To the Editor: I enjoyed the article on end-of-life palliative care and appreciate its recognition of family physicians' place in palliative care.1 However, I believe the language used in the title is potentially misleading and is a disservice to the role of family physicians in primary palliative care.
As the authors noted, there is a shortage of specialty palliative care clinicians worldwide. To ensure safe care for patients living with terminal illness, family physicians should be trained in primary palliative care.2 The authors did an excellent job introducing palliative care, addressing symptom management for conditions frequently encountered in advanced illness, and guiding physicians in timing for a palliative care referral.
However, I recommend separating palliative care from end-of-life language whenever possible because language discordance has a negative impact on patient access to palliative and hospice care.3 To empower family physicians to engage in primary palliative care, I believe we need to increase exposure to concepts of palliative care by acknowledging its role on the continuum of any diagnosis of advanced illness.
Adopting palliative care as a quality-of-life care model instead of a brink-of-death care plan helps increase concordance with palliative care as a part of any advanced illness treatment plan.4 This type of linguistic alignment will help facilitate earlier engagement between patients and physicians, which leads to the benefits that come with earlier palliative care: increased quality of life, greater adoption of advance directives, and higher patient satisfaction.5,6
In Reply: Thank you for your thoughtful comments on our article. We completely agree and support the need to separate palliative medicine from end-of-life terminology, especially in the setting of family physicians caring for seriously ill patients who need (and deserve) a skill set that includes excellent communication skills and anticipatory symptom management at all stages of life. Prevention of complications, symptom management in the context of life-prolonging therapies, and keen recognition of physical or emotional changes in the early stages of illness before end-of-life are paramount in the care family physicians provide to seriously ill patients.
Our purpose in the article was to summarize common symptoms in the context of specific organ failure and cancer settings and to highlight the parallels between primary and palliative care (frequently provided by the same family physician). We could not agree more on the need to continue to learn, teach, and demonstrate the ongoing role of family physicians in delivering and facilitating better care of our patients long before the end becomes the present but were limited by scope and word count.
Again, we thank you for your support, attention, thoughtfulness, great references, and valid comments.
- 1.McGregor TL, Morphew J, Dalton HA. End-of-life palliative care: role of the family physician. Am Fam Physician. 2025;112(5):493-503.
- 2.Munday D, Pastrana T, Murray SA. Defining and developing primary palliative care as an essential element of primary health care. Palliat Med. 2024;38(8):766-769.
- 3.Dookie SP, Martin L. The effect of language discordance on the experience of palliative care: a scoping review. PLoS One. 2025;20(4):e0321075.
- 4.Buss MK, Rock LK, McCarthy EP. Understanding palliative care and hospice: a review for primary care providers. Mayo Clin Proc. 2017;92(2):280-286.
- 5.Haroen H, Maulana S, Harun H, et al. The benefits of early palliative care on psychological well-being, functional status, and health-related quality of life among cancer patients and their caregivers: a systematic review and meta-analysis. BMC Palliat Care. 2025;24(1):120.
- 6.Cohen MG, Althouse AD, Arnold RM, et al. Primary palliative care improves uptake of advance care planning among patients with advanced cancers. J Natl Compr Canc Netw. 2023;21(4):383-390.
