Brief History of Palliative Care

Palliative care is a relatively new field of medicine. Below is a brief timeline of important events in the history of palliative care.

• 1967: Palliative care was born out of the hospice movement.Dame Cicely Saunders is widely regarded as the founder of the hospice movement. She had degrees in nursing, social work, and medicine. She introduced the idea of “total pain,” which included the physical, emotional, social, and spiritual dimensions of distress. Saunders opened St. Christopher’s Hospice in London in 1967.

• 1969:Elisabeth Kübler-Ross published her bookOn Death and Dying. In this book, she defined the five stages of grief through which many terminally ill patients progress: denial, anger, bargaining, depression, and acceptance. Although we now believe dying patients do not necessarily go through these phases and that these phases do not necessarily occur in a set order, Kübler-Ross’s book and lectures raised public consciousness about care for patients at the end of life.

• 1974: Florence Wald, the dean of Yale School of Nursing, was so inspired by a lecture by Dr. Saunders at Yale that she went to visit St. Christopher’s in 1969. Florence Wald then founded the first hospice in the United States, in Branford, Connecticut, in 1974. At the start of the hospice movement in the United States, most hospices were home based and volunteer led.

• 1974:Dr. Balfour Mount, a surgical oncologist from McGill University, coined the term “palliative care” to distinguish it from hospice care. While hospice falls under the umbrella of palliative care, palliative care can be provided from the time of diagnosis of a serious illness and concurrently with curative or life-prolonging treatment.

• 1980: The federal government mandated that hospice care be covered by Medicare.

• 1990:The World Health Organization recognized palliative care asa distinct specialty dedicated to relieving suffering and improving quality of life for patients with life-limiting illness.

• 1997: The Institute of Medicine report “Approaching Death: Improving Care at the End of Life” noted discrepancies between what the American public wanted for end-of-life care and how Americans were experiencing end of life in the United States. With tremendous support from multiple philanthropic foundations, multifaceted efforts were made to promote palliative care.

• 2006:The American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education (ACGME) recognized hospice and palliative care as its own specialty.

• 2010:The New England Journal of Medicine published astudy by Dr. Jennifer Temel and colleagues that showed that people with lung cancer who received early palliative care in addition to standard oncologic care experienced less depression and increased quality of life and survived 2.7 months longer than those receiving standard oncologic care.