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Palliative care and hospice outside of the United States

Suresh Kumar, MBBS, DA, Dip Palmed, MA
Section Editor
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD


Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing serious illness. The primary tenets of palliative care are symptom management; establishing goals of care that are in keeping with the patient’s values and preferences; consistent and sustained communication between the patient and all those involved in his or her care; psychosocial, spiritual, and practical support both to patients and their family caregivers; and coordination across sites of care.

Hospice and Palliative Medicine is a recognized medical subspecialty in the United States and internationally, including in Canada, England, Ireland, Australia, and New Zealand. Many European countries are also in the process of developing certification for palliative care. Unfortunately, in other parts of the world access to quality palliative care is very limited. In one study, only 8 percent of eligible patients worldwide had access to palliative care services [1].

This topic will discuss palliative care and hospice services outside of the United States. A more comprehensive overview of palliative care is available separately. (See "Benefits, services, and models of subspecialty palliative care".)


Palliative care services focus mainly on noncommunicable causes of death, which bring about the great majority of deaths worldwide [2]. Adults in need of palliative care for progressive nonmalignant disease represent the highest proportion of cases for all regions, followed by cancer. One exception to this is in Africa, where people with HIV/AIDS remain the largest group of patients in need of palliative care [3]. The World Health Organization (WHO) estimates that the great majority (78 percent) of adults in need of end-of-life care belong to low- and middle-income countries [3]. Similarly, the vast majority of children (98 percent) in need of palliative care at the end of life belong to low- and middle-income countries [3]. However, the highest rates of palliative care availability and utilization among adults are in higher-income countries.

One study that included over 230 countries evaluated the availability of palliative care internationally and reported that 58 percent had one or more palliative care systems available [4]. Separate studies indicate that specialist-level palliative care is available in only approximately 30 to 45 percent of nations [5,6].


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Literature review current through: Sep 2016. | This topic last updated: Feb 11, 2016.
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