| Domain | Summary | Example Strategy |
| Symptom Management | Identifying and addressing physical symptoms such as pain and dysphonia | Use a symptom scale to identify distressing physical symptoms and provide symptomatic relief |
| Polypharmacy | Reducing the number of medications and complexity of treatment regimens to reduce side effects and improve adherence | Review medication lists at each office visit and remove unnecessary medications |
| Advanced Care Planning | Early discussion and documentation of patient and family goals of care for emergency or end of life situations as well as designation of healthcare proxy where applicable | Review and document wishes for emergency situations (code status) and common terminal interventions (e.g., placement of feeding tube) at each office visit |
| Psychosocial and Spiritual Support | Identifying and addressing the impact of spiritual and psychosocial wellness on quality of life for the patient and family | Review and document patient’s support systems and spiritual beliefs and provide appropriate resources as necessary |
| Caregiver Burnout | Acknowledging and addressing the significant impact of advanced PD on the family, especially the primary caregiver | Inquire at each office visit the support systems available to the primary caregiver and provide appropriate resources (e.g., social work) as necessary |
| Multidisciplinary Care | Physician and non-physician providers work as a team to provide high quality comprehensive care to patients and families | Advanced care nursing can assess psychosocial and spiritual support for patients or identify any medications that may be unnecessary to reduce polypharmacy |
| Specialist Referral and Hospice | Appropriate referral to palliative medicine specialists for more complicated support requirements or referral to inpatient/outpatient hospice services | Provide early information to patients and families regarding the role of hospice and palliative medicine specialists and make referrals as appropriate or requested |