Palliative care: a review of past changes and future trends.

Palliative care arose out of the change from acute to chronic causes of death and the emphasis of health care on improving quality of life. In the United Kingdom, specialist palliative care is provided mainly for cancer patients through hospices and support teams, which have grown rapidly in the last 30 years. Single sites and more recently several units have demonstrated their effectiveness, acceptability and efficiency. However, the majority of people who die will not receive these services but will receive much of their care in hospital, nursing home and community settings. The growing numbers of people who are likely to die from HIV/AIDS and the growing numbers of older people make it important that palliative care becomes more integrated with hospital, community and general practitioner services. Palliative care should become a gradually increasing part of care from diagnosis to death, rather than being concerned only with the terminal phase. A palliative care component and appropriate standards could be included in the needs assessment and the contracts for many hospital and community services. In research on new treatments, particularly for cancer and HIV/AIDS, palliative aspects should be measured along with survival and the usually fairly basic estimates of quality of life. Hospices, and in particular support teams and day care, require further evaluation if they are to extend their role to providing care for the younger people with HIV/AIDS and the older people who are dying from chronic diseases such as cardiovascular disease.