Evolving Scope of Specialty Palliative Care: Guidelines, Implications, and Future Directions

Area of Science:

• Palliative Care Medicine
• Health Services Research

Background:

• Specialty palliative care (SPC) programs face challenges due to inconsistent referral criteria and scope of practice, leading to confusion.
• Increasing demand for SPC, coupled with workforce limitations, necessitates clear prioritization frameworks.

Purpose of the Study:

• To develop a consensus-based guideline for the scope of practice in specialty palliative care.
• To address variability in referral criteria and ensure consistent care delivery.

Main Methods:

• Convened a task force of six palliative care physicians.
• Conducted a literature review, surveyed clinicians, and solicited input from peer institutions.
• Finalized the guideline through departmental review and leadership endorsement.

Main Results:

• Identified wide variation in defining "serious illness" and appropriateness for SPC.
• Developed an institutional guideline prioritizing patients with serious illness and high mortality risk.
• The guideline excludes patients with chronic pain or psychosocial distress without serious illness and addresses safe opioid prescribing.

Conclusions:

• This initiative provides the first SPC scope guideline, aiming for consistency in defining and communicating SPC scope.
• The guideline can inform resource allocation, health policy, workforce education, and public understanding of palliative care.
• Ongoing national discussions are recommended to refine SPC scope and ensure consistent care delivery.