Palliative care and hospice programs are points on the continuum of comprehensive patient care. Unfortunately, provision of care for terminally ill patients is suboptimal. There are many new approaches to improving the skills of all physicians to fulfill the needs of patients, including better education for house staff, "train-the-trainers" programs for physicians in practice, research into methods of symptom control, and better access to established hospice programs. This review covers the history, current status, and practical suggestions for improving palliative care and hospice programs in primary care settings.