Visionary "Total Pain Model" Guides Hospice Care

Hospice professionals today owe a debt of gratitude to Dame Cicely Saunders for the model of healthcare she developed in the 1960s. As a nurse, turned social worker, turned physician, she established St. Christopher's Hospice in London in 1967.  St. Christopher's, still thriving today, credits her  for revolutionizing the way society cares for the ill, the dying, and bereaved.

The cornerstone of Dame Cicely's philosophy of care is the total pain model, which illustrates that the pain experienced by a seriously ill person is a complex combination of physical, emotional, social and spiritual factors. 

The total pain model is central to hospice care; it reminds us that the pain experienced by a seriously ill and dying person cannot be alleviated with medication alone. Hospice care is provided by a team of caring professionals, each with unique skills and training to address one aspect of the total pain. A key component is its acknowledgement that the pain experienced by the patient and caregiver are interrelated. Therefore, hospice care focuses equally on the patient and caregiver.

Dame Cicely's work - and modern-day hospice - are influenced by the experiences and wisdom of the early hospices in medieval Europe. Their care for the sick and dying was deeply holistic, focusing in large part on the spiritual aspect of pain and suffering. They realized that pain is primarily a physical and emotional experience centered in our physical body. 

Suffering, however, develops when we apply meaning or "tell ourselves a story" about the pain. For example, a patient with severe cancer-related pain may have intractable suffering if he or she believes the "cancer is punishment" for prior misdeeds. Suffering, as a result, does not often improve with medication. The medieval approach to addressing suffering - based on Celtic tradition - was to "lean into it."  They believed it was possible to have a more peaceful death if the spiritual pain of a dying person was dealt with directly, and with compassionate support. Celtic wisdom also understood that having a realistic acceptance of death throughout life allowed for a more joyous life and a more peaceful death.

Sadly, in today's world, we often deny the existence of death until we are facing it. Studies have confirmed that we are the most death-denying culture in all of history. We also tend to ignore, repress, and self-medicate the spiritual pain accumulated during life. The result is that serious illness often becomes a time of suffering and "total pain." Caregivers become victims of the transmitted suffering of their loved ones.

The hospice philosophy of care understands this reality. Hospice team members are uniquely trained and compassionately motivated to guide patients and their caregivers through this final part of life's journey. Their holistic approach recognizes that pain and suffering respond best to a combination of medication and interventions provided over time, often beginning early in the terminal illness. Hospice professionals understand the end of life can be a time of healing, forgiveness, transformation and hope.

About Dr. Kevin Dieter

Dr. Kevin Dieter, M.D., FAAHPM, is Medical Director at David Simpson Hospice House and supervises the agency’s Lakeshore East home care clinical teams. He is a nationally known speaker on the “total pain” model of care, a holistic approach to addressing pain and suffering.

Dr. Dieter earned his medical degree at Northeastern Ohio Universities College of Medicine (NEOMED) in Rootstown, Ohio, in 1985. He is Board Certified in Hospice and Palliative Medicine as well as Family Medicine and is a Fellow of the American Academy of Hospice and Palliative Medicine.

Additional Resources

Spiritual Health Assessment Form

The Total Pain Model - 9 Key Points