Table 1. Definition of Palliative Care.

“Palliative care generally refers to patient and family-centered care that optimizes quality of life by anticipating, preventing, and alleviating suffering across the continuum of a patient's illness. Historically, palliative care referred to treatment available to patients at home and enrolled in hospice. More recently, palliative care has become available to acutely ill patients and its meaning has evolved to encompass comprehensive care that may be provided along with disease-specific, life-prolonging treatment. End-of-life (EOL) care refers to comprehensive care for a life-limiting illness that meets the patient's medical, physical, psychological, spiritual and social needs. Hospice care is a service delivery system that emphasizes symptom management without life-prolonging treatment, and is intended to enhance the quality of life for both patients with a limited life expectancy and their families”. (National Quality Forum [13])

	Primary Stroke Palliative Care Skills
Pain and symptoms	Recognize early signs of pain, depression, anxiety, delirium Basic symptom management skills
Communication skills	Communicate with empathy and compassion Authentic and active listening Narrative competence to elicit the patient's story Effectively elicit individual treatment goals (see Goals of care) Effectively share information with the patient and family using terms they understand Communicate prognosis for quantity and quality of life Provide anticipatory guidance regarding illness and treatment trajectories Develop consensus for difficult decisions in a way that is sensitive to the patient's/family's preferred role of decision-making Identify and manage moral distress among interdisciplinary team members
Psychosocial and spiritual support	Identify psychosocial and emotional needs of patients and families Identify needs for spiritual or religious support and provide referral Access resources that can help meet psychosocial needs Practice cultural humility
Goals of care	Help family establish goals of care based on patent and family values, goals, and treatment preferences Willing and able to engage in shared decision-making and adapt shared decision-making approach to patient and family preferences Incorporate ethical principles In communication and decision-making
End-of-life care	Emphasize nonabandonment and provide continued emotional support through the dying process for patents and their families Provide anticipatory guidance regarding the dying process for patients and their families Facilitate bereavement support for family members