A More Cohesive Home: Integrating Primary And Palliative Care For Seriously Ill Patients

Treatment for Mr. M’s advanced heart failure was no longer extending or improving his life. He was becoming increasingly short of breath and confused -and hospital stays provided only short-term relief. Mr. M’s cardiologist contacted Dr. P, his long-time primary care physician, to initiate a discussion about his goals of care. Dr. P met with Mr. M and his family at their home. Mr. M was adamant that he would rather spend time with his family than go to the hospital again. Dr. P referred Mr. M to hospice and collaborated with hospice nurses to manage his pain and breathlessness. Mr. M later died peacefully a short while later, surrounded by family.

What Is Palliative Care?

Individuals like Mr. M who are living with a serious or life-limiting illness regularly experience pain, difficulty breathing, and/or fatigue, symptoms that worsen in their last days of life. Palliative care—defined by the Center to Advance Palliative Care as “focused on providing patients with relief from the symptoms, pain, and stress of a serious illness — whatever the diagnosis”—aims to address this burden.

However, deficiencies in existing delivery systems of palliative care make it unavailable to a significant portion of seriously ill patients. The recent Institute of Medicine Report Dying in America calls for health systems to emphasize longitudinalnterdisciplinary palliative care for individuals with serious illness. Integrated primary and palliative care is a potential solution. Due to their longitudinal interactions and preexisting relationships with patients, primary care teams may be optimally positioned to help provide outpatient palliative care to those with serious illness.

Gaps In Current Delivery Of Palliative Care

Specialty palliative care early in treatment has been shown to improve symptoms and quality of life for patients with serious illness. However, while early outpatient palliative care is the goal of many programs, specialty palliative care services are often only available to patients who are hospitalized or enrolled in hospice. Demand for palliative care specialists exceeds supply, particularly in the outpatient setting as outpatient specialty care clinics are rare. As the number of patients with serious illness grows, this gap may widen even further.