From the hospital to the community: reshaping the palliative care paradigm

Palliative care (PC) has traditionally developed within hospital settings, shaped by biomedical models, specialist hierarchies, and episodic care delivery. However, demographic change, rising multimorbidity, patient preferences, and health system constraints increasingly challenge hospital-centric approaches. In contrast, improving the community palliative care model requires moving beyond the simple decentralization of services toward a more integrated, person-centered, and ethically grounded system of care. At its core, an effective community model must recognize the individuality of people living with serious illness and respond to their needs across time, relationships, and care settings rather than in isolated clinical encounters. This perspective paper argues that a paradigm shift from hospital-based to community-anchored PC is no mere organizational adjustment but requires a conceptual transformation. Drawing on recent evidence and global policy frameworks, the paper explores the drivers, opportunities, and tensions of community-based PC, highlighting implications for clinical practice, professional roles, health systems, and communities. The transition between models is framed as a reorientation toward continuity, relational care, and shared responsibility, requiring new forms of integration between specialist services, primary care, and civil society.