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Charles F. von Gunten, MD,PhD

JAMA. 2002;287:875-881.

Palliative care services provide secondary and tertiary levels of palliative care, the interdisciplinary care of patients in which the goal is comfort and quality of life. Primary palliative care refers to the basic skills and competencies required of all physicians and other health care professionals. Secondary palliative care refers to the specialist clinicians and organizations that provide consultation and specialty care. Tertiary palliative care refers to the academic medical centers where specialist knowledge for the most complex cases is practiced, researched, and taught. The case of Reverend J, a man with advanced cancer admitted to an acute palliative care unit in a teaching hospital, illustrates the use of secondary and tertiary clinical palliative care services in hospitals and health care systems.

Author Affiliation: Center for Palliative Studies, San Diego Hospice, San Diego, Calif; Department of Medicine, University of California, San Diego.

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