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  • Interdisciplinary palliative care improves the quality of life of patients and families by focusing on alleviation of physical, psychosocial, and spiritual distress.

  • The literature consists of a variety of outpatient palliative care models with different team composition, the timing of referral, and the place of delivery.

  • Outpatient palliative care provided by an interdisciplinary team and earlier in the disease trajectory is generally more beneficial than that provided by a single discipline or later in the disease trajectory.

  • Automatic referrals to palliative care can increase both the volume and timeliness of referral.

  • Standalone clinics are more suitable for larger centers than multiple embedded clinics.

  • Ultimately, no one model fits all, and each institution needs to determine the optimal model based on patient population, infrastructure, staff, and resource availability.


Palliative care is “an approach that improves the quality of life of patients and their families facing the problem associated with a life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”1 According to the World Health Organization, palliative care “is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.”1

Palliative care first started in the community with the hospice movement. It evolved over the past six decades to offer care in acute care facilities by providing inpatient consultations and palliative care units.2 In 1990s, Edmonton, Canada, established one of the first palliative care clinics, providing outpatient care to patients in the ambulatory setting.3,4 This represented a significant shift in paradigm because patients at palliative care clinics generally had better performance status and fewer acute symptom distress than patients at other palliative care settings (ie, palliative care inpatient consultation teams, palliative care units, and home palliative care programs and hospices).5 Palliative care clinics allowed patients to be referred earlier in the disease trajectory while they were actively receiving cancer treatments. As a result, these patients could be followed longitudinally by the palliative care team, with many more opportunities to optimize care. The focus of care also shifted from dealing with acute symptom crisis at the end-of-life care to anticipatory care to address chronic symptoms (eg, fatigue, nutrition, function) through education and monitoring, and timely serious illness conversations to enhance illness understanding and facilitate care planning.6 As a result, an increasing number of cancer centers now offer outpatient palliative care services. For example, 67% of the National Cancer Institute (NCI)-designated cancer centers in the United States reported having outpatient palliative care clinics in 2009, and this number had increased to 98% in 2018.7

The literature for outpatient palliative care has grown substantially over time.8 Timely referral of cancer ...

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