Figure 1. UroPal conceptual model. ACP indicates advance care planning; PMD, primary medical doctor; Psych, psychiatry; SW, social work.

Palliative care is an interdisciplinary approach to managing patients with advanced disease, with a focus on quality of life, symptom and pain control, and assessment of patient and family goals. Early consultation with palliative care among individuals with advanced disease carries enormous benefits to patients, families, and health systems. Patients live longer and have improved symptom control and quality of life. Families benefit from higher satisfaction with care and lower caregiver distress. Due to better communication between providers and patients and their families, unnecessary health care utilization and cost of care are reduced dramatically. Due to these benefits, organizations including the National Academy of Medicine, the World Health Organization, the American Society of Clinical Oncology, and the AUA (among others) recommend early palliative care for patients with advanced disease. However, the palliative care workforce is insufficient to support the full range of patient needs.^1-4 These shortages are expected to worsen over time, as increased palliative care specialist training is unlikely to maintain pace with the aging population. Underserved populations have less reliable access to palliative care, exacerbating their disparities in advanced disease outcomes.⁵

As a clinical specialty, urology is well positioned to lead efforts at improving palliative care use among patients with advanced urological health conditions. The relationship between a patient and their urologist is often deeper and more intricately woven than with most other practitioners. A man with advanced stage prostate cancer, for instance, has known his urologist for an average of 13 years; a woman with advanced voiding dysfunction has likely been cared for by her urologist for several decades.^6,7 Although the palliative care needs of urological patients are substantial, the breadth of patients needing palliative care support vastly exceeds the capacity of the current palliative care workforce.^4,8

Figure 2. eConsult integration of UroPal. A-C, Examples of eConsult-mediated interdisciplinary care. PMD indicates primary medical doctor.

Against this backdrop of palliative care needs and challenges, the AUA focused its 2021-2022 Quality Improvement Summit on Opportunities to Improve Palliative Care in Urology. The summit brought together a diverse panel of experts from urology, palliative care, broader surgical specialties, psychiatry, nursing, social work, and pain management to discuss a variety of topics, including management of the disease course of individuals with advanced urological diseases, identification of the aspects of palliative care services that can be efficiently and efficaciously offered in a urology practice, overview of the current palliative care workforce, and development of a health services and educational agenda that advances urologist–palliative care partnerships. Through the conference, urologists from across the country delineated how a urology-centered primary palliative care intervention could be structured and what implementation barriers would need to be removed. The AUA buttressed the palliative care model in urology by incorporating it into our profession’s Core Curriculum and creating a dedicated teaching slide set.

The conceptual model for how urologists could pioneer creation of an implementable, scalable model of primary palliative care is shown in the UroPal figure (Figure 1). The team of interdisciplinary providers includes urologists, oncologists, primary care providers, nurses, chaplains, geriatricians, social workers, palliative care providers, psychiatrists, and nurses, with a urologist at the hub of care as the “quarterback.” To connect the care hub with spoke providers, platforms like electronic consultation (eConsult) could be used to enable communication among providers and with patients and families. eConsult within an integrated system has been successfully deployed in the Los Angeles County Department of Health Services, where it maximized efficiency and effectiveness while improving access to urological care.⁹ Instituting a similar framework, as shown in Figure 2, may help urologists achieve a successful primary palliative care model. Everyone agrees that targeted palliative care is essential; urologists are uniquely positioned to achieve what, to date, has remained aspirational.

Conflict of Interest Disclosures: None.

Author Contributions: All Authors have contributed meaningfully to this manuscript.