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.
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.  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. 
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.  Referral criteria also need to be tailored to the local institution and should complement, instead of replace, clinical judgment to facilitate appropriate referrals. 
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