{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T14:48:42Z","timestamp":1793976522202,"version":"4.8.0"},"reference-count":72,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliative Medicine Reports"],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:p>The field of hospice and palliative care in the United States is experiencing serious problems and faces an uncertain future. Quality of hospice care is highly variable. Unethical hospice business practices are common in some regions. Palliative care\u2019s integration within American health care has stalled, despite demonstrating that much better care for seriously ill and dying people is both feasible and affordable. Corrective steps have been halting. Urgent work is needed to safeguard seriously ill patients and their families and ensure quality and reliability of hospice and palliative care programs and services. The moment has come for the clinical specialties and corporate community of hospice and palliative care to chart a strategic path forward. Efforts must start with zero tolerance of fraudulent business and clinical practices that harm vulnerable patients. The four components of this strategic approach are (1) publishing clear clinical and programmatic standards, (2) making meaningful data readily available, (3) driving quality-based competition, and (4) embracing the field\u2019s authentic brand of expert care that fosters well-being for patients and their families. Part I of this white paper examines the root causes of the key problems facing the field. Part II presents the rationale and practical considerations for each of the four components of this strategy. This path forward addresses the hard problems the field faces and enables it to realize its dual mission of caring well for ill and dying people and helping society integrate illness, caregiving, dying, and grieving within a continuum of full and healthy living.<\/jats:p>","DOI":"10.1089\/pmr.2025.0030","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T22:13:53Z","timestamp":1749075233000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["A Strategic Path Forward for Hospice and Palliative Care: A White Paper on the Potential Future of the Field"],"prefix":"10.1177","volume":"6","author":[{"given":"Ira","family":"Byock","sequence":"first","affiliation":[{"name":"Dartmouth Geisel School of Medicine, Missoula, Montana, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2015.10.018"},{"key":"e_1_3_3_3_2","unstructured":"NHPCO Facts and Figures 2024. 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Available from: https:\/\/chemed.com\/ [Last accessed: January4 2024]."},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.6300"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.20546"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2015.05.001"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06982-4"},{"key":"e_1_3_3_24_2","unstructured":"MedPac. 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