Automatic referral to standardize palliative care access: an international Delphi survey
- 800 Downloads
Palliative care referral is primarily based on clinician judgment, contributing to highly variable access. Standardized criteria to trigger automatic referral have been proposed, but it remains unclear how best to apply them in practice. We conducted a Delphi study of international experts to identify a consensus for the use of standardized criteria to trigger automatic referral.
Sixty international experts stated their level of agreement for 14 statements regarding the use of clinician-based referral and automatic referral over two Delphi rounds. A consensus was defined as an agreement of ≥70% a priori.
The response rate was 59/60 (98%) for the first round and 56/60 (93%) for the second round. Twenty-six (43%), 19 (32%), and 11 (18%) respondents were from North America, Asia/Australia, and Europe, respectively. The panel reached consensus that outpatient palliative care referral should be based on both automatic referral and clinician-based referral (agreement = 86%). Only 18% felt that referral should be clinician-based alone, and only 7% agreed that referral should be based on automatic referral only. There was consensus that automatic referral criteria may increase the number of referrals (agreement = 98%), facilitate earlier palliative care access, and help administrators to set benchmarks for quality improvement (agreement = 86%).
Our panelists favored the combination of automatic referral to augment clinician-based referral. This integrated referral framework may inform policy and program development.
KeywordsCritical pathways Delphi technique Neoplasms Outpatients Palliative care Referral and consultation Standards
Compliance with ethical standards
This study is partly supported by a grant from the Multinational Association of Supportive Care in Cancer. D.H. is supported in part by a National Institutes of Health grant (R21CA186000-01A1), an American Cancer Society Mentored Research Scholar Grant in Applied and Clinical Research (MRSG-14-1418-01-CCE), and an Andrew Sabin Family Foundation Fellowship. We would like to thank all the Delphi panel participants for their expert input.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Adelson K, Paris J, Smith CB, Horton J, Morrison SR (2013) Standardized criteria for required palliative care consultation on the solid tumor oncology service. In: Editor (ed)^(eds) Book standardized criteria for required palliative care consultation on the solid tumor oncology service. J Clin Oncol, City, pp. Abstact 37Google Scholar
- 2.Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, Hull JG, Li Z, Tosteson TD, Byock IR, Ahles TA (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 302(7):741–749CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Board IOMNCP (2001) Improving palliative care for cancer. Institute of Medicine, Washington, DCGoogle Scholar
- 4.Calton BA, Alvarez-Perez A, Portman DG, Ramchandran KJ, Sugalski J, Rabow MW (2016) The current state of palliative care for patients cared for at leading US cancer centers: the 2015 NCCN Palliative Care Survey J Natl Compr Cancer Netw 14(7): 859–866Google Scholar
- 5.Doorenbos AZ, Starks H, Bourget E, McMullan DM, Lewis-Newby M, Rue TC, Lindhorst T, Aisenberg E, Oman N, Curtis JR, Hays R, Clark JD, Baden HP, Brogan TV, Di Gennaro JL, Mazor R, Roberts JS, Turnbull J, Wilfond BS (2013) Examining palliative care team involvement in automatic consultations for children on extracorporeal life support in the pediatric intensive care unit. J Palliat Med 16(5):492–495CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Hui D, Titus A, Curtis T, Ho-Nguyen VT, Frederickson D, Wray C, Granville T, Bruera E, McKee DK, Rieber A (2017) Implementation of the Edmonton symptom assessment system for symptom distress screening at a community cancer center: a pilot program. Oncologist. doi: 10.1634/theoncologist.2016-0500
- 13.Levy MH, Smith T, Alvarez-Perez A, Back A, Baker JN, Beck A, Block S, Dalal S, Dans M, Fitch TR, Kapo J, Kutner J, Kvale E, Misra S, Mitchell W, Portman DG, Sauer TM, Spiegel D, Suzumilowicz E, Taylor RM, Temel J, Tickoo R, Urba SG, Weinstein SM, Zachariah F (2016) NCCN clinical practice guidelines in oncology. Palliative care. In: Editor (ed)^(eds) Book NCCN Clinical Practice Guidelines in Oncology. Palliative Care. National Comprehensive Cancer Network, CityGoogle Scholar
- 16.Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, Ferrell BR, Loscalzo M, Meier DE, Paice JA, Peppercorn JM, Somerfield M, Stovall E, Von Roenn JH (2012) American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol 30(8):880–887CrossRefPubMedGoogle Scholar