Indications for Palliative Care Referral
Is your patient appropriate for a palliative care referral? Palliative care is holistic care based strictly on need, not prognosis. A palliative care consultation will assist you in managing complex pain, symptoms, comorbidities, patient/family communication, and other issues. Palliative care can be provided in the outpatient setting, a facility, or at home. Virtual visits are also available.
The following general referral criteria have been developed to help you assess whether a palliative care consultation would be beneficial to you and your patient. One or more of the following criteria may indicate the need for referral to the palliative care team:
Overall Presence of a Serious, Chronic Illness
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Alzheimer's disease
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ALS
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Cancer
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Chronic Obstructive Pulmonary Disease (COPD)
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Dementia
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Heart disease (CHF, CAD)
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HIV/AIDS
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Liver or kidney disease
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Multiple Sclerosis
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Parkinson's disease
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Progressive Neurological Disease
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Sickle Cell Anemia
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Stroke/CVA
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Genetic disorders
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Other chronic life-limiting diseases, with disabling pain is an appropriate referral.
Declining ability to complete activities of daily living
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Generalized debility
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Chronic uncontrolled pain
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Difficulty attending doctors visits
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Multiple hospitalizations
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Difficult to control physical or emotional symptoms related to serious medical illness
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Patient, family or physician uncertainty regarding prognosis or goals of care
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Use of tube feeding or TPN in cognitively impaired or seriously ill patients
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Limited social support and a serious illness (e.g., homeless, chronic mental illness)
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Patient, family or physician request for information regarding hospice appropriateness
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Patient or family psychological or spiritual distress
Oncology Patients and Palliative Care
Consider referral at any stage of the disease for symptoms management, emotional, physical, and/or spiritual support. Hospice will not be discussed unless indicated by the patient or oncologist.
Oncology Indications:
Metastatic or locally advanced cancer progressing despite systemic treatments with or without weight loss and functional decline.
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Karnofsky < 50 or ECOG > 3
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Progressive brain metastases following radiation
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New spinal cord compression or neoplastic meningitis
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Malignant hypercalcemia
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Progressive pleural/peritoneal or pericardial effusions
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Failure of first – or second-line chemotherapy
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Multiple painful bone metastases
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Consideration of interventional pain management procedures
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Severe prolonged pancytopenia in the context of an untreatable hematological problem (e.g., relapsed leukemia)