Reconciling Palliative Care Policy with Clinical Reality: Family and Caregiver Needs versus Provider Service Structures

Palliative care, defined broadly as a holistic approach to care for patients with progressive and advanced disease with limited prospects for long‐term survival (World Health Organization, 2008), confronts a number of formidable policy obstacles and challenges to its development in the U.S. Included among them are inadequate access, fragmented delivery systems, inadequate financing mechanisms, limited professional education, and the shortage of health care providers that is endemic throughout the U.S. health care system (Institute of Medicine, 2001; Reb, 2003). In the brief analysis that follows, two of the dominant policy issues in palliative care are highlighted. The first is the problematic approach to palliative care in the U.S. that, for historical reasons, forces an often harsh choice between curative health care and health care that is narrowly limited to comfort and “death with dignity.” This dichotomous orientation toward palliative care contrasts with that of other countries (e.g., Australia, Canada, New Zealand, the United Kingdom), which approach palliative care as more of a holistic continuum with permeable boundaries between curative and purely supportive care. The second policy issue brought into focus concerns the economic viability of more progressive approaches to palliative care, in particular the need to promote research that identifies the most cost‐effective approaches to palliative care.