Recommendations
Workforce, Knowledge, and Skills
Recommendation 3.1 Basic (Primary Health Care Provider)
➤ All health professionals should be trained in basic palliative care
skills. This basic training should include identifying the palliative care
needs of patients and their families, communication skills, assessment
and management of pain and other symptoms, supportive care, and
prescribing and/or dispensing of medications at a level appropriate to
responsibilities. These needs may be addressed by primary health care
providers, nurses, community health workers, volunteers, and/or clinical
officers. If trained professionals are not available at the local level, health
professionals should seek distance consultation and referral where
appropriate. (Strong Recommendation; EB/FC-I)
Recommendation 3.2 Limited (District-Level Facility)
➤ Interdisciplinary teams are the core of palliative care. At this level, teams
should include at least a nurse and a medical officer who have palliative
care training. An appropriately trained counselor should be added, if
available. Team members should be trained to assess, diagnose, and
deliver care. All specialists in fields relevant to palliative care should
have the knowledge and skills described in the basic level plus additional
training in symptom assessment and management, communication issues,
and psychosocial and spiritual needs. Oncologists practicing at this
level should have basic training in palliative care. This level may or may
not have professionals with formal advanced training in palliative care.
(Strong Recommendation; EB/FC-I)
Recommendation 3.3 Enhanced (Regional Facility)
➤ A team including a physician, a nurse, and a counselor should provide
palliative care. The team must include a health care provider trained to
prescribe and access to someone licensed to dispense medications. In the
absence of a palliative care specialist, oncologists at this level should be
trained in basic palliative care. All health professionals in relevant fields
should have the knowledge and skills described in Recommendations 1.1
and 1.2, plus enhanced skills on how to treat refractory symptoms, how
to manage emotional crisis and existential distress. This level should
include professionals with formal advanced training and education in
palliative care, such as (but not limited to) physicians, nurses, counselors,
and pharmacists. (Strong Recommendation; EB/FC-I)
Recommendation 3.4 Maximal (National Cancer Center/Institute)
➤ See Ferrell BR, Temel JS, Temin S, et al. J Clin Oncol 35:96-112, 2016.
