From the Guidelines
Palliative care in primary care settings should prioritize comprehensive symptom management, emotional support, and advance care planning for patients with serious illnesses, as this approach has been shown to substantially improve quality of life and comfort whilst dying 1.
Key Components of Palliative Care in Primary Care
- Comprehensive symptom management: This includes assessing and treating physical symptoms such as pain, dyspnea, nausea, and constipation, as well as addressing emotional, social, and spiritual needs.
- Emotional support: Providing support to patients and their families, including counseling and bereavement services, is crucial in maintaining personal integrity and promoting emotional healing.
- Advance care planning: Conducting goals of care discussions, helping complete advance directives, and establishing when to refer to specialist palliative care services are essential in ensuring that patient care aligns with their personal values and goals.
Implementing Palliative Care in Primary Care
Primary care physicians should integrate basic palliative approaches into their practice by:
- Routinely screening for pain and other symptoms using standardized tools
- Treating symptoms with appropriate medications, such as opioids for severe pain, and addressing associated anxiety and other symptoms
- Conducting regular reassessments of symptoms and care goals, with increased frequency as disease progresses
- Referring to specialist palliative care services when needed, particularly for complex cases or those requiring intensive palliative care
Importance of Palliative Care in Primary Care
The inclusion of palliative care in primary care settings results in improved quality of life, comfort, and dignity for patients with serious illnesses, as well as reduced unnecessary hospitalizations and alignment of care with patient preferences 1. Additionally, palliative care can be provided alongside disease-modifying therapies, and its implementation is not limited to patients with cancer, but applicable to all individuals with incurable diseases 1.
From the Research
Palliative Care Needs in Primary Care
- The need for primary care providers to deliver basic palliative care has emerged as patients' needs outstrip the capacity of specialty palliative care 2.
- Primary care providers recognize palliative needs in patients with complex problems and reactively respond to those needs using practice and community resources 2.
- Patients with serious illnesses are living longer and with greater disabilities, and palliative-care interventions have been shown to increase quality of life, lower costs, and improve survival 3.
- Primary-care clinicians are ideally suited to incorporate palliative care into their practice, and by working together with palliative-care specialists, many more patients and families will receive comprehensive, individualized, coordinated care and support 3.
Barriers to Palliative Care in Primary Care
- Identifying palliative care needs is challenging due to infrequent communication and lack of shared information between providers 4.
- A lack of structured communication across settings is a major barrier to introducing and providing palliative care 4.
- Primary care providers can identify opportunities to improve the delivery of a basic palliative approach in primary care through practice change and redesign strategies used in enhanced primary care environments 2.
Strategies for Improving Palliative Care in Primary Care
- Systematic attention along the multidimensional domains of basic palliative care might allow practices to address unmet needs in patients with complex illnesses by using existing practice improvement models, strategies, and prioritization 2.
- Patient-centered dissemination and implementation frameworks, strategies, and protocols can be used in palliative care settings to improve quality of life and health outcomes 5.
- A multi-setting approach to palliative care discussions may improve the identification of palliative care needs and facilitate these conversations 4.