For Clinicians
Is your patient appropriate for a palliative care referral? A palliative care consultation will assist you in managing complex pain, symptoms, comorbidities, patient/family communication and other issues. Palliative care teams will also save you time.
The following criteria have been developed to help you assess whether a palliative care consultation would be beneficial to you and your patient.
General Referral Criteria (one or more of the following):
Presence of a Serious, Chronic Illness
Declining ability to complete activities of daily living
Weight loss
Multiple hospitalizations
Difficult to control physical or emotional symptoms related to serious medical illness
Patient, family or physician uncertainty regarding prognosis
Patient, family or physician uncertainty regarding goals of care
Patient or family requests for futile care
DNR order conflicts
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
Intensive Care Unit Criteria
Admission from a nursing home in the setting of one or more chronic life-limiting conditions (e.g., dementia)
Two or more ICU admissions within the same hospitalization
Prolonged or difficult ventilator withdrawal
Multi-organ failure
Consideration of ventilator withdrawal with expected death
Metastatic cancer
Anoxic encephalopathy
Consideration of patient transfer to a long-term ventilator facility
Family distress impairing surrogate decision making
Oncology Criteria
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 setting of an untreatable hematological problem (e.g., relapsed leukemia)
Emergency Department Criteria
Multiple recent prior hospitalizations with same symptoms/problems
Long-term-care patient with Do Not Resuscitate (DNR) and/or Comfort Care (CC) orders
Patient previously enrolled in a home or residential hospice program
Patient/caregiver/physician desires hospice but has not been referred
Consideration of ICU admission and or mechanical ventilation in a patient
with metastatic cancer and declining function
with moderate to severe dementia
with one or more chronic diseases and poor functional status at baseline