Palliative Care for Providers

Whether caring for somebody recently diagnosed with an advanced illness or standing by the bedside of someone living their last moments, providing patient-centered, quality care is fundamental to being a provider.

Palliative care is patient-centered and family-focused care that provides an adult or child of any age with relief from the symptoms, pain and stress of a serious illness. It addresses complex symptom management including assistance with the emotional, social and spiritual suffering often associated with serious illness. Palliative care may be offered to patients alongside treatments intended to cure or treat the illness. Or, it may replace those treatments and serve as a transition to hospice services.

Supportive Palliative Care vs Hospice Care (PDF)

For more information on the types of care that can be offered, visit HHSC's Palliative Care services page.

National Consensus Project Guidelines for offering palliative care are available at the National Coalition for Hospice and Palliative Care website.

Working With an Interdisciplinary Team

Collaboration with other professionals and placing the patient at the center of treatment and comfort care makes palliative care an effective service. The following people can be part of palliative care teams:

  • Physicians
  • Psychologists and psychotherapists
  • Advanced practice providers, such as advanced practice registered nurses and physician assistants
  • Social workers
  • Nurses
  • Pharmacists
  • Dieticians
  • Chaplains
  • Child life specialists
  • Family members of the patient

Other health care providers, such as respiratory therapists, physical therapists and occupational therapists

Patient Qualifications for Palliative Care Services

Based on the clinician referral guide from the Center to Advance Palliative Care’s website, Get Palliative Care, patients may qualify for palliative care services in one or more of the following situations.

Presence of a Serious or Chronic Illness, defined by:

  • Weight loss
  • Multiple hospitalizations
  • Do-not-resuscitate order conflicts
  • Limited social support due to factors such as homelessness or chronic mental illness
  • Severe symptom burdens
  • Patient or family psychological or spiritual distress

Intensive Care Unit History, including:

  • Two or more ICU admissions within the same hospitalization
  • Multi-organ failure
  • Family distress that impairs surrogate decision making
  • Prolonged or difficult ventilator withdrawal
  • Consideration of patient transfer to a long-term ventilator facility

Oncology Criteria

Metastatic or locally advanced cancer that is progressing despite systemic treatments with or without weight loss and functional decline.

Note: The American Society of Clinical Oncology recommends palliative care consultation within eight weeks of diagnosis for metastatic cancer. Palliative care may occur alongside active treatment of the patient’s cancer.

Emergency Department Criteria:

  • Multiple recent prior hospitalizations with the same symptoms and problems
  • Long-term-care patient with do not resuscitate or comfort care orders
  • Patient previously enrolled in a home or residential hospice program
  • Consideration of ICU admission or mechanical ventilation in a patient

A more detailed list can be found in the clinician’s section of the Get Palliative Care website.

Communicating with Patients & Families about Palliative Care

Having a conversation about palliative care services can be a challenge depending on the severity of the patient's illness. Providers must understand and differentiate between types of services when recommending palliative care.

Quick Guideline for Palliative Care Communications

The acronym COMFORT, developed through the Pain and Palliative Care Resource Center at City of Hope, is an easy way to remember seven key principles when having conversations with patients and their families:

  • Communication is patient-centered and family-focused.
  • Orientation and Opportunity takes into account health literacy and stresses cultural competency.
  • Mindfulness emphasizes empathy and actively listening to the patient and family.
  • Family takes into consideration family dynamics and their needs.
  • Opening up allows for free and open communication. 
  • Relating to the patient and families helps a clinician work alongside families.
  • Team values include clinical collaboration.

Various publications on COMFORT principles and palliative care communication skills can be found on the City of Hope website.

Palliative Care Performance Scales and Tools

The following tools will help providers determine if hospice is appropriate for the patient.

Measurement and Evaluation

Learn more about Measurement and Evaluation tools used by providers to assess the need for Palliative Care service.

Pain and Symptom Management

Functional Status

  • Karnofsky Performance Scale
    Commonly used for assessing terminally ill patients, often used to determine appropriateness of hospice referral.
  • Palliative Performance Scale version 2 (PPSv2)
    Measures the functional status of a patient and assigns a Palliative Performance Value; serves as a communication tool for quickly describing a patient's current functional level.

Psychological Care

  • Caregiver Strain Index
    A tool that measures strain related to care provision. Used to assess individuals who have assumed the role of caregiver for an older adult.
  • Hamilton Depression Scale
    Provides an indication of depression and, over time, provides a guide to progress.
  • Blessed-Roth Dementia Scale (DS)
    A brief behavioral scale based on the interview of a close informant. The DS has proved to be a sensitive and specific screening test for dementia.

Caregiver Assessment

  • Caregiver Strain Index
    A tool that measures strain related to care provision. Used to assess individuals who have assumed the role of caregiver for an older adult.
  • FAMCARE Scale
    A 20-item scale measuring family satisfaction with health care given to the patient and to them.

Professional Resources: