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Comment & Response
February 2019

Ambiguities in Comfort Care Discussions—Reply

Author Affiliations
  • 1Section of Palliative Care, MedStar Washington Hospital Center, Washington, DC
  • 2University of Maryland School of Pharmacy, Baltimore
  • 3Department of Medicine, Georgetown University Medical Center, Washington, DC
JAMA Intern Med. 2019;179(2):274-275. doi:10.1001/jamainternmed.2018.7486

In Reply We appreciate the response by Umar and colleagues to our article.1 We wholeheartedly agree with the premise of early palliative care; perhaps, in the case of our article, palliative care was engaged too late in the patient’s hospital stay. Barriers to early palliative care integration include misconceptions that palliative care equates to end-of-life care, a need for culture change across disciplines and institutions, and a lack of education among health care professionals regarding the benefits of palliative care involvement.2 Moreover, although studies continue to underline the clinical benefits of early palliative care, current data indicates a workforce deficit of specialty-trained palliative care clinicians.3 Education and training on expert communication skills, symptom management, and end-of-life care must be prioritized to increase so-called primary palliative care skills among all clinicians.4 The use of a standardized patient simulation exercise showed promise in improving communication skills among first-year residents.5

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