The end of life has changed dramatically in recent years as life expectancies have increased, chronic disease rates have risen, and families, health care systems, and society have changed. As technology has advanced, death too often has become viewed by society as "failure" and even "optional." Too often, referral to hospice has come too late to be sufficiently effective. While expertise in palliation of pain and symptoms at the end of life has been developed, palliative care has not been well integrated with management of chronic diseases or incorporated into the continuum of medical management from health and wellness to the end of life. We can, and must, do better.
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