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 may indicate the need for a referral to the palliative care team:
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
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-line 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
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
