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Benefits, services, and models of subspecialty palliative care

Authors
Diane E Meier, MD, FACP
Elizabeth McCormick, MD
Section Editor
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing serious illness. 

The primary tenets of palliative care are symptom management; establishing and implementing care plans in keeping with the patient’s values and preferences; consistent and sustained communication between the patient and all those involved in his or her care; psychosocial, spiritual, and practical support both to patients and their family caregivers; and coordination across sites of care.

Palliative care aims to relieve suffering in all stages of disease and is not limited to end of life care. Palliative medicine services, including setting patient-centered achievable goals for medical care and aggressive symptom management, should be routinely offered alongside curative and disease-modifying treatments for patients with serious illnesses [1,2].

The traditional model of medical care has been dichotomous, with curative or disease-modifying treatment offered initially and comfort care provided only when/if these measures are no longer appropriate (algorithm 1). However, most illnesses and personal goals do not lend themselves well to such dichotomous service models [3]. For example, heart failure is characterized by stable disease punctuated by acute exacerbations often requiring hospitalization (figure 1). During these exacerbations, life-prolonging treatments, such as diuretics, that also improve symptom burden are administered. Within an integrated model of medical care, palliative care is provided at the same time as curative or life-prolonging treatments (algorithm 1).

Hospice and Palliative Medicine is now recognized as a medical subspecialty by the American Board of Medical Specialties, as well as in Canada, England, Ireland, Australia, New Zealand, and many other European nations [4]. Other countries are in the process of developing certification for palliative care [5]. Clinicians who are specifically trained in palliative care provide in-depth pain and symptom management, communication regarding goals of care, and care coordination across settings and over time [6]. However, in order for the large and rapidly growing number of patients with advanced and serious illness to receive timely and high-quality palliative care, it is important that the core principles and practices of palliative care be incorporated into the practices of all clinicians.

                   
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Literature review current through: Nov 2017. | This topic last updated: Sep 25, 2017.
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