How to Initiate Palliative Care
Any patient with a serious or life-limiting illness should request palliative care directly from their primary oncologist or attending physician at diagnosis, rather than waiting for end-stage disease, and this request should trigger immediate consultation with an interdisciplinary palliative care team. 1
Who Should Request Palliative Care
Patients themselves, their family members, or any member of the healthcare team can and should initiate the request for palliative care services. 1 The attending physician is responsible for facilitating these discussions and coordinating the referral, but patients do not need to wait for their doctor to bring it up—they can ask directly. 2
Specific Triggers That Should Prompt a Request
Patients should request palliative care consultation when experiencing any of the following: 1
- Uncontrolled physical symptoms (pain, shortness of breath, nausea, fatigue)
- Moderate to severe emotional distress about their diagnosis or prognosis
- Questions about disease course or what to expect as illness progresses
- Difficulty making treatment decisions or uncertainty about goals of care
- Desire to discuss advance directives or end-of-life preferences
- Family conflict about treatment decisions
- Spiritual or existential concerns about meaning and purpose
For cancer patients specifically, palliative care should be requested at the time of diagnosis for metastatic lung cancer, pancreatic cancer, or glioblastoma. 1 For patients with COPD, heart failure, or other chronic progressive diseases, palliative care should be requested when symptoms become burdensome, regardless of disease stage. 2, 1
The Practical Steps to Access Palliative Care
Step 1: Speak Directly With Your Attending Physician
The patient or family should explicitly state to the attending physician: "I would like a palliative care consultation to help manage my symptoms and discuss my goals of care." 2 This direct request is important because studies show physicians often delay these discussions—in one study of cystic fibrosis patients, palliative care was not discussed until the final month of life in 40% of patients and not discussed at all in 25%. 2
Step 2: Expect Immediate Coordination by Your Medical Team
Once requested, the attending physician should immediately facilitate introduction to the institutional or community palliative care team. 2 This team typically includes physicians, nurses, social workers, chaplains, and other specialists trained in symptom management and communication. 2
Step 3: Initial Palliative Care Assessment
The palliative care team will conduct a comprehensive assessment addressing: 2, 1
- Physical symptoms requiring management (pain, dyspnea, nausea, fatigue)
- Psychosocial needs (anxiety, depression, family dynamics, financial concerns)
- Spiritual and existential concerns (meaning, purpose, legacy)
- Goals of care and treatment preferences
- Advance care planning needs (healthcare proxy, living will, resuscitation preferences)
Step 4: Ongoing Concurrent Care
Palliative care continues alongside disease-directed treatments—it is not an either/or choice. 2, 1, 3 The palliative care team works collaboratively with the primary oncology or medical team throughout the illness trajectory, intensifying support as disease progresses. 2
Common Misconceptions That Prevent Patients From Requesting Palliative Care
Palliative care is NOT the same as hospice and does NOT mean giving up on treatment. 1, 4 Many patients mistakenly believe palliative care is only for the last days of life, but this is incorrect—palliative care should begin at diagnosis and continue concurrently with chemotherapy, radiation, surgery, or other disease-modifying treatments. 2, 1, 3
Requesting palliative care does NOT mean you will die sooner. 2 In fact, evidence shows palliative care improves quality of life, reduces unnecessary aggressive treatments at end of life, and may even extend survival in some cancer patients. 3
You do NOT need to have a specific prognosis (like "6 months to live") to qualify for palliative care. 1 Eligibility is based on symptom burden and needs assessment, not prognosis alone. 1
Where Palliative Care Can Be Provided
Palliative care services are available in multiple settings: 2
- Outpatient palliative care clinics (for ongoing symptom management while receiving treatment)
- Hospital-based palliative care consultation services (for acute symptom crises or complex decision-making)
- Specialized inpatient palliative care units (for intensive symptom management)
- Home-based palliative care (for patients preferring care at home)
- Nursing homes and long-term care facilities
Critical Pitfalls to Avoid
Do not wait for your physician to bring up palliative care—you must advocate for yourself and request it directly. 2, 1 Studies consistently show physicians delay these discussions far too long, often until the last weeks of life. 2
Do not confuse palliative care with hospice. 1, 4 Hospice is a specific type of palliative care for patients with prognosis of 6 months or less who have chosen to forgo disease-directed treatment. Palliative care is much broader and available at any stage of serious illness. 2, 1
Do not assume that because you are still receiving chemotherapy or other treatments, you cannot have palliative care. 2, 1, 3 This is one of the most harmful misconceptions—palliative care is designed to work alongside curative or life-prolonging treatments. 2
Special Considerations for Different Diseases
For Cancer Patients
All patients with metastatic cancer should request palliative care at the time of diagnosis. 1 The National Comprehensive Cancer Network explicitly recommends early integration of palliative care for all patients with advanced cancer, as it improves quality of life and helps align treatment decisions with patient values. 2, 1
For Patients With COPD or Pulmonary Disease
Patients with COPD should request palliative care when experiencing progressive dyspnea, frequent exacerbations, or declining functional status, regardless of FEV1 or other objective measures. 2, 1 The unpredictable course of COPD makes prognosis-based referral inappropriate—symptom burden should drive the request. 2
For Patients With Heart Failure, Cirrhosis, or Kidney Disease
Patients with progressive chronic organ failure should request palliative care when symptoms become burdensome or when facing decisions about advanced interventions like dialysis, transplant, or mechanical circulatory support. 1 These patients are often overlooked for palliative care despite having similar or worse symptom burden than cancer patients. 1
The Role of Family Members in Requesting Palliative Care
Family members can and should request palliative care consultation on behalf of their loved one, especially when the patient lacks decision-making capacity or is too ill to advocate for themselves. 2 The palliative care team provides support not just to the patient but to the entire family system, including bereavement support after death. 2