Introduction to the special series: multidisciplinary and holistic palliative care
Palliative care has evolved substantially over recent decades. Once narrowly associated with terminal cancer care and the final days of life, it is now recognized as an essential component of comprehensive health care across the disease trajectory, relevant to all people living with serious illness regardless of diagnosis, age, prognosis, or care setting (1-3).
While this evolution has brought welcome clarity to the field, it has also introduced greater complexity in the organization and delivery of care. Contemporary palliative care is expected not only to relieve physical symptoms, but also to address psychosocial distress, spiritual concerns, ethical dilemmas, family burden, social vulnerability, and inequities in access (1-3).
This special series in the Annals of Palliative Medicine brings together a diverse collection of contributions that reflect the breadth, maturity, and continued evolution of contemporary palliative care. Collectively, these papers demonstrate that palliative care is most effective when it is multidisciplinary in structure, person-centred in orientation, and holistic in scope.
Although the term “multidisciplinary” is widely used in health care, in palliative care it carries particular significance. It is not merely a matter of assembling professionals around a table, but of integrating perspectives into coherent, compassionate care that recognizes the patient as a whole person. Holistic palliative care, in this sense, is not an adjunct to medical treatment; it is the form that high-quality palliative care must take. This principle becomes especially evident when one considers the nature of suffering in serious illness. The needs of patients rarely fit neatly within disciplinary boundaries. Pain may be physical, but also psychological, social, and existential. A wish to hasten death may arise from uncontrolled symptoms, fear, dependency, depression, demoralization, or loss of meaning rather than from physical suffering alone. Treatment preferences may reflect medical realities, but also family dynamics, spiritual beliefs, cultural norms, and trust. The complexity of such needs requires a coordinated response that integrates the expertise of physicians, nurses, psychologists, social workers, chaplains, therapists, ethicists, and community actors. It also requires listening to patients and families as active participants in care, not merely recipients of it. Such integration reflects the increasingly accepted understanding that palliative care is not a discrete intervention, but a multidimensional model of care responsive to the totality of suffering.
Several papers in this series focus on communication and decision-making, both central pillars of high-quality palliative care. Shared decision-making has become a defining principle of person-centred medicine, yet its implementation in palliative care remains challenging. Decisions near the end of life are often emotionally charged, prognostically uncertain, and shaped by differing values among patients, families, and clinicians. The contribution on shared decision-making and early palliative care highlights the importance of integrating palliative care principles early in the illness trajectory, not only to improve symptom burden and quality of life, but also to establish the relational and communicative foundation necessary for meaningful decisions later in the course of illness.
Closely related to this, the practical implementation of person-centred and holistic care also depends on valid and meaningful ways of eliciting and understanding patients’ experiences. In this regard, the editorial on patient-reported outcome measures (PROMs) in palliative care contributes to a longstanding and highly relevant discussion: how can we systematically assess what matters most to patients while preserving the individual and relational nature of care? Framed in this way, PROMs are not merely measurement instruments, but communicative tools that can support dialogue, clarify priorities, and strengthen shared understanding between patients, families, and clinicians. This question is particularly salient in palliative care, where standardization must remain attentive to the singularity of lived experience.
The ethical dimensions of care are further explored in several contributions. Ethical practice in palliative care cannot be reduced to rule-based decision-making; it is relational, contextual, and deeply human. Ethical care requires more than procedural correctness: it demands attentiveness to the values and existential frameworks through which patients understand illness, suffering, and mortality.
This theme is echoed in the contribution on end-of-life wishes and the wish to hasten death. Few issues in palliative care are more ethically and emotionally complex. Such wishes challenge clinicians not only to assess intent and suffering, but also to understand what lies beneath the expression: fear, loss, hopelessness, dependency, demoralization, or a need for control. A multidisciplinary approach is indispensable here, as no single professional lens is sufficient to understand or respond to such complexity. The paper offers an important and nuanced examination of these expressions, emphasizing the need for careful interpretation, interdisciplinary reflection, and compassionate clinical engagement.
Holistic palliative care also requires sustained attention to the spiritual and cultural dimensions of care. This is addressed explicitly in the review on religion and treatment decisions in palliative care. Religious and spiritual beliefs often shape preferences around suffering, hope, life-prolonging treatment, disclosure, and dying. Yet these influences are not always visible in routine clinical practice, and clinicians may feel insufficiently prepared to engage with them. This contribution highlights the importance of recognizing spiritual and religious frameworks as integral, rather than peripheral, to clinical understanding and decision-making.
Several papers in this series extend the scope of palliative care beyond traditional (Western) settings and populations, underscoring the importance of equity and inclusion. The article on palliative care in prisons addresses one of the most neglected areas in the field. People who are incarcerated often experience profound health inequities, including high rates of multimorbidity, mental illness, trauma, and social exclusion. Providing palliative care in custodial settings raises unique clinical, ethical, and logistical challenges, but also compels us to confront a fundamental question: for whom is palliative care intended? A truly holistic and public health-oriented palliative care must include marginalized and structurally excluded populations (1,3).
Similarly, the paper on community palliative care in Kenya broadens the geographical and systemic lens of this series. It reminds us that multidisciplinary and holistic palliative care must always be adapted to context, and that innovation often emerges most clearly where resources are constrained. Community-based models of care, often developed in close partnership with families, lay caregivers, and local networks, challenge overly institutional models of palliative care and offer important lessons in flexibility, cultural responsiveness, and community integration.
The paper on compassionate communities reinforces this perspective by placing palliative care within a public health framework. Serious illness, dying, caregiving, and bereavement are not solely medical events; they are social experiences embedded in families, neighbourhoods, and communities. Compassionate communities represent a powerful reimagining of palliative care as a shared societal responsibility, in which care extends beyond professional services and is supported by social networks, civic structures, and collective compassion. This approach does not replace specialist palliative care; rather, it complements it by recognizing that holistic care requires both professional excellence and social participation.
This attention to inclusion and complexity is further reflected in contributions that focus on populations and clinical situations that remain insufficiently recognized within mainstream palliative care. The paper on end-of-life care for individuals with severe and persistent mental illness highlights a population whose palliative care needs are frequently overlooked and poorly served. These patients often face stigma, fragmented care, reduced access, and complex interactions between psychiatric and somatic suffering. Their inclusion in this series is both timely and necessary, challenging palliative care to expand not only its reach, but also its conceptual frameworks.
Likewise, the retrospective study on pacemaker presence raises clinically specific yet highly relevant questions about technology, treatment limitation, and end-of-life decision-making. Such issues exemplify the increasingly complex interface between modern medicine and palliative care, where technical interventions and existential considerations frequently intersect. Together, these contributions underscore that multidisciplinary and holistic palliative care must remain attentive not only to broad public health challenges, but also to the nuanced and evolving clinical realities that shape care at the bedside.
At the same time, their broader significance depends on how palliative care is understood, communicated, and made visible within health systems and society. The contribution on how to “spread the word” about palliative care therefore addresses a final but essential dimension of the field: its public and professional visibility. Despite growing evidence for its benefits, palliative care remains misunderstood, underused, and too often introduced too late. Misconceptions persist among professionals, policymakers, patients, and the public alike. Education, advocacy, and public discourse are therefore not peripheral concerns, but essential to the continued development, accessibility, and integration of palliative care.
Taken together, the contributions in this special series offer no single model of multidisciplinary and holistic palliative care, nor should they. The strength of the series lies precisely in its plurality. It reflects palliative care as a field that is clinically grounded, ethically reflective, socially engaged, and globally relevant. It demonstrates that multidisciplinary and holistic palliative care is defined not by any single intervention, profession, or setting, but by a way of seeing and responding to serious illness in all its complexity.
It is our hope that the articles published in this series will contribute meaningfully to ongoing reflection, research, and practice in palliative care, and encourage readers to continue building models of care that are collaborative, compassionate, and truly holistic.
Acknowledgments
None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine for the series “Multidisciplinary and Holistic Palliative Care”. The article did not undergo external peer review.
Funding: None.
Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-2026-0048/coif). The series “Multidisciplinary and Holistic Palliative Care” was commissioned by the editorial office without any funding or sponsorship. E.O. and J.M. served as the unpaid Guest Editors of the series. E.O. serves as an unpaid Palliative Radiotherapy Subcommittee member of Annals of Palliative Medicine from December 2024 to December 2026. The authors have no other conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
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- World Health Organization. Palliative care. WHO Fact Sheet. Geneva: WHO; 2020.
