Framework for Considering Primary and Subspecialty Palliative Care and Guiding Serious Illness Communication for...

Palliative care is a comprehensive approach aimed at enhancing the quality of life of patients and their families living with serious illnesses such as breast cancer. This approach includes assessing and managing pain and other physical symptoms, attending to psychosocial and spiritual aspects of care, fostering effective communication and decision making, and providing support in coordinating care that upholds a person's values and preferences from the time of diagnosis throughout the illness trajectory. This type of care can be provided by palliative care specialists (ideally an interprofessional team) working alongside the oncology team, referred to as subspecialty palliative care. Conversely, the fundamental aspects of this approach, which we sometimes call primary palliative care, are provided by all clinicians caring for patients with breast cancer. Given that access to subspecialty palliative care can vary globally, especially in rural and resource-constrained settings, it is imperative for all oncology clinicians to receive training in the core components of palliative care. This study aims to provide a basic framework to recognize what the core primary palliative care skills are in routine oncology practice, to delineate basic serious illness communication strategies, and to introduce when to consider the integration of subspecialty palliative care into the care of patients with breast cancer.