Interdisciplinary Pain and Symptom Management - multidimensional assessment of pain and other symptoms, expertise in non-pharmacological interventions for pain and symptoms related to advanced illness, inquiring about the attributed meaning, spiritual aspects, cultural variables, hopelessness, helplessness, associated mood aspects, providing psycho education, teaching relaxation, reframing, imagery, working with caregiver distress. Care Coordination Across Practice Settings - provides continuity between hospital service and outpatient palliative practice; extensive collaboration with case management, liaison for hospice representatives, expert anticipatory guidance for patients and families re-illness progression.