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Adult nursing
Palliative care for dying patients could be enhanced by early goals-of-care discussion and strong collaboration between care providers
  1. Lloyd Allen
  1. Royal Marsden School, Royal Marsden Hospital NHS Trust, London, UK
  1. Correspondence to Lloyd Allen, Royal Marsden Hospital NHS Trust, London SW3 6JJ, UK; lloyd.allen{at}

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Commentary on: Ernecoff NC, Wessell KL, Hanson LC, et al. Elements of palliative care in the last 6 months of life: Frequency, predictors, and timing. J Gen Intern Med, 24 Oct 2019, DOI: 10.1007/s11606-019-05349-0

Implications for practice and research

  • A prompt-based tool such as a treatment escalation plan might support earlier palliative care referral and advanced care planning.

  • Further research is needed into the implementation of prompt-based tools and their effectiveness in supporting earlier Advanced Care planning and hospice referrals.


There is a growing body of evidence linking early palliative care referral in patients with life-limiting illness and better patient and family outcomes across a number of measures, including symptom control and psychological well-being of patient and relatives, as well as long-term bereavement issues.1 2 However, significant obstacles still remain in achieving early referrals to specialist palliative care within acute settings,1 …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.