From the Guidelines
Approximately 10-20% of patients in primary care settings have palliative care needs, which can be identified through regular assessment of symptoms, quality of life, and goals of care for patients with serious illnesses. This estimate includes patients with chronic, progressive, or life-limiting conditions who could benefit from symptom management, psychosocial support, and advance care planning, even if they are not at the end of life 1. The percentage tends to be higher among older adults and those with multiple comorbidities. Primary care providers should be prepared to identify these needs and either provide basic palliative care services or refer to specialist palliative care teams when appropriate.
Some key points to consider when identifying patients with palliative care needs include:
- Regular assessment of symptoms, quality of life, and goals of care for patients with serious illnesses
- Identification of patients with chronic, progressive, or life-limiting conditions who could benefit from symptom management, psychosocial support, and advance care planning
- Consideration of the patient's preferences and values in care planning
- Collaboration with specialist palliative care teams when necessary
It's also important to note that palliative care is not limited to end-of-life care and can be beneficial alongside curative treatments 1. Integrating palliative care principles into primary care can significantly improve patient outcomes and quality of life, reduce unnecessary hospitalizations, and ensure that patient preferences are respected throughout their illness trajectory.
In terms of specific triggers for palliative care referrals, some studies suggest that patients with advanced-stage malignancies, prior hospitalization in the last 30 days, hospitalization longer than 7 days, and uncontrolled symptoms may benefit from specialty palliative care 1. However, these criteria alone would likely overwhelm current palliative care resources, and primary care providers should be educated in primary palliative care competencies to ensure basic palliative care needs are addressed.
From the Research
Palliative Care Needs in Primary Care
- The percentage of patients in primary care with palliative care needs is estimated to be around 69%-82% of those who die, as reported by 2.
- A study by 2 refined existing population-based methods and estimated that a minimum of 63.03% of all deaths need palliative care, with lower and upper mid-range estimates between 69.10% and 81.87%.
- Another study by 3 found that primary care team clinicians persistently reported needing support with basic palliative care skills, indicating a high demand for palliative care in primary care settings.
- The need for palliative care in primary care is also highlighted by 4, which found that many patients with complex illnesses have unmet needs and are seen in primary care more than other settings.
Factors Influencing Palliative Care Needs
- The study by 3 identified late initiation of the palliative care approach as a major barrier to providing palliative care in primary care settings.
- Clinicians reported a need for education on physical symptom management and basic palliative care principles, as found by 3.
- The use of national symptom management guidelines and awareness of support options, such as palliative care consultation teams, can improve the delivery of palliative care in primary care, as reported by 3.
- Patients with multimorbidity often experience treatment burden, which can be addressed by primary care services, as found by 5.