25 Years: Looking Back, Looking Forward.

Palliative medicine and the practice of palliative care has disseminated around the world for the past 25 years. In many countries, palliative medicine is a formally recognized specialty of medicine. Yet, there is a high variability, due in part to the variable resources devoted to its development. New research is needed to improve our ability to control symptoms and to know how best to implement the existing science so that the patients who need palliative care can get it easily and equitably. Achieving this level of access requires expertise in organizational structure and system change strategies. Building the evidence base for best practices requires us to forge research collaborations with collegues from all medical subspecialities, including experts from allied health disciplines, and partner closely with patients and families. It also compels us to look critically at ourselves to overcome the barriers we put in our own way to becoming a routine part of standard health care in all countries.