Building definitional consensus in palliative care

Definitional inconsistencies and confusion about core principles and practices have been part of the history of palliative care for more than five decades. The term ‘palliative care’ was first used to describe clinical services that had a singular focus on end of life care, particularly in the context of cancer; the ‘good death’ was its definitional touchstone. Modern use of the term ‘hospice’ predated this label and described services with the same intent, and ‘supportive care’, a term that emerged decades later, referenced elements that were comparable. Over time, the use of these labels evolved, and although global consensus has not yet been achieved, the development of palliative care as a clinical discipline has promoted greater agreement. Specialists increasingly favour the use of ‘palliative care’ to depict a multiprofessional model of care appropriate for all populations with potentially life-limiting chronic illnesses, the goal of which is to enhance the potential for a satisfactory quality of life and end of life experience by preventing or managing the suffering and illness burden of the patient and family. Around the world, specialists use both ‘palliative care’ and ‘hospice’ to describe programmes that advance the objectives of palliative care; ‘hospice’ is usually preferred when programmes serve those with advanced illness and short prognosis in a home-like environment. ‘Supportive care’ is generally applied to a parallel oncology-based model with a strong focus on problems related to cancer treatment. As specialist palliative care programmes are continuing to emerge globally, expansion of the model of care is occurring through early integration approaches that include the efforts of non-specialists. This chapter discusses the evolving perspectives on the definitions applied to palliative care and related terms, and the core principles and practices that have supported its global development.