Referral criteria for outpatient specialty palliative cancer care: an international consensus
Although outpatient specialty palliative-care clinics improve outcomes, there is no consensus on who should be referred or the optimal timing for referral. In response to this issue, we did a Delphi study to develop consensus on a list of criteria for referral of patients with advanced cancer at sec...
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| Published in: | The lancet oncology Vol. 17; no. 12; pp. e552 - e559 |
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| Main Authors: | , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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England
Elsevier Ltd
01.12.2016
Elsevier Limited |
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| ISSN: | 1470-2045, 1474-5488 |
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| Abstract | Although outpatient specialty palliative-care clinics improve outcomes, there is no consensus on who should be referred or the optimal timing for referral. In response to this issue, we did a Delphi study to develop consensus on a list of criteria for referral of patients with advanced cancer at secondary or tertiary care hospitals to outpatient palliative care. 60 international experts (26 from North America, 19 from Asia and Australia, and 11 from Europe) on palliative cancer care rated 39 needs-based criteria and 22 time-based criteria in three iterative rounds. Nearly all experts responded in each round. Consensus was defined by an a-priori agreement of 70% or more. Panellists reached consensus on 11 major criteria for referral: severe physical symptoms, severe emotional symptoms, request for hastened death, spiritual or existential crisis, assistance with decision making or care planning, patient request for referral, delirium, spinal cord compression, brain or leptomeningeal metastases, within 3 months of advanced cancer diagnosis for patients with median survival of 1 year or less, and progressive disease despite second-line therapy. Consensus was also reached on 36 minor criteria for specialist palliative-care referral. These criteria, if validated, could provide guidance for identification of patients suitable for outpatient specialty palliative care. |
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| AbstractList | Although outpatient specialty palliative-care clinics improve outcomes, there is no consensus on who should be referred or the optimal timing for referral. In response to this issue, we did a Delphi study to develop consensus on a list of criteria for referral of patients with advanced cancer at secondary or tertiary care hospitals to outpatient palliative care. 60 international experts (26 from North America, 19 from Asia and Australia, and 11 from Europe) on palliative cancer care rated 39 needs-based criteria and 22 time-based criteria in three iterative rounds. Nearly all experts responded in each round. Consensus was defined by an a-priori agreement of 70% or more. Panellists reached consensus on 11 major criteria for referral: severe physical symptoms, severe emotional symptoms, request for hastened death, spiritual or existential crisis, assistance with decision making or care planning, patient request for referral, delirium, spinal cord compression, brain or leptomeningeal metastases, within 3 months of advanced cancer diagnosis for patients with median survival of 1 year or less, and progressive disease despite second-line therapy. Consensus was also reached on 36 minor criteria for specialist palliative-care referral. These criteria, if validated, could provide guidance for identification of patients suitable for outpatient specialty palliative care. Summary Although outpatient specialty palliative-care clinics improve outcomes, there is no consensus on who should be referred or the optimal timing for referral. In response to this issue, we did a Delphi study to develop consensus on a list of criteria for referral of patients with advanced cancer at secondary or tertiary care hospitals to outpatient palliative care. 60 international experts (26 from North America, 19 from Asia and Australia, and 11 from Europe) on palliative cancer care rated 39 needs-based criteria and 22 time-based criteria in three iterative rounds. Nearly all experts responded in each round. Consensus was defined by an a-priori agreement of 70% or more. Panellists reached consensus on 11 major criteria for referral: severe physical symptoms, severe emotional symptoms, request for hastened death, spiritual or existential crisis, assistance with decision making or care planning, patient request for referral, delirium, spinal cord compression, brain or leptomeningeal metastases, within 3 months of advanced cancer diagnosis for patients with median survival of 1 year or less, and progressive disease despite second-line therapy. Consensus was also reached on 36 minor criteria for specialist palliative-care referral. These criteria, if validated, could provide guidance for identification of patients suitable for outpatient specialty palliative care. |
| Author | Strasser, Florian Saarto, Tiina Kaasa, Stein Watanabe, Sharon M Hui, David Cherny, Nathan Caraceni, Augusto Glare, Paul Mori, Masanori Bruera, Eduardo |
| Author_xml | – sequence: 1 givenname: David surname: Hui fullname: Hui, David email: dhui@mdanderson.org organization: Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA – sequence: 2 givenname: Masanori surname: Mori fullname: Mori, Masanori organization: Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan – sequence: 3 givenname: Sharon M surname: Watanabe fullname: Watanabe, Sharon M organization: Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada – sequence: 4 givenname: Augusto surname: Caraceni fullname: Caraceni, Augusto organization: Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy – sequence: 5 givenname: Florian surname: Strasser fullname: Strasser, Florian organization: Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St Gallen, Switzerland – sequence: 6 givenname: Tiina surname: Saarto fullname: Saarto, Tiina organization: Department of Palliative Care, Helsinki University Central Hospital, Cancer Center, Helsinki, Finland – sequence: 7 givenname: Nathan surname: Cherny fullname: Cherny, Nathan organization: Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel – sequence: 8 givenname: Paul surname: Glare fullname: Glare, Paul organization: Pain and Palliative Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA – sequence: 9 givenname: Stein surname: Kaasa fullname: Kaasa, Stein organization: European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway – sequence: 10 givenname: Eduardo surname: Bruera fullname: Bruera, Eduardo organization: Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27924753$$D View this record in MEDLINE/PubMed |
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| Snippet | Although outpatient specialty palliative-care clinics improve outcomes, there is no consensus on who should be referred or the optimal timing for referral. In... Summary Although outpatient specialty palliative-care clinics improve outcomes, there is no consensus on who should be referred or the optimal timing for... |
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| SubjectTerms | Agreements Cancer Clinical medicine Consensus Delphi Technique Hematology, Oncology and Palliative Medicine Hospice care Humans Interdisciplinary aspects Likert scale Medical prognosis Medicine Neoplasms - therapy Oncology Outpatients Palliative Care Patients Referral and Consultation |
| Title | Referral criteria for outpatient specialty palliative cancer care: an international consensus |
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