Specialist palliative care along the trajectory of illness

Abstract

The benefits of early, integrated palliative care have been demonstrated through several randomized controlled trials. These benefits include improved quality of life, satisfaction with care, symptom management, and, in some cases, survival. Despite heterogeneity in study design and execution, as well as limitation to mainly the oncology population, these trials have answered the question of why patients should receive palliative care early in their disease trajectory. Attention must now shift to the practicalities of early integration; these include questions about when is the optimal time to refer to palliative care services, who is best placed to provide palliative care supports, where early palliative care should be provided, and how best to integrate early palliative care services across the care continuum. This chapter summarizes current evidence supporting early integration of palliative care; describes the respective roles of primary, secondary, and tertiary care providers in the delivery of early palliative care; explores the optimal timing and venues for the delivery of early palliative care; and outlines a hierarchy of integration models to best meet the needs of all patients throughout the illness trajectory. Although rooted in evidence primarily from oncology trials conducted in North American and European settings, these options may be adaptable across a variety of healthcare settings, irrespective of available resources and stages of development of palliative care services. Future research should include patients from non-oncology populations, and focus on models of integration that include primary and secondary providers, rather than relying only on tertiary palliative care.