Hospice care in the United States is a type and philosophy of end-of-life care which focuses on the palliation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual or social in nature. The concept of hospice as a place to treat the incurably ill has been evolving since the 11th century and came into the United States in the 1970s in response to the work of Cicely Saunders in the United Kingdom. Since its first establishment, the industry has rapidly expanded. In the United States, it is distinguished by more extensive volunteerism and a greater emphasis on the patient's psychological needs in coming to terms with dying.