In the United States, the development of palliative care has been supported by national organizations and legislative initiatives to improve access and quality. Although there is no single federal framework, several acts and guidelines emphasize the importance of high-quality, accessible palliative care for all Americans. The Palliative Care and Hospice Education and Training Act (PCHETA) was reintroduced in Congress in recent years to address these needs by supporting workforce development, research, and education for health professionals (American Academy of Hospice and Palliative Medicine [AAHPM], 2021). While PCHETA has not yet passed, the Act reflects a growing recognition of the essential role of palliative care in the U.S. healthcare system (AAHPM, 2021).

Guiding Principles in Palliative Care in the United States (Adapted from National Consensus Project for Quality Palliative Care)

• Palliative care is patient- and family-centered.
• Recognizes that death and dying are a part of life.
• Integrates physical, emotional, spiritual, and social aspects of care.
• Provides equitable access to all who need it, regardless of condition or setting.
• Prioritizes quality of life and symptom management over curative measures.
• Supports caregivers as partners in care and recipients of support.
• Embraces diversity and adapts to the unique values of patients and families.
• Is evidence-based and focuses on continuous quality improvement.
• Includes coordinated care across settings, from hospitals to homes (National Consensus Project for Quality Palliative Care, 2018).

Challenges in U.S. Palliative Care

Despite significant advances, gaps in access and consistency in quality persist. Reports indicate that while many Americans prefer to receive end-of-life care at home, only a small percentage have access to home-based palliative care services. A 2019 study by the Center to Advance Palliative Care (CAPC) found that palliative care availability varies widely, especially in rural areas, with only about half of U.S. hospitals with 50 or more beds offering palliative care services (CAPC, 2019).

Key challenges in U.S. palliative care include:

• Limited access to palliative care in rural areas and underserved communities.
• A shortage of trained palliative care providers.
• Disparities in care access, with people of lower socioeconomic status and non-cancer diagnoses often less likely to receive palliative care.
• Insufficient public and professional awareness of palliative care benefits, which leads to delayed referrals and underutilization of services (CAPC, 2019).

To address these issues, U.S. palliative care organizations recommend expanding provider education, establishing national standards for palliative care, and increasing public awareness of its benefits.

References

• American Academy of Hospice and Palliative Medicine (AAHPM). (2021). The Palliative Care and Hospice Education and Training Act. Retrieved from https://www.aahpm.org
• Center to Advance Palliative Care (CAPC). (2019). America’s Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals. Retrieved from https://www.capc.org
• National Consensus Project for Quality Palliative Care. (2018). Clinical Practice Guidelines for Quality Palliative Care. Retrieved from https://www.nationalcoalitionhpc.org/ncp