Primary (Generalist) vs. Specialist Level Palliative Care
Not every person needs a specialist to receive palliative care. The core concepts behind palliative care—such as patient-centered care, pain and symptom management, and whole patient care—are integral to many health care disciplines and are some of the key foci of the Affordable Care Act. However, for those with serious illness with refractory symptoms, existential distress, and/or challenging family dynamics, a specialist may be required.
To illustrate this point, think about the provider caring for a person with hypertension. When first diagnosed, the “generalist” provider is well trained to manage any person with hypertension. However, as the hypertension progresses, the more in depth training and skills of a cardiologist may be required.
Here are some reasons to consider a referral to a palliative care specialist:
- > 3 hospitalizations in the last 6 months for the same symptom
- Continued experience of >3/10 of any symptom such as pain, dyspnea, anxiety despite routine evidence based care (see Symptom Assessment)
- Diagnosis of cancer with metastasis or primary pancreatic cancer
- Multiple comorbid illnesses
- Complex psychosocial issues, especially as it relates to a serious illness
- Need for Advance Care Planning (see Advance Care Planning)
- Ferrell, B. “Building Generalists’ Knowledge of Palliative Care.” Medscape (2014)
- Quill, T.E., and Abernethy, A.P. “Generalist plus Specialist Palliative Care – Creating a More Sustainable Model.”