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That’s right: palliative care is not simple
  1. Sebastiano Mercadante1 and
  2. Eduardo Bruera2
  1. 1Pain Relief and Supportive Care, Private Hospital La Maddalena, Palermo, Italy
  2. 2Palliative Care & Rehabilitation Medicine, UT M D Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Sebastiano Mercadante, Pain Relief and Supportive Care, Private Hospital La Maddalena, Palermo 90100, Italy; terapiadeldolore{at}

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We thank the authors for reading our paper and sending their comments. We agree with their title: palliative care is complex. However, their comments seem to be in contrast with this statement. They describe acute palliative care units (APCUs) in hospitals, particularly in oncological departments, as a simplistic response. We are surprised, since APCUs are not simple, They report about the ability of consulting teams in hospital. Probably they ignore the need for a specialist team involved in APCU assessment and therapeutic strategies requiring high level of expertise by physicians, nurses and other disciplines in resolving complex problems that cannot be resolved by single persons providing simple advice at a certain time of the day. Some patients with severe physical and psychosocial suffering require continuous evaluation, including imaging studies, specialist consultations and rapid changes of therapeutic regimes according to the patients’ response. They quote that hospital inpatient facilities, through palliative care network (PCN) teams, should provide advice, facilitating the activation of palliative care pathways or eventually supporting the hospital admitting teams, which are far from reality. For instance, differences have been reported.1 This approach of only a role of advisors for activating palliative care services (on average only 2–3 weeks before death!)2 does not mean resolving the present problem of a patient admitted to hospital. Indeed, do they know that …

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  • Contributors Both authors share the responsibility for the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.