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Nov 2025
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End-of-Life Palliative Care: Role of the Family Physician

Tamara L. McGregor, MD, MA
Jared Morphew, MD
Heather Ann Dalton, MD

American Family Physician. 2025;112(5):493-503A.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

To care for patients at the end of life, family physicians should be able to evaluate the causes of symptoms, differentiate between distressing symptoms and common end-of-life changes, and balance treatment effectiveness with potential adverse effects, while ensuring alignment with the patient's values and wishes. For severe pain and dyspnea, opioids are the mainstay of treatment. Palliation of pain with adjuvant medications and nonpharmacologic measures may delay or decrease the need for opioids. Nausea can be treated by reducing exacerbating factors and choosing agents that target the specific receptor site affected. Constipation should be prevented or treated quickly with osmotic and stimulant laxatives. Severe opioid-induced constipation may require enemas, prokinetics, or mu-opioid antagonists. Anorexia is extremely common at the end of life and may not warrant specific treatment in the absence of distress. Appetite stimulants can be considered after dysphagia, dyspepsia, nausea, and constipation are addressed. Early recognition of delirium, reduction of offending medications, and frequent reorientation may reduce the need for psychotropic medications. Mood disturbances should be distinguished from grief and cognitive loss, and treatment should consider prognosis and time to benefit.

Palliative care aims to prevent and relieve health-related distress through a person-centered approach, with a focus on symptom relief and improved quality of life.1,2 However, the current palliative care workforce cannot keep up with the growing population of aging and seriously ill patients.3 Family medicine and palliative care health care professionals seek to improve patient and family quality of life by clarifying goals of care across all ages and stages of life. An American Academy of Family Physicians advocacy statement describes the core principles of vital end-of-life care, which include respecting patient autonomy and promoting symptom control.4

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments
Opioids are recommended for moderate to severe pain at the end of life.6,7,11,14,15 CMultiple narrative reviews with limited quality evidence
Oral and parenteral opioids have shown symptomatic benefit for patients with refractory or terminal dyspnea.23 BCochrane review demonstrating benefit in a small number of study participants and overall low-quality evidence
A combination of stimulant and osmotic laxatives should be used for the treatment of constipation in palliative care patients.40,41 COpinion from clinical practice guidelines; limited studies comparing different laxatives showed no clear differences in effectiveness or adverse effects
Peripherally acting mu-opioid antagonists can be useful for treatment of refractory opioid-induced constipation second line after usual laxative therapies.44,45 BCochrane review and meta-analysis demonstrating benefit compared with placebo
Psychostimulants, such as methylphenidate, can reduce depression symptoms at the end of life.9,68 BCochrane review demonstrating short-term benefit with a note of need for long-term follow-up and evaluation for tolerance and dependence

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

TAMARA L. MCGREGOR, MD, MA, is an associate professor in the Department of Family and Community Medicine and the Department of Internal Medicine Palliative Medicine Section at the University of Texas Southwestern Medical Center, Dallas.

JARED MORPHEW, MD, is an assistant professor in the Department of Family and Community Medicine and the Department of Internal Medicine Palliative Medicine Section at the University of Texas Southwestern Medical Center, Dallas.

HEATHER ANN DALTON, MD, FAAFP, is an assistant professor in the Department of Family and Community Medicine and Department of Internal Medicine Palliative Medicine Section at the University of Texas Southwestern Medical Center, Dallas.

Address correspondence to Tamara L. McGregor, MD, MA, at Tamara.McGregor@UTSouthwestern.edu.

Author disclosure: No relevant financial relationships.

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