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Representative primary and subspecialty palliative care skills in each domain

Representative primary and subspecialty palliative care skills in each domain
Primary palliative care skills Subspecialty palliative care skills
Assessment/treatment of physical symptoms
  • Basic pain management
  • Basic management of other physical symptoms
  • Basic use of adjuvant pain relievers
  • Equianalgesic dose conversion
  • Management of refractory pain
  • Management of other refractory symptoms
  • Methadone transition when large doses of opioids are being used
  • Patients with addiction problems and serious illness
Psychological, social, cultural, and spiritual aspects of care
  • Basic management of depression/anxiety
  • Exploration of psychosocial suffering
  • Basic exploration of spiritual and religious views
  • Basic exploratory family meeting
  • Management of more complex depression, anxiety, grief, and existential distress
  • Severe religious/spiritual suffering
Serious illness communication issues
  • Exploring patient goals in light of circumstances
  • Making recommendations about code status
  • Seeking consensus among treating professionals
  • Seeking consensus among the patient and family
  • Dying patients who want "everything"
  • Major conflict among family members
  • Major conflict among treating teams
  • Requests about assisted dying
Care coordination
  • Coordinating care among specialists
  • Clearly defining the primary treating team
  • Managing transitions to hospice care
  • Managing transitions out of the hospital
  • Transition to hospice with no clear provider
  • Patient/family major resistance to discharge
  • Conflict with the designated outpatient provider
Adapted from: Quill TE, Abernathy AP. Generalist plus specialist palliative care - creating a more sustainable model. N Engl J Med 2013; 368:1173.
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