Table 4.

Palliative care resource allocations: pain management and end-of-life care with metastatic disease

	Basic	Limited	Enhanced	Maximal
Pain Management ^a	Pain consideration^b (simple assessment) Pain drugs^a, including morphine (basic) Management of pain-related physical symptoms CAM and non-drug pain management	Other pain drugs^a Radiotherapy (single and multi-fraction) PT and OT for functional limitations or pain management	Pain screening Pain care plan Opioid pumps, methadone, fentanyl patch Consultation with specialist in pain therapy Surgery (cord compression, fracture, obstruction)	Locoregional anesthesia, spinal analgesia
Psychosocial (End-of-life)	Psychosocial (end-of-life) consideration^b Patient, family, and caregiver education^c Psychosocial support: community-based Bereavement support: community based	Patient, family, and caregiver education^c: emotional aspects of death Advanced care planning	Screening and referrals for depression / distress by mental health specialist Psychosocial counseling by mental health specialist Antidepressants Social services for financial, legal and family matters	Psychiatrist, psychologist, or social worker coordinated mental health care
Spiritual (End-of-life)	Spiritual consideration^b Spiritual support: community based		Clinic or hospital associated spiritual support Hospital or hospice spiritual reflection and meditation space

Note: The table stratification scheme implies incrementally increasing resource allocation at the basic, limited, and enhanced levels. Maximal-level resources should not be targeted for implementation in LMICs, even though they may be used in some higher-income settings.

Pain management should follow the WHO pain ladder. Morphine should be available and easily accessible at a basic level of resources.

“Consideration” is a term used in this table to refer to basic patient evaluation through patient-provider interactions, including dialogue, observations, and other appropriate means of evaluation.

Patient, family and caregiver education may be the primary intervention for some supportive care services.