a duty to be clear to all what we provide and where we provide it to manage peoples expectations and understanding appropriately.

  20. pallcare says:

    It would be good to bring this discussion to the EAPC congress, and we may have to find a place to squeeze that in the programme. I agree that standards are important and should be enforced as much as possible. This is why I like this blog discussion, which tries to clarify the issue.

    However, going back to the example of inpatient hospices in Germany, they would not agree that they provide comfort care only, but that they cater for the needs (in accordance with EAPC standards) of patients who are in the terminal stage of their life-limiting disease. They would be able to do good pain and symptom management in collaboration with the GP (inpatient hospices have no physician on staff) or with palliative care specialists, but blood samples or transfusions as well as some other kinds of interventions would not be possible. If patients need these interventions, they would be transferred to an inpatient palliative care unit, which provides all that.

    So it seems difficult to decide which standards are being missed in those units. We have to acknowledge that there is are widely different health care systems as well as differences in the basis of the palliative care and hospice services in the European countries.

  21. Augusto Caraceni, Director Palliative Care, Virgilio Floriani Hospice National Cancer Istitute, Milan Italy says:

    In our hospice we provide blood tests, xrays, transfusions and antibiotics, when and if appropriate according to a palliative care perspectie, ie. improving patients’ quality of life, respect patients’ choices, assure a multidisciplinary holistic approch to the end of life. Assisted ventilation is a very unusual procedure in advanced cancer and we had only one case, in 7 year of activity, of a young patient with a brainstem lesion which was mechanically ventilated and was admitted until death to our hospice. We managed the ventilator with external support and in collaboration with the family, as they were experienced in its use. Ethical and therapeutic dilemmas were important, they were tackled and we tried to do our best.
    In Italy hospices can be either within hospitals or selfstanding institutions, outside the hospital walls, and can therefore have different access to diagnostic and therapeutic interventions.
    However, there are standards of care which needs to be fullfilled by all hospices requiring nursing and medical staff and specific structural characteristics. Some hospices cannot provide blood tranfusions, but it is very often true that blood trasfusion can be inappropriate in many palliative cancer patients.
    It would be a dreadful perspective to say that hospices cannot provide any therapeutic intervention, such as antibiotics, by definition, this would have an enormous negative impact on the public image of hospices. The opposite is true, there are medical interventions and therapies which have to be available in all hospices to control symptoms and to offer treatment for complications and comorbidities, at the appropriate level of care. Dogma are not responding to patients needs and there has to be a safeguard for patients who may benefit for more treatment to be referred to other institutions, if admitted to hospices where that level of intervention is not available. Patients have often benefitted from hospice care by improving their performance status, going back to home care and, even, rarely, to outpatient clinic. Patients discharged from hospice in good clinical conditions to longterm-care facilities, suddenly deteriorated and died, may be due to the reduced level of care. We have to avoid the risk that the type of available care dictates the therapeutic indication.
    In a progressive view of palliative care, and of improving the health care systems, it is the integration of palliative care within the system via a network of services which cooperates to the patient care at the different levels : home, hospice and hospital, which can guarantee that we try to encounter more an more patients’ needs, also in terms of autonomy and respect of individual human rights. Rationing of resources or ideological dogma are not included in this view, or at least in my view, and this is the view I would like to share with the Palliative care community and within the EAPC.

    • AS says:

      I would whole hearted agree with most the comments posted so far with regard to providing holistic care in a variety of settings. However, I am not sure that we can side step the issue of economics and the healthcare landscape of each country. Just as our other medical colleagues from oncology and in other specialisties must look at what they provide, to how many and for what benefit we must do the same. It would be interesting to look at life expectancy on discharge from hospice to NH and from hospice to home – if standard of care is felt to be a factor then it may be more beneficial to improve the skills of the generalists in NH care rather than provide more hospice care.

  22. Ofra Fried says:

    We shouldn’t ‘throw out the baby with the bathwater’ because we haven’t got agreement over defintions. While there are different interpretations of what is meant by ‘palliative care’, ‘hospice care, ‘terminal care’ etc across different jurisdictions and health care economies, the aspirations described – idealistic and inclusive as they are – have created something of a revolution in health and end-of-life care and should I believe be maintained.

  23. This issue will be debated this coming friday morning at the EAPC conference (May 8 2015). Join the debate and discussion let your voice be heard

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