Palliative Care evolved
out of the Hospice Care movement that began in the late 1950’s in the United Kingdom.
Dame Cicely Saunders is credited with fostering the idea that more needed
to be done to provide profession care for those who were suffering from terminal
illness. Evidence-based
research was used to demonstrate in clear and certain scientific terms that charitable homes and
nursing homes were woefully inadequate to address the needs of patient and
families at the end of life. The concept
of “total pain” was defined in 1964 as something that went beyond physical
symptoms to include mental distress and social or spiritual issues, and a focus on relief of total pain became a main goal of care for terminal patients.
Dame Saunders began the first hospice
program at Saint Christopher’s in 1967. At Saint Christopher's the initial research was done to identify ways to
relieve the distress of the dying using a multidisciplinary approach to
address fear and grief as well as physical symptoms of disease. The idea began to spread throughout the Royal Medical Association. The term
palliative care was coined in 1974 by Dr. Balfour Mount, an oncologist at the
Royal Victoria Hospital of McGill University in Montreal to avoid the negative
connotations the word hospice has in some cultures. He described palliative care as a holistic
approach to addressing the physical, psychological, social and spiritual distress
of people with chronic or life-limiting disease.
Two common myths
had to be overcome in order for palliative medicine to gain acceptance: the belief
that patients would become drug dependent if doctors focused on pain relief and
that increased drug tolerance would make the administration of pain medication
ineffective. Clinical pain researchers in
the United Kingdom allied with their counterparts in the United States
conducted international studies showing that these risks could be mitigated.
Simultaneously public
attitudes about end of life care changed as a result of ongoing philosophical,
political and spiritual research into the most humane and effective way to
support the dying. In the initial years,
hospices were buildings for the dying where research was conducted to improve
the quality of care for the dying. By the 1990’s, hospice care and palliative
care became services that could be offered at home or in a hospital as well as
in a hospice setting.
The American Board
of Medical Specialties (ABMS) and the Accreditation Council for Graduate
Medical Education recognized the subspecialty of Hospice and Palliative
Medicine in 2006 and by 2008 the American Academy of Hospice and Palliative
Medicine had over 3000 members and the field has steadily grown in the past
decade. From the beginning Palliative Medicine sought to integrate the care of social
workers, psychologists and chaplains into the delivery of total care for patients
referred for palliative care. All three
fields have developed subspecialties.
The four
professional organizations that certify chaplains in the United States through the ACPE process: Association of
Professional Chaplains, the National
Association of Catholic Chaplains, the National Association of
Jewish Chaplains, and the American
Association of Pastoral Counselors agreed upon the current common standards
for Palliative Care and Hospice Advanced Care (PCHAC) in late 2018.
Although there are some overlapping skills in the services provided by palliative care and hospice chaplains, there is a distinct difference between when one service or the other is recommended. Palliative care has to do with quality of life and pain management when a person has a life-threatening or life-limiting illness. Hospice care is recommended when a patient has 6 months or less to live and the family needs the supports it can offer to minimize pain and suffering at end of life. Dame Saunders published several books about palliative and hospice care. My favorite is Hospice and Palliative Care: An Interdisciplinary Approach.
