End-of-life care: lessons from other nations

Abstract

Palliative care and hospice services have evolved across the globe in different contexts and in different ways, although many of the challenges faced are similar. Comparison between countries helps to identify the best solutions for individual patients and their families, who have complex needs and problems. This paper describes the globally shared challenges and beginnings in hospice and palliative care. It reviews evolution of services and approaches. It compares the models of hospice and palliative care in the United States and the United Kingdom, where pioneer hospices were developed through the work of Dame Cicely Saunders, and then seeks to highlight ways to learn from the different approaches to address common questions. Several research recommendations result from this review. In many countries the research agenda in palliative and end-of-life care must move from describing need (where there are ample studies) to understanding how and determining whether services and interventions work, for whom, and when. Studies should consider the whole trajectory of illness, particularly in slowly progressive or relapsing conditions (including neurological conditions). Future studies should work toward the use of a similar set of core outcome measures, as well as take advantage of the opportunity to undertake "natural experiments" by comparing and contrasting care systems developed in different contexts around the world.