A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses

The disease-centered, pathophysiological approach to medical care and the development of targeted innovations to various disease processes has brought about notable improvements in the technical aspects of managing disease. However, though the reductionist approach has brought about many advances, the sum of the advances is often less than the quality of care that is desired (1,2). The result is a dramatic increase in health care costs relative to outcomes. For example, in the United States rapidly rising health care costs have not lead to commensurate improvements in quality of health care compared to other economically developed countries (3). Technical advancements in care have not fully translated into benefits in quality of care at least in part due to the fact that the disease-centered approach often neglects the multi-dimensional aspects of patient and family quality of life, including physical and psychosocial-spiritual aspects of wellbeing. This gap is most apparent in the context of chronic and serious illnesses, where technological advancement and attendant costs are escalating rapidly; patient and family suffering is often multidimensional and significant; and care communication and decision-making is highly complex and enmeshed with values and goals