Primary palliative care is the set of skills every clinician caring for people with serious illness should bring to their work: recognizing and responding to suffering, managing common symptoms within one’s expertise, communicating honestly about prognosis and uncertainty, understanding what matters to patients, and helping people make decisions consistent with their goals. These skills belong throughout medicine, to surgeons, oncologists, intensivists, cardiologists, emergency physicians, primary care clinicians, nurses, social workers, and others on the team. Their application differs by profession and setting, but the responsibility is shared. Specialty palliative care builds on that foundation, bringing interprofessional expertise when symptoms are hard to control, decisions become especially complex, or patients and families need more intensive support. Surgical palliative care brings both into decisions about operations, procedures, recovery, and serious injury or illness.
What is palliative care?
“Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.”
If we expect clinicians in every discipline to provide primary palliative care, the institutions that train them have to teach, assess, and support these competencies, rather than assuming they develop on their own.
A note on words: “primary” here means foundational, or generalist, palliative care, the part every clinician practices. It doesn’t refer to the specialty of primary care medicine.
Where this framing comes from
- Generalist plus Specialist Palliative Care — Creating a More Sustainable Model Quill TE, Abernethy AP. New England Journal of Medicine, 2013;368(13):1173–1175.
Training All Clinicians in Palliative Care Skills
Center to Advance Palliative Care. A toolkit for training clinicians in every specialty and discipline in communication and shared decision-making, pain and symptom management, and caregiver support. (opens in a new tab)