Timely Palliative Care: Personalizing the Process of Referral

Abstract

Timely palliative care is a systematic process to identify patients with high supportive care needs and to refer these individuals to specialist palliative care in a timely manner based on standardized referral criteria. It requires four components: (1) routine screening of supportive care needs at oncology clinics, (2) establishment of institution-specific consensual criteria for referral, (3) a system in place to trigger a referral when patients meet criteria, and (4) availability of outpatient palliative care resources to deliver personalized, timely patient-centered care aimed at improving patient and caregiver outcomes. In this review, we discuss the conceptual underpinnings, rationale, barriers and facilitators for timely palliative care referral. Timely palliative care provides a more rational use of the scarce palliative care resource and maximizes the impact on patients who are offered the intervention. Several sets of referral criteria have been proposed to date for outpatient palliative care referral. Studies examining the use of these referral criteria consistently found that timely palliative care can lead to a greater number of referrals and earlier palliative care access than routine referral. Implementation of timely palliative care at each institution requires oncology leadership support, adequate palliative care infrastructure, integration of electronic health record and customization of referral criteria.

Keywords: access and evaluation; delivery of health care; health care quality; hospital; implementation; outpatient clinics; palliative care; patient-centered care; psychological distress; randomized controlled trial; referral and consultation; supportive care; symptom assessment.

Figure 1

Conceptual model for timely palliative care. Timely palliative care has four key components: routine systematic screening, a defined set of referral criteria, a mechanism to trigger referral for appropriate patients, and an adequately staffed outpatient specialist palliative care clinic. The expected outcome is a greater number of patients receiving specialist palliative care and earlier timing of referral, which would lead to improved patient outcomes such as quality of life, quality of end-of-life care, and possibly survival.

Figure 2

Barriers and facilitators to timely palliative care referral. Currently, there is much heterogeneity with respect to how patients with advanced cancer are being referred to specialist palliative care, resulting in low rates of referral and delayed consultations. Timely palliative care is a systematic process that is specifically designed to overcome some of the common barriers to early referral.