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

Abstract

As specialty palliative care (SPC) programs expand nationwide, variability in referral criteria and care scope has led to inconsistent care delivery and confusion among clinicians and patients. As demand for SPC increases, workforce limitations necessitate prioritization frameworks. The Brookdale Department of Geriatrics and Palliative Medicine at the Mount Sinai Health System convened a task force of six palliative care physicians to reach consensus on SPC scope of practice. The group conducted a literature review, surveyed department clinicians, and solicited input from 10 peer academic institutions to inform guideline development. The task force met four times over three months and finalized the guideline through departmental review and leadership endorsement. Findings highlighted wide variation in definitions of "serious illness" and appropriateness for SPC. Most surveyed clinicians supported a definition requiring both high mortality risk and negative impact on quality of life or caregiver burden. The resulting institutional guideline emphasizes prioritization of patients with serious illness and high risk of mortality, explicitly excluding patients with chronic pain or psychosocial distress in the absence of a serious illness. The guideline also addresses safe opioid prescribing and recommends tracking "non-eligible" referrals to identify unmet system needs. This initiative offers the first SPC scope guideline. Ongoing discussions, both at individual institutions and nationally, may be necessary to determine the importance of consistency in defining and communicating the scope of SPC. Health care leaders can use this guideline to address resource allocation, health policy, workforce education, and public understanding of palliative care.