Author Affiliation: Center for Palliative Studies, San Diego Hospice, San Diego, Calif; Department of Medicine, University of California, San Diego.
Perspectives on Care at the Close of Life Section
Editor: Margaret A. Winker, MD, Deputy Editor, JAMA.
Palliative care services provide secondary and tertiary levels of palliative
care, the interdisciplinary care of patients in which the goal is comfort
and quality of life. Primary palliative care refers to the basic skills and
competencies required of all physicians and other health care professionals.
Secondary palliative care refers to the specialist clinicians and organizations
that provide consultation and specialty care. Tertiary palliative care refers
to the academic medical centers where specialist knowledge for the most complex
cases is practiced, researched, and taught. The case of Reverend J, a man
with advanced cancer admitted to an acute palliative care unit in a teaching
hospital, illustrates the use of secondary and tertiary clinical palliative
care services in hospitals and health care systems.
von Gunten CF. Secondary and Tertiary Palliative Care in US Hospitals. JAMA. 2002;287(7):875-881. doi:10.1001/jama.287.7.875