Introduction   Palliative care consultative services are commonplace in academic and community hospitals and clinics. Patients and families may have negative perceptions of palliative care and hospice, viewing such a discussion as signaling that the clinician is “giving up on the patient” and that the reality of impending death must be faced.  For primary clinician, conveying to a patient and family that a palliative care consultation is needed can provoke patient and family anxiety. Clinicians may fear such a discussion will provoke anxiety, anger, or a sense of hopelessness.  This Fast Fact provides tips for beginning a discussion leading to a visit by a palliative care consultation team. 

First, decide why you want assistance from the palliative care team. Typically, physicians seek assistance in four domains:  

1. Pain and non-pain symptom assessment and management. 
2. Assistance in making difficult decisions, usually about continued use or withdrawal of potentially life-prolonging treatments such as feeding tubes, antibiotics, dialysis, or ventilators.  
3. Assistance in planning for the most appropriate care setting to meet patient/family goals for end-of-life care.  
4. Providing psychological support to patients, families, and the health care team. 

Second, contact the palliative care team. Discuss your reason(s) for consultation along with pertinent details of the patient’s history and family support structure.  Describe both what your goals are for the consultation, as well as what the family’s/patient’s goals may be. This is a good time to discuss any concerns you have about using the term palliative care with the patient or family. 

Third, engage the patient/family in a discussion of the current medical condition and goals of care. A prepared script can help guide your advice. For example: “The specialty of palliative care is an extra layer of care that focuses on providing relief and improving the lives for those dealing with serious illness. “Members of the palliative care team are experts at helping patients plan and they provide support along the way. Palliative care focuses on the patient, not just the disease.” 

You should not say that the reason you are asking for palliative care to be involved is that “There is nothing more to do” or because “I have nothing more to offer.”  Talk about the benefits of a palliative care consultation in helping the patient achieve specific care goals. 

Fourth, it may be appropriate at this point to discuss the difference between palliative care consultations and hospice care.   

• “Hospice is a program or insurance benefit for those who may die within 6 months due to an underlying illness and who agree to let go of curative care and focus on comfort for the time remaining. You literally sign paperwork to be on the hospice care program.” 
• “Palliative care consultations do not depend on whether a condition is curable can be added to anyone’s care plan.” 

Finally, emphasize your continued involvement: “You and I will talk about the recommendations of the palliative care experts.  I’ll make sure all your questions are answered.” This can help relieve fears of abandonment.   

Navigating conflicts about a palliative care consultation   If a patient or family reacts negatively to the suggestion for a consultation, explore their concerns.  Someone may have encountered palliative care before and this may have negative connotations to them. Ask, “What experience do you have with hospice/palliative care?  What are your concerns?”  It may be important to discuss that palliative care is compatible with aggressively treating the underlying disease.  Emphasize the positive aspects of what palliative care can do, rather than focusing on how the palliative care team will help them accept death and dying.  After all, the goal of palliative care is to achieve the best possible quality of life through relief of suffering, control of symptoms and restoration of functional capacity, while remaining sensitive to the patient and family’s values. Palliative care guides the patient and family as they face disease progression and changing goals of care and helps those who wish to address issues of life closure.   

References 

1. Weissman DE.  Consultation in Palliative Medicine. Arch Int Med. 1997; 157:733-737.
2. Last Acts Campaign Task Force on Palliative Care. Precepts of Palliative Care. J Pall Med. 1998; 1:109-115. 

Version History:  This Fast Fact was originally edited by David E Weissman MD.  2nd Edition published July 2005; 3rd Edition May 2015; 4th Edition February 2024.
Conflicts of Interest: None to report.