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Referral to Specialist Palliative Care

Key Messages

  • The majority of older people can be managed within their normal place of care with support.
  • Recognising the need for palliative care precedes referral to specialist palliative care. [1-4]
  • A number of possible criteria supporting referral to specialist palliative care have been identified including: severe physical or emotional symptoms, request for hastened death, spiritual or existential crisis, assistance with decision making or care planning, patient request, delirium, spinal cord compression, brain or leptomeningeal metastases, median survival of 1 year or less, and progressive disease despite second-line therapy. [5]
  • Early referral may be beneficial. [1,3]
  • The standards for providing quality palliative care for all Australians established by Palliative Care Australia consider referral as integral in allowing patients to access appropriate and timely care consistent with their level of need. [6,7]

Background

Referral systems should enable people to receive optimal care at the appropriate level. Within a system framework, referral requires consideration of all parts and may be adjusted for the local circumstance. Criteria which guide the decision to refer could inform the referral process. Referral processes will also need to comply with funding and legislative requirements.


Evidence Summary

Recognising the need or treatment preference for palliative care precedes referral. [2-5] The concept of transition within palliative care is ill-defined and there is no accepted definition in this context. [2] Transition in the palliative care literature goes further than just change in place or carer, it also relates to the personal meaning of life, life/role changes, perceptions of end of treatment and likelihood of death. Timing of referral is an important issue. Early integration of palliative care may have advantages in terms of symptom management, quality of life, less aggressive treatment and hospitalisation and carer support. The optimal time for such referral is still unclear. [1]


Recent reviews have begun to identify criteria that could be used to help decide to refer to specialist palliative care but primarily from cancer. Criteria identified include cancer diagnosis, prognosis, physical symptoms, performance status, psychosocial distress, and end-of-life care planning needs. [3] Referral criteria also need to be tailored to the local institution and should complement, instead of replace, clinical judgment to facilitate appropriate referrals. [3]


Quality Statement

The evidence base included reviews of observational and interventional studies. Most studies were retrospective. The conduct of the reviews was adequate.

 

Page updated 22 May 2017

 

  • References

  • About PubMed Search

  1. Davis MP, Temel JS, Balboni T, Glare P. A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Ann Palliat Med. 2015 Jul;4(3):99-121.
  2. Gardiner C, Ingleton C, Gott M, Ryan T. Exploring the transition from curative care to palliative care: a systematic review of the literature. BMJ Support Palliat Care. 2011 Jun;1(1):56-63.
  3. Hui D, Meng YC, Bruera S, Geng Y, Hutchins R, Mori M, et al. Referral criteria for outpatient palliative cancer care: A systematic review. Oncologist. 2016 Jul;21(7):895-901. Epub 2016 May 16.
  4. Kirolos I, Tamariz L, Schultz EA, Diaz Y, Wood BA, Palacio A. Interventions to improve hospice and palliative care referral: a systematic review. J Palliat Med. 2014 Aug;17(8):957-64. Epub 2014 Jul 7.
  5. Hui D, Mori M, Watanabe SM, Caraceni A, Strasser F, Saarto T, et al. Referral criteria for outpatient specialty palliative cancer care: an international consensus. Lancet Oncol. 2016 Dec;17(12):e552-e9.
  6. Palliative Care Australia. Standards for providing quality palliative care for all Australians (633kb pdf). Deakin (ACT): Palliative Care Australia; 2005.
  7. Palliative Care Australia. National Standards Assessment Program (745kb pdf). Deakin West (ACT): Palliative Care Australia; 2016.
 

Definitions

The practice of sending a patient to another program or practitioner for services or advice which the referring source is not prepared to provide. (Source: MeSH thesaurus)

Searches

"Referral and Consultation"[mh] OR Referral[ti] OR referred[ti] OR refer[ti] OR gatekeeper*[ti] OR second opinion*[ti] OR consultation*[ti]
"Referral and Consultation"[mh] OR Referral[tiab] OR referred[tiab] OR refer[tiab] OR gatekeeper*[tiab] OR second opinion*[tiab] OR consultation*[tiab]
(Note: Broader strategy used in referral and palliative care and aged care search only)