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

  • Alzheimer's disease

  • ALS

  • Cancer

  • Chronic Obstructive Pulmonary Disease (COPD)

  • Dementia

  • Heart disease (CHF, CAD)

  • HIV/AIDS

  • Liver or kidney disease

  • Multiple Sclerosis

  • Parkinson's disease

  • Progressive Neurological Disease

  • Sickle Cell Anemia

  • Stroke/CVA

  • Genetic disorders

  • Other chronic life-limiting diseases, with disabling pain is an appropriate referral.

Declining ability to complete activities of daily living

  • Generalized debility

  • Chronic uncontrolled pain

  • Difficulty attending doctors visits

  • Multiple hospitalizations

  • Difficult to control physical or emotional symptoms related to serious medical illness

  • Patient, family or physician uncertainty regarding prognosis or goals of care

  • Use of tube feeding or TPN in cognitively impaired or seriously ill patients

  • Limited social support and a serious illness (e.g., homeless, chronic mental illness)

  • Patient, family or physician request for information regarding hospice appropriateness

  • 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.

 

  • Karnofsky < 50 or ECOG > 3

  • Progressive brain metastases following radiation

  • New spinal cord compression or neoplastic meningitis

  • Malignant hypercalcemia

  • Progressive pleural/peritoneal or pericardial effusions

  • Failure of first – or second-line chemotherapy

  • Multiple painful bone metastases

  • Consideration of interventional pain management procedures

  • Severe prolonged pancytopenia in the context of an untreatable hematological problem (e.g., relapsed leukemia)