Referral criteria for outpatient specialty palliative cancer care: an international consensus

Abstract

Although outpatient specialty palliative-care clinics improve outcomes, there is no consensus on who should be referred or the optimal timing for referral. In response to this issue, we did a Delphi study to develop consensus on a list of criteria for referral of patients with advanced cancer at secondary or tertiary care hospitals to outpatient palliative care. 60 international experts (26 from North America, 19 from Asia and Australia, and 11 from Europe) on palliative cancer care rated 39 needs-based criteria and 22 time-based criteria in three iterative rounds. Nearly all experts responded in each round. Consensus was defined by an a-priori agreement of 70% or more. Panellists reached consensus on 11 major criteria for referral: severe physical symptoms, severe emotional symptoms, request for hastened death, spiritual or existential crisis, assistance with decision making or care planning, patient request for referral, delirium, spinal cord compression, brain or leptomeningeal metastases, within 3 months of advanced cancer diagnosis for patients with median survival of 1 year or less, and progressive disease despite second-line therapy. Consensus was also reached on 36 minor criteria for specialist palliative-care referral. These criteria, if validated, could provide guidance for identification of patients suitable for outpatient specialty palliative care.

The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

“…NRS ≥7/10, agreement 97%). (128) These ESAS cutoffs may vary somewhat at each institution by the resource availability of specialty palliative care and the level of interest among oncologists to provide basic symptom management. (129, 130) Importantly, any automatic referral should complement rather than override clinician judgement.…”

“…A recent international consensus identified severe symptom distress as a criteria for palliative care referral, although this threshold may need to be refined at each institution. (128)…”

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

“…Similarly, the ideal timing for referral was within 3 months of diagnosis of advanced cancer if patients had a median survival of 1 year or less, had progressed through at least a single line of systemic therapy, and had an Eastern Cooperative Oncology Group performance of 2 or greater (Fig. ) . A survey asked patients with advanced cancer who were referred to outpatient palliative care about their opinion regarding the optimal timing of referral .…”

“…Referral based on patient care needs also is supported by the findings from a 2016 international consensus panel. After 3 rounds of deliberation, a panel of 60 experts reached consensus on 11 major criteria for referral to outpatient palliative care . Patients who met any one of the criteria would be appropriate for referral.…”

“…One approach to determining the right time involves a Delphi consensus. 69 In one study, 60 international experts were asked about the appropriate time to refer patients with advanced cancer to outpatient palliative care. A consensus was defined a priori, with at least 70% of experts reaching agreement.…”