With this definition by the WHO and current efforts expanding palliative care beyond terminal illnesses,
palliative care should be seen as partially overlapping but not synonymous with end-of-life care. Palliative
care does not necessarily revolve around end of life. This is an important conceptual differentiation of the
terms; however, palliative care is still often used interchangeably with hospice care or end of life care in
clinical settings and in the society. Most in-hospital units providing hospice care are named as ‘‘palliative
care units’’ in Japan because the term hospice implies the strong connotation of a place for dying. ‘‘Palliative care teams’’ in hospital settings in various countries also are providing palliative care mostly to patients
whose curative treatment options are limited, and in the United States, there was a trend in the last 10 years
Despite the increased use of the term ‘‘end of life’’ and ‘‘end-of-life care’’ in health-care and nursing literature, over the last 30 years, there is no exact definition of what constitutes the time interval referred to as
end of life.10 The period of time and types of patients who are considered to receive specific ‘‘end-of-life
care’’ such as hospice service may be defined by regulatory, policy, or administrative guidelines, but there is
no scientific evidence to support the clinical indications characterizing a period of end of life.10 This lack of
clinical evidence is largely due to the difficulty of reliable prognostication.11,12 To date, there is no clear
clinical indicator to predict time of death. Therefore, it is impossible, and may be unreasonable, to mark
a date such as 6 months before the predicted death as the beginning day of an end-of-life period.10