Table 1.

Primary and subspecialty palliative care skills

Primary Palliative Care	Subspecialty Palliative Care
Management of basic symptoms, such as pain, edema, pruritis, sleep disturbance	Management of refractory symptoms
Diagnosis and treatment of depression and anxiety, attendance to psychosocial challenges	Management of complex depression, anxiety, and existential suffering
Delivery of patient- and family-centered communication addressing topics such as goals of care, prognostic discussion, advanced care planning	Delivery of complex, serious illness communication, such as addressing disagreements in goals of care between patient and family, family and clinicians, or care teams

All clinicians should be equipped to provide primary palliative care, but as concerns become increasingly complex, subspecialty PPC consultation is indicated. Adapted from refs. 20 and 21, with permission.