Changes in the world of palliative care

The last quarter of the 20th century produced considerable advances in hospice and palliative care. In many countries, specialist services developed, education programmes got underway and in some cases palliative care ideas began to infiltrate national health policies. Globally, however, palliative care still faces many challenges: lack of recognition and understanding on the part of the health professions and the public; limited expression in health policy; insufficient funding; few accredited training programmes; and a paucity of evidence to demonstrate efficacy and cost benefits. We describe what is known about the development of palliative care around the world, how its clinical focus is changing and what prospects there are for further development