Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Benefits, services, and models of subspecialty palliative care

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


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.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2017. | This topic last updated: May 25, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Ferrell BR, Temel JS, Tenin J. Integration of palliative care. J Clin Oncol 2016.
  2. Braun LT, Grady KL, Kutner JS, et al. Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association. Circulation 2016; 134:e198.
  3. Lynn J. Living long in fragile health: the new demographics shape end of life care. Hastings Cent Rep 2005; Spec No:S14.
  4. https://eapcnet.wordpress.com/2014/07/21/palliative-medicine-now-a-medical-specialty-in-18-european-countries/ (Accessed on November 11, 2016).
  5. Centeno C, Noguera A, Lynch T, Clark D. Official certification of doctors working in palliative medicine in Europe: data from an EAPC study in 52 European countries. Palliat Med 2007; 21:683.
  6. Morrison RS, Meier DE. Clinical practice. Palliative care. N Engl J Med 2004; 350:2582.
  7. Partridge AH, Seah DS, King T, et al. Developing a service model that integrates palliative care throughout cancer care: the time is now. J Clin Oncol 2014; 32:3330.
  8. Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care. J Palliat Med 2011; 14:17.
  9. https://palliativeinpractice.org/palliative-pulse/june-2016/thank-palliative-care-education-community/ (Accessed on November 11, 2016).
  10. Quill TE, Abernethy AP. Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med 2013; 368:1173.
  11. Bernacki RE, Block SD, American College of Physicians High Value Care Task Force. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med 2014; 174:1994.
  12. http://bmjopen.bmj.com/content/5/10/e009032.long (Accessed on November 11, 2016).
  13. Sepúlveda C, Marlin A, Yoshida T, Ullrich A. Palliative Care: the World Health Organization's global perspective. J Pain Symptom Manage 2002; 24:91.
  14. World Health Organization (WHO) definition of palliative care, available online at http://www.who.int/cancer/palliative/definition/en (Accessed on January 07, 2011).
  15. Federal Register 2008 - 73 FR 32204, June 5, 2008.
  16. Center to Advance Palliative Care (CAPC) definition of palliative care. http://www.capc.org/building-a-hospital-based-palliative-care-program/case/definingpc (Accessed on September 04, 2012).
  17. Center to Advance Palliative Care (CAPC) definition of palliative care. https://www.capc.org/about/palliative-care/ (Accessed on November 11, 2016).
  18. https://www.cms.gov/Medicare/Medicare-fee-for-service-payment/hospice/index.html (Accessed on November 11, 2016).
  19. Medicare Hospice Benefits. Centers for Medicare and Medicaid Services 2010. http://www.medicare.gov/Publications/Pubs/pdf/02154.pdf. Accessed November 21, 2010. (Accessed on January 06, 2011).
  20. Teno JM, Connor SR. Referring a patient and family to high-quality palliative care at the close of life: "We met a new personality... with this level of compassion and empathy". JAMA 2009; 301:651.
  21. Approaching death: improving care at the end of life, Field, MJ, Cassel, CK (Eds), National Academy Press, Washington, DC 1997.
  22. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA 1995; 274:1591.
  23. Desbiens NA, Mueller-Rizner N, Connors AF Jr, et al. The symptom burden of seriously ill hospitalized patients. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcome and Risks of Treatment. J Pain Symptom Manage 1999; 17:248.
  24. Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients' perspectives. JAMA 1999; 281:163.
  25. Steinhauser KE, Christakis NA, Clipp EC, et al. Preparing for the end of life: preferences of patients, families, physicians, and other care providers. J Pain Symptom Manage 2001; 22:727.
  26. Elsayem A, Swint K, Fisch MJ, et al. Palliative care inpatient service in a comprehensive cancer center: clinical and financial outcomes. J Clin Oncol 2004; 22:2008.
  27. Smith TJ, Coyne P, Cassel B, et al. A high-volume specialist palliative care unit and team may reduce in-hospital end-of-life care costs. J Palliat Med 2003; 6:699.
  28. Higginson IJ, Finlay I, Goodwin DM, et al. Do hospital-based palliative teams improve care for patients or families at the end of life? J Pain Symptom Manage 2002; 23:96.
  29. Higginson IJ, Finlay IG, Goodwin DM, et al. Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers? J Pain Symptom Manage 2003; 25:150.
  30. Manfredi PL, Morrison RS, Morris J, et al. Palliative care consultations: how do they impact the care of hospitalized patients? J Pain Symptom Manage 2000; 20:166.
  31. Casarett D, Johnson M, Smith D, Richardson D. The optimal delivery of palliative care: a national comparison of the outcomes of consultation teams vs inpatient units. Arch Intern Med 2011; 171:649.
  32. Wachterman MW, Pilver C, Smith D, et al. Quality of End-of-Life Care Provided to Patients With Different Serious Illnesses. JAMA Intern Med 2016; 176:1095.
  33. Brumley R, Enguidanos S, Jamison P, et al. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc 2007; 55:993.
  34. Maltoni M, Scarpi E, Dall'Agata M, et al. Systematic versus on-demand early palliative care: A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life. Eur J Cancer 2016; 69:110.
  35. Morrison RS, Penrod JD, Cassel JB, et al. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med 2008; 168:1783.
  36. Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 2009; 302:741.
  37. Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008; 300:1665.
  38. Wright AA, Keating NL, Balboni TA, et al. Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health. J Clin Oncol 2010; 28:4457.
  39. Jang RW, Krzyzanowska MK, Zimmermann C, et al. Palliative care and the aggressiveness of end-of-life care in patients with advanced pancreatic cancer. J Natl Cancer Inst 2015; 107.
  40. Wang L, Piet L, Kenworthy CM, Dy SM. Association between palliative case management and utilization of inpatient, intensive care unit, emergency department, and hospice in Medicaid beneficiaries. Am J Hosp Palliat Care 2015; 32:216.
  41. May P, Garrido MM, Cassel JB, et al. Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients With Advanced Cancer: Earlier Consultation Is Associated With Larger Cost-Saving Effect. J Clin Oncol 2015; 33:2745.
  42. Smith S, Brick A, O'Hara S, Normand C. Evidence on the cost and cost-effectiveness of palliative care: a literature review. Palliat Med 2014; 28:130.
  43. Braus N, Campbell TC, Kwekkeboom KL, et al. Prospective study of a proactive palliative care rounding intervention in a medical ICU. Intensive Care Med 2016; 42:54.
  44. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363:733.
  45. Rabow MW, Dibble SL, Pantilat SZ, McPhee SJ. The comprehensive care team: a controlled trial of outpatient palliative medicine consultation. Arch Intern Med 2004; 164:83.
  46. Rabow MW, Schanche K, Petersen J, et al. Patient perceptions of an outpatient palliative care intervention: "It had been on my mind before, but I did not know how to start talking about death...". J Pain Symptom Manage 2003; 26:1010.
  47. Casarett D, Pickard A, Bailey FA, et al. Do palliative consultations improve patient outcomes? J Am Geriatr Soc 2008; 56:593.
  48. Gade G, Venohr I, Conner D, et al. Impact of an inpatient palliative care team: a randomized control trial. J Palliat Med 2008; 11:180.
  49. Dionne-Odom JN, Azuero A, Lyons KD, et al. Benefits of Early Versus Delayed Palliative Care to Informal Family Caregivers of Patients With Advanced Cancer: Outcomes From the ENABLE III Randomized Controlled Trial. J Clin Oncol 2015; 33:1446.
  50. Higginson IJ, Bausewein C, Reilly CC, et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. Lancet Respir Med 2014; 2:979.
  51. Grudzen CR, Richardson LD, Johnson PN, et al. Emergency Department-Initiated Palliative Care in Advanced Cancer: A Randomized Clinical Trial. JAMA Oncol 2016.
  52. El-Jawahri A, LeBlanc T, VanDusen H, et al. Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial. JAMA 2016; 316:2094.
  53. Kavalieratos D, Corbelli J, Zhang D, et al. Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis. JAMA 2016; 316:2104.
  54. Bekelman DB, Plomondon ME, Carey EP, et al. Primary Results of the Patient-Centered Disease Management (PCDM) for Heart Failure Study: A Randomized Clinical Trial. JAMA Intern Med 2015; 175:725.
  55. Jordhøy MS, Fayers P, Saltnes T, et al. A palliative-care intervention and death at home: a cluster randomised trial. Lancet 2000; 356:888.
  56. Temel JS, Greer JA, El-Jawahri A, et al. Effects of Early Integrated Palliative Care in Patients With Lung and GI Cancer: A Randomized Clinical Trial. J Clin Oncol 2017; 35:834.
  57. Jacobsen J, Jackson V, Dahlin C, et al. Components of early outpatient palliative care consultation in patients with metastatic nonsmall cell lung cancer. J Palliat Med 2011; 14:459.
  58. Greer JA, Pirl WF, Jackson VA, et al. Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol 2012; 30:394.
  59. Bakitas MA, Tosteson TD, Li Z, et al. Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial. J Clin Oncol 2015; 33:1438.
  60. Peppercorn JM, Smith TJ, Helft PR, et al. American society of clinical oncology statement: toward individualized care for patients with advanced cancer. J Clin Oncol 2011; 29:755.
  61. Morrison RS, Siu AL. A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. J Pain Symptom Manage 2000; 19:240.
  62. O'Mahony S, Blank AE, Zallman L, Selwyn PA. The benefits of a hospital-based inpatient palliative care consultation service: preliminary outcome data. J Palliat Med 2005; 8:1033.
  63. Quill TE. Perspectives on care at the close of life. Initiating end-of-life discussions with seriously ill patients: addressing the "elephant in the room". JAMA 2000; 284:2502.
  64. Teno JM, Clarridge BR, Casey V, et al. Family perspectives on end-of-life care at the last place of care. JAMA 2004; 291:88.
  65. Hotopf M, Chidgey J, Addington-Hall J, Ly KL. Depression in advanced disease: a systematic review Part 1. Prevalence and case finding. Palliat Med 2002; 16:81.
  66. Rayner L, Price A, Evans A, et al. Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis. Palliat Med 2011; 25:36.
  67. Desbiens NA, Mueller-Rizner N, Virnig B, Lynn J. Stress in caregivers of hospitalized oldest-old patients. J Gerontol A Biol Sci Med Sci 2001; 56:M231.
  68. Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA 1999; 282:2215.
  69. O'Hara RE, Hull JG, Lyons KD, et al. Impact on caregiver burden of a patient-focused palliative care intervention for patients with advanced cancer. Palliat Support Care 2010; 8:395.
  70. http://www.nationalacademies.org/hmd/Activities/Aging/FamilyCaregivingforOlderAdults.aspx (Accessed on November 11, 2016).
  71. National Quality Forum: A National Framework and Preferred Practices for Palliative and Hospice Care: A Consensus Report. http://www.qualityforum.org/Publications/2006/12/A_National_Framework_and_Preferred_Practices_for_Palliative_and_Hospice_Care_Quality.aspx (Accessed on September 09, 2010).
  72. Balboni MJ, Sullivan A, Amobi A, et al. Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. J Clin Oncol 2013; 31:461.
  73. Meyerson EM, Meier DE, Kestenbaum A. Honoring thy parents: Applying the spiritual domain in palliative care decision-making. J Law Relig 2016; 31:183.
  74. Ehman JW, Ott BB, Short TH, et al. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Arch Intern Med 1999; 159:1803.
  75. Puchalski C, Ferrell B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference. J Palliat Med 2009; 12:885.
  76. Mukamel DB, Bajorska A, Temkin-Greener H. Health care services utilization at the end of life in a managed care program integrating acute and long-term care. Med Care 2002; 40:1136.
  77. Hughes SL, Weaver FM, Giobbie-Hurder A, et al. Effectiveness of team-managed home-based primary care: a randomized multicenter trial. JAMA 2000; 284:2877.
  78. Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med 2006; 166:1822.
  79. Fischberg D, Meier DE. Palliative care in hospitals. Clin Geriatr Med 2004; 20:735.
  80. Morrison RS, Maroney-Galin C, Kralovec PD, Meier DE. The growth of palliative care programs in United States hospitals. J Palliat Med 2005; 8:1127.
  81. https://reportcard.capc.org/ (Accessed on November 12, 2016).
  82. www.capc.org (Accessed on June 09, 2011).
  83. https://palliativeinpractice.org/palliative-pulse/february-2016/registry-2014-annual-survey-summary/ (Accessed on November 09, 2016).
  84. https://registry.capc.org/metrics-resources/summary-data/ (Accessed on November 11, 2016).
  85. Aslakson RA, Curtis JR, Nelson JE. The changing role of palliative care in the ICU. Crit Care Med 2014; 42:2418.
  86. Cook D, Rocker G. Dying with dignity in the intensive care unit. N Engl J Med 2014; 370:2506.
  87. Quest T, Herr S, Lamba S, et al. Demonstrations of clinical initiatives to improve palliative care in the emergency department: a report from the IPAL-EM Initiative. Ann Emerg Med 2013; 61:661.
  88. Gaertner J, Frechen S, Sladek M, et al. Palliative care consultation service and palliative care unit: why do we need both? Oncologist 2012; 17:428.
  89. Chai E, Meier DE. Identifying the effective components of palliative care: comment on "The optimal delivery of palliative care". Arch Intern Med 2011; 171:655.
  90. Miller SC, Dahal R, Lima JC, et al. Palliative Care Consultations in Nursing Homes and End-of-Life Hospitalizations. J Pain Symptom Manage 2016; 52:878.
  91. Comart J, Mahler A, Schreiber R, et al. Palliative care for long-term care residents: effect on clinical outcomes. Gerontologist 2013; 53:874.
  92. Meier DE, Lim B, Carlson MD. Raising the standard: palliative care in nursing homes. Health Aff (Millwood) 2010; 29:136.
  93. Miller SC, Lima JC, Intrator O, et al. Palliative Care Consultations in Nursing Homes and Reductions in Acute Care Use and Potentially Burdensome End-of-Life Transitions. J Am Geriatr Soc 2016; 64:2280.
  94. Chochinov HM, Kristjanson LJ, Breitbart W, et al. Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol 2011; 12:753.
  95. Hudson P, Trauer T, Kelly B, et al. Reducing the psychological distress of family caregivers of home-based palliative care patients: short-term effects from a randomised controlled trial. Psychooncology 2013; 22:1987.
  96. Ferrell B, Sun V, Hurria A, et al. Interdisciplinary Palliative Care for Patients With Lung Cancer. J Pain Symptom Manage 2015; 50:758.
  97. Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 2014; 383:1721.
  98. Uitdehaag MJ, van Putten PG, van Eijck CH, et al. Nurse-led follow-up at home vs. conventional medical outpatient clinic follow-up in patients with incurable upper gastrointestinal cancer: a randomized study. J Pain Symptom Manage 2014; 47:518.
  99. Thoonsen B, Vissers K, Verhagen S, et al. Training general practitioners in early identification and anticipatory palliative care planning: a randomized controlled trial. BMC Fam Pract 2015; 16:126.
  100. Cunningham C, Ollendorf D, Travers K. The Effectiveness and Value of Palliative Care in the Outpatient Setting. JAMA Intern Med 2017; 177:264.
  101. Nordly M, Vadstrup ES, Sjøgren P, Kurita GP. Home-based specialized palliative care in patients with advanced cancer: A systematic review. Palliat Support Care 2016; 14:713.
  102. Lustbader D, Mudra M, Romano C, et al. The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization. J Palliat Med 2017; 20:23.
  103. Ng AY, Wong FK, Lee PH. Effects of a transitional palliative care model on patients with end-stage heart failure: study protocol for a randomized controlled trial. Trials 2016; 17:173.
  104. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-08-09.html (Accessed on November 09, 2016).
  105. Fainsinger RL, Demoissac D, Cole J, et al. Home versus hospice inpatient care: discharge characteristics of palliative care patients in an acute care hospital. J Palliat Care 2000; 16:29.
  106. Adelson K, Paris J, Horton JR, et al. Standardized Criteria for Palliative Care Consultation on a Solid Tumor Oncology Service Reduces Downstream Health Care Use. J Oncol Pract 2017; 13:e431.
  107. Kelley AS, Covinsky KE, Gorges RJ, et al. Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care. Health Serv Res 2017; 52:113.
  108. Hui D, Mori M, Watanabe SM, et al. Referral criteria for outpatient specialty palliative cancer care: an international consensus. Lancet Oncol 2016; 17:e552.
  109. Lakin JR, Robinson MG, Bernacki RE, et al. Estimating 1-Year Mortality for High-Risk Primary Care Patients Using the "Surprise" Question. JAMA Intern Med 2016; 176:1863.
  110. Downar J, Goldman R, Pinto R, et al. The "surprise question" for predicting death in seriously ill patients: a systematic review and meta-analysis. CMAJ 2017; 189:E484.
  111. Javier AD, Figueroa R, Siew ED, et al. Reliability and Utility of the Surprise Question in CKD Stages 4 to 5. Am J Kidney Dis 2017; 70:93.
  112. Shaw KL, Clifford C, Thomas K, Meehan H. Review: improving end-of-life care: a critical review of the gold standards framework in primary care. Palliat Med 2010; 24:317.
  113. Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study. BMJ Support Palliat Care 2014; 4:285.
  114. Gómez-Batiste X, Martínez-Muñoz M, Blay C, et al. Utility of the NECPAL CCOMS-ICO© tool and the Surprise Question as screening tools for early palliative care and to predict mortality in patients with advanced chronic conditions: A cohort study. Palliat Med 2016.
  115. Thoonsen B, Engels Y, van Rijswijk E, et al. Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC). Br J Gen Pract 2012; 62:e625.
  116. Walsh RI, Mitchell G, Francis L, van Driel ML. What Diagnostic Tools Exist for the Early Identification of Palliative Care Patients in General Practice? A systematic review. J Palliat Care 2015; 31:118.
  117. Levy MH, Smith T, Alvarez-Perez A, et al. Palliative care, Version 1.2014. Featured updates to the NCCN Guidelines. J Natl Compr Canc Netw 2014; 12:1379.
  118. Munday D, Petrova M, Dale J. Exploring preferences for place of death with terminally ill patients: qualitative study of experiences of general practitioners and community nurses in England. BMJ 2009; 339:b2391.
  119. Steinhauser KE, Christakis NA, Clipp EC, et al. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA 2000; 284:2476.
  120. Hickman SE, Keevern E, Hammes BJ. Use of the physician orders for life-sustaining treatment program in the clinical setting: a systematic review of the literature. J Am Geriatr Soc 2015; 63:341.
  121. Barazzetti G, Borreani C, Miccinesi G, Toscani F. What "best practice" could be in Palliative Care: an analysis of statements on practice and ethics expressed by the main Health Organizations. BMC Palliat Care 2010; 9:1.
  122. Heyland DK, Dodek P, Rocker G, et al. What matters most in end-of-life care: perceptions of seriously ill patients and their family members. CMAJ 2006; 174:627.
  123. Tishelman C, Lövgren M, Broberger E, et al. Are the most distressing concerns of patients with inoperable lung cancer adequately assessed? A mixed-methods analysis. J Clin Oncol 2010; 28:1942.
  124. Weiss SC, Emanuel LL, Fairclough DL, Emanuel EJ. Understanding the experience of pain in terminally ill patients. Lancet 2001; 357:1311.
  125. Center to Advance Palliative Care 2011 Public Opinion Research on palliative care. http://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdf (Accessed on September 04, 2012).
  126. The Regence Foundation Living Well at the End of Life Poll Results. http://syndication.nationaljournal.com/communications/NationalJournalRegenceDoctorsToplines.pdf.
  127. Schenker Y, Park SY, Maciasz R, Arnold RM. Do patients with advanced cancer and unmet palliative care needs have an interest in receiving palliative care services? J Palliat Med 2014; 17:667.
  128. Maciasz RM, Arnold RM, Chu E, et al. Does it matter what you call it? A randomized trial of language used to describe palliative care services. Support Care Cancer 2013; 21:3411.