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Palliative Care Perspectives : Chapter 1: Death and Dying in Modern Times : Recent History

The 1990s witnessed remarkable changes in the palliative care/hospice movement. The first major textbook in the field, The Oxford Textbook of Palliative Medicine, was published in 1993. This text was a quantum leap beyond earlier handbooks in the field. While initially hospice was made available primarily to cancer patients, patients with other diseases have begun requesting such care. Pressure is growing to build upon what has been learned in hospices and apply this knowledge to the care of other patients and in other venues. Clinicians are finally beginning to realize that their training has been grossly deficient in the skills and the art of palliative care. Perhaps most important, a significant portion of the public has been exposed to hospice. Consumers are demanding better symptom management and better care - whether they are dying or not-in all venues of care. The public is debating the ethics of assisted suicide and pain management. The tide is beginning to turn.

For the physician-in-training the changes are just beginning. Until recently most medical schools and residency programs in the United States offered limited training in palliative care.21-24 Most medical schools offer some brief exposure to medical ethics, but rarely symptom management. Residents have been expected to learn skills (such as pain management, sharing bad news, and how to pronounce patients) on the job, usually from residents a year or so senior with similarly poor preparation. This is changing. Many accrediting bodies, from the American Academy of Medical Colleges to the American Board of Internal Medicine, now require some training in palliative care.25,26 In January 2000 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which accredits hospitals in the United States, issued stringent new requirements for symptom management in hospitals, nursing homes, and clinics.27 California has passed a law requiring all physicians to receive 12 hours of continuing education credit in pain and end-of-life care between 2002 and 2006 in order to be relicensed. While the quantity and quality of such training is still highly variable, the trend seems irreversible. Palliative care is finally on the radar screen.

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Palliative Care Perspectives

James L. Hallenbeck, M.D.

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Copyright 2003 by Oxford University Press, Inc.

The online version of this book is used with permission of the publisher and author on web sites affiliated with the Inter-Institutional Collaborating Network on End-of-life Care (IICN), sponsored by Growth House, Inc.