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Adopt a bundled payment model for home-based and outpatient palliative care.


Increase the number of clinicians with generalist palliative care skills and encourage use of generalist palliative care when specialty palliative care is not needed.

Despite an increase in the number of specialty palliative care clinicians and the emergence of more pathways for pursuing a career or training in specialty palliative care, a workforce shortage of specialty palliative care clinicians is likely to persist over the next 20 years. Additionally, some seriously ill patients' needs can be met by basic palliative care interventions which do not require a palliative care specialist or a full interdisciplinary team. Given these considerations, generalist palliative care (also known as “primary palliative care”) has been gaining momentum as a complement to specialty palliative care. Generalist palliative care skills used in communication and symptom management enable front-line clinicians to administer basic palliative care comfortably and competently. If made widely available, generalist palliative care would ensure that a minimum level of palliative care is accessible to anyone who would benefit—and allow specialty palliative care services to focus on more complex situations.

Reference: Lupu D, Quigley L, Mehfoud N, Salsberg ES. The Growing Demand for Hospice and Palliative Medicine Physicians: Will the Supply Keep Up? J Pain Symptom Manage. 2018 Apr;55(4):1216-1223. doi: 10.1016/j.jpainsymman.2018.01.011. Epub 2018 Feb 2. PMID: 29410071. 


At the very least, start here


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Action Items

At the very least, start here

Disseminate information on available generalist palliative care educational programs to non-palliative care physicians who care for people with serious illness (cancer, heart failure, renal failure, chronic obstructive pulmonary disease, etc.) and geriatricians.


The Case for Improving Symptom Management and Communication Skills (Center to Advance Palliative Care)

Succinct outline of rationale for improving symptom management and communication skills for all providers who care for seriously ill patients.


Clinical Training Recommendations for All Clinicians Caring for Patients with Serious Illness (Center to Advance Palliative Care)

Recommendations and links to courses to build generalist palliative care skills.


Essential Skills and Supports for All Clinicians Treating Serious Illness: Building Generalist Palliative Care Capabilities Across Services and Settings (California Health Care Foundation)

Cases studies and resources that can inform design of a generalist palliative care initiative.


Recommendations for Integrating Palliative Care Capabilities and Specialists into Population-Based Models (National Coalition for Hospice and Palliative Care)

Example of incorporating generalist palliative care capabilities into population-based strategy/policy.

Training Program

End-of-Life Nursing Education Consortium (End-of-Life Nursing Education Consortium)

Nurse education program that uses a train-the-trainer model to scale palliative and end of life care clinical skills.

Training Program


Serious illness communication skills training appropriate for all clinicians who care for seriously ill patients.


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