No longer limited to end-of-life support, palliative care now finds applications and indications throughout the treatment pathway for cancer patients, as well as for those with neurodegenerative and chronic diseases, providing effective support to improve symptoms and quality of life. However, sixteen years after Italy’s Law 38/2010 on palliative care, there remain numerous challenges, for example regarding Local Palliative Care Networks (LPCNs), with overall development data in the country still scarce and often fragmented.
The General Practitioner is a key figure in promoting effective and timely territorial partnerships with hospitals and specialists. The spotlight is on palliative care during the National Day on November 11.
Role and aims. Early and simultaneous
In this framing, palliative care integrates specialty care in oncology, cardiology, pulmonology and neurology to improve the patient’s and the family’s quality of life, rapidly manage symptoms and support shared care decisions. The evidence shows benefits across symptoms, communication, advance care planning, and reductions in hospitalizations and inappropriate Emergency Room visits.
The general practitioner (GP) is a fundamental reference point: he or she identifies palliative needs early, for example by recognizing signs of frailty, clinical deterioration, refractory symptoms, recurrent exacerbations, or frequent calls to urgent services. Moreover, the GP activates and coordinates care with specialists such as oncologists, cardiologists, pulmonologists, neurologists, home palliative care teams, community nurses and social services; promotes shared care planning by engaging the patient and family in goals, preferences, limits of therapies, and future care choices; and supports patients and caregivers throughout the journey. An early alliance among the GP, specialists, and palliative care enables more continuous, appropriate, and person-centered care, recognizing caregiver burden and facilitating access to information, psychological support, and local resources. The GP’s involvement is therefore essential for palliative care to become a regular and early component of disease trajectories, not a late option.
Palliative care in non-oncologic chronic diseases
There is growing recognition of the role of palliative therapies in chronic illnesses, such as chronic obstructive pulmonary disease (COPD), heart failure, and progressive neurodegenerative diseases like Parkinson’s, amyotrophic lateral sclerosis (ALS), and dementias. In all these settings, early introduction supports symptom management—from motor and non-motor symptoms in degenerative diseases to recurrent exacerbations in chronic conditions like COPD—producing tangible benefits not only for symptom control but also for quality of life, psychological well-being, patient and family satisfaction, and more prudent use of healthcare resources.
Available evidence shows that integrating palliative care into the pathways of advanced chronic diseases, along with shared care planning and early involvement of the local network, is associated with fewer inappropriate hospitalizations and fewer unplanned ER visits. Even in this context, the GP remains a central figure, thanks to the continuity of the relationship with the patient and the family context. This alignment of aims and professional perspectives allows for holistic protection of health and alleviation of suffering, even within a longevity horizon.
«We need to move toward a new reading of disease and longevity – said Gianpaolo Fortini of ASST Sette Laghi and President of the Italian Society of Palliative Care, on the occasion of Longevity Day (Milan, October 15) – shifting from a monocentric approach, i.e., the management of a single organ disease with one clinical lead overseeing a few targeted therapies, to an integrated, multidisciplinary vision, as outlined by Decree 77, which manages and treats multiple conditions, with several specialists who work in synergy and in a coordinated way to care for a single patient, first as a person who also has comorbidities
Geographic disparities
Geographic disparities represent one of the main challenges facing palliative care in Italy. The uneven availability of hospices, Home Palliative Care Units (UCPs), integrated home care (ADI), and specialized staff leads to variable timing of care initiation, delayed activations, and greater reliance on hospital admissions and inappropriate ER visits.
The GP is often the first point of contact to detect these gaps and can play an active role in reducing them, for example by recognizing early, based on proximity to the patient, the need for palliation even when a specialized service is not immediately available; promptly activating available pathways and referring the case to the territorial network, ADI or UCPs; promoting shared care planning and continuity between home, hospital, nursing homes (RSA) and hospices.
In addition, he or she can collaborate with nurses, specialists, home-care teams and social services to build, even in underserved areas, a care pathway as integrated as possible; supporting caregivers who in disadvantaged areas risk bearing a heavier caregiving load due to limited service availability.
Palliative care and family medicine
The demographic shift, the rising prevalence of chronic diseases, and the growing complexity of care make the role of family medicine increasingly strategic within palliative care. Today the general practitioner is a champion and executor of care continuity: not only the clinician who follows the patient over time, but the guarantor of appropriate care and of integration between hospital and community settings.
The evolving demographic and socio-health landscape on the ground opens new challenges: «It is necessary to change the narrative of palliative care – Fortini concluded – to be understood not only as end-of-life management and support, but as a strategic capability to govern the trajectories of chronicity and fragility, with an approach that considers the cost of the entire care journey rather than the cost of a single service».
Abbonati a Karla Miller
