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The academic hospice is a recent development in health care. Hospice programs and hospitals evolved from the same historical roots in Greek and Roman medicine. The academic hospital emerged as a place where patient care, education, and research are pursued as inextricable parts of the mission. The unique role of the academic medical center in health care is supported by the government, the medical profession, and the public. This article provides a perspective on the emergence of the academic hospice. Dr. Cicely Saunders, who died on 14 July 2005, founded the first such hospice in London, England, in 1967. The authors show that the philosophy of hospice care has the same historical roots as standard health care and describe those elements that distinguish academic hospice programs from other kinds of hospice programs. Finally, the authors note that demographic and economic challenges in the United States and elsewhere only increase the need for academic hospice programs. more...

Healthcare decisionmakers in acute settings might well benefit from lessons learned over two decades of hospice experience providing community-based, cost-effective care. Now the hospice concepts of interdisciplinary symptom management and transition counseling are being made available to patients and families long before they reach the traditional six-month prognosis entry point. more...

Patients who are facing terminal illness frequently experience changes in health care settings which are necessitated by acute events during palliative care. This pilot study evaluates the reliability, criterion validity, and appropriateness of the San Diego Severity Index (SDSI) in a population of advanced cancer patients in different care settings. The SDSI includes diagnostic, acuity, and psychosocial assessments. Cancer patients were evaluated in an outpatient oncology clinic (SCRF), a hospice home care (HC) program, and an acute care hospital/hospice centre (ACC). Scores were lowest for SCRF (9.51 +/- 3.7), HC was intermediate (24.04 +/- 8.8), while patients at the ACC scored the highest (29.33 +/- 7.0). Patients admitted to the ACC were significantly more acute, as assessed by the SDSI, than those utilizing outpatient services. This instrument may be useful as an indicator of appropriate transitions between health care settings. more...