Editorials

Evidence based palliative care

BMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7208.462 (Published 21 August 1999) Cite this as: BMJ 1999;319:462

There is some evidence—and there needs to be more

  1. Irene J Higginson, professor of palliative care and policy
  1. New Medical School, King's College, and St Christopher's Hospice, London SE5 9PJ

    In the first decades of the 21st century much healthcare spending will be concentrated on the end of life. Predictions for the year 2025 show an ageing population, with more people worldwide dying from chronic or progressive illnesses rather than acute conditions.1 Indeed, this revolution is already upon us. In the United States end of life expenditure through Medicare consumes 10-12% of the total health budget and 27% of the Medicare budget.2 Among older people healthcare expenditure for those in the last year of life was 276% higher than for people of similar age.3 Cartwright and Seale estimated that in England about 22% of hospital bed days were taken up by people in the last year of life.4 Although discussion of death is still taboo in our society, all health and social professionals must now be assessing the best way of caring for a person with a progressive illness and their family. This underlines the importance of palliative care.

    Palliative care is a person centred approach concerned with physical, psychosocial, and spiritual care in progressive disease. It focuses on both the quality of life remaining to patients and supporting their families and those close to them. Throughout the world specialist palliative care services have grown, though their distribution is uneven. In 1999 there were over 6560 hospice or palliative care services in 84 countries, with 933 services in …

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