Redefining Care: Making End-of-Life Support a Priority in Hospitals
"Discover how integrating palliative care principles can transform hospital settings, ensuring dignity and comfort for patients and their families."
Imagine a patient, battling metastatic lung cancer for over a year, admitted to a hospital ward. Gravely ill, struggling with acute respiratory distress, pain, confusion, and fear. Their family, anxious and seeking reassurance, asks how their loved one will be cared for. This scenario, while specific, highlights a broader challenge: how effectively do hospitals address the needs of patients in their final stages of life?
Too often, despite best efforts, the patient's end-of-life needs are not recognized or adequately addressed. The family may feel unheard, and healthcare providers might question whether they did everything possible. This reflects a gap in training and a need for a more integrated approach to end-of-life care within general hospital settings.
This article delves into the importance of integrating palliative care principles into hospital settings to ensure dignity, comfort, and support for both patients and their families. It addresses the need for a shift in perspective, viewing death not as a failure, but as an inevitable part of life that deserves compassionate and comprehensive care.
The Scale of Need
The CDC reports 1.8 million hospice patients in the United States in 2022. A separate 2026 report estimates that 40 million people worldwide required palliative care in 2022 and projects that need will rise as populations age and chronic illnesses increase. U.S. reporting also identifies hospital-team availability, hospice enrollment, late referrals, care settings, and cost savings as important measures of palliative-care delivery.
Evidence, Access, and Ethics
Palliative and end-of-life care aims to relieve suffering while respecting patients’ wishes, but clinicians still face ethical and clinical uncertainty. One review notes that even the benefits and harms of artificial hydration at the end of life remain uncertain, and that established evidence can take time to influence practice. Access is also variable: many inpatients do not receive palliative care, while barriers in hospitals and long-term-care settings can obstruct optimal support.
From Hospice to Global Health
Modern palliative care developed from the experience of British hospices in the 1960s and moved toward a public-health approach during the 1990s. Although modern palliative care began more than 50 years ago, its formal recognition by the World Health Organization in 1990 marked a major turning point. Since then, the field has expanded from a niche service associated with terminal cancer to a broader global-health priority connected with universal health coverage.
The Urgent Need for Better End-of-Life Care: Why Hospitals Must Adapt
Studies across different countries, including Italy, reveal a concerning trend: the quality of care for patients in the final stages of life within hospitals is often insufficient. A significant percentage of patients experience poorly managed pain and physical symptoms, despite available treatments. This highlights a systemic failure to prioritize comfort and holistic well-being during a patient's final days.
- Uncontrolled Symptoms: Many patients suffer from poorly managed pain and other distressing physical symptoms.
- Inappropriate Interventions: Patients are subjected to unnecessary and burdensome diagnostic tests and treatments.
- Communication Gaps: Lack of clear and consistent communication between medical staff, patients, and families leads to dissatisfaction and mistrust.
- Emotional Toll: Healthcare providers face emotional strain and ethical dilemmas due to the challenges of providing end-of-life care in inadequately supported environments.
A Broadening Research Agenda
Recent palliative-care research is examining the inclusion of diverse patient groups, care during pandemics, telepalliative care, and the use of modern technologies in practice. Research collections also emphasize goal-aligned end-of-life care across the life course. Current JAMA coverage includes prognosis, advance directives, spiritual support, and relationships between oncology and palliative-care teams that may affect hospice use among patients with metastatic cancer.
Limits of Implementation
Arguments against expanding end-of-life support may arise when evidence is incomplete, resources are constrained, or clinicians and patients differ over treatment goals. Implementation can also fail when services are difficult to access or when communication does not adequately reflect patients’ wishes. These concerns suggest that making palliative care a priority requires attention not only to clinical ideals but also to practical delivery and ethical decision-making.
Palliative Care and Hospice
Palliative care and hospice both focus on quality of life, symptom relief, and support, but they are not interchangeable. Palliative care can be considered as part of care for serious illness, while hospice is generally associated with terminal illness and a focus on comfort rather than curative treatment. The National Institute on Aging, the American Cancer Society, and other care guides present the distinction between these options as important for choosing care that fits a patient’s needs.
Transforming Hospital Care: Steps Towards a More Compassionate Approach
The hospice model, with its emphasis on palliative care, demonstrates that providing dignified and comfortable end-of-life care is achievable. The challenge lies in translating these principles into the hospital setting, particularly in general medicine wards where a significant portion of patients with chronic and degenerative diseases die.
Defining High-Quality Care
End-of-life care is shaped by subject-matter experts who influence treatment decisions, policies, programs, and practice guidelines. Recent research is examining which elements these experts consider most important when delivering high-quality care. The AMA’s Council on Ethical and Judicial Affairs also develops reports whose adopted recommendations become Opinions in the Code of Medical Ethics, providing guidance for applying ethical principles in practice.
Planning Ahead
Advance-care planning is identified as a major direction for improving future end-of-life care. The cited review reports that it can decrease life-sustaining treatment, increase use of hospice and palliative care, and prevent hospitalization. It also reports that complex advance-care-planning interventions can improve compliance with patients’ end-of-life wishes, while professional surveys continue to track what palliative-care teams are focusing on.
A System-Wide Responsibility
End-of-life support is affected by more than individual clinical decisions. Hospitals and health systems may need to align staffing, communication, access, ethics, and care coordination so that patients’ goals can be addressed consistently. A broader priority on supportive care therefore depends on implementation across the system, not only on the availability of specialized services.
Communication, Symptoms, and Families
Case-based palliative-care literature organizes real-world practice around communication, symptom management, and family care. These cases reflect the practical challenges of delivering care that is both appropriate and acceptable, a policy priority that still encounters obstacles in practice. A 2025 study is examining how the timing of palliative care and the intensity of end-of-life care relate to overall survival in a large real-world cohort, while hospice case examples emphasize eligibility, care plans, pain management, and family involvement.
Integrated care pathways, such as the Liverpool Care Pathway (LCP), offer a structured approach to improving end-of-life care in hospitals. These pathways aim to equip entire hospital departments with the knowledge and skills to address the complex needs of dying patients and their families. A recent study describes the implementation of a care pathway, adapted from the LCP, in an internal medicine ward in Italy, with encouraging preliminary results.
Providing good end-of-life care in hospitals should be the norm, not the exception. By embracing palliative care principles, adopting integrated care pathways, and investing in training and resources, hospitals can transform the dying experience for patients and their families, ensuring dignity, comfort, and peace in their final moments.