Palliative Care Referral Criteria: COVID-19 Context
Following is guidance on when to refer patients with COVID-19 or pre-existing serious illnesses for specialty palliative care.
COVID-19 Criteria
- Pre-existing palliative care patient
- Symptoms refractory to palliative symptom protocols
- On ventilatory support
- Difficult-to-control emotional symptoms
- Patient, family, or physician uncertainty regarding prognosis
- Patient, family, or physician uncertainty regarding non-beneficial treatment options
- Patient or family psychological or spiritual/existential distress
- Patient or family request
General Referral Criteria
Presence of a serious illness and one or more of the following:
- New diagnosis of life-limiting illness for symptom control, patient/family support
- Declining ability to complete activities of daily living
- Weight loss
- Progressive metastatic cancer
- Admission from long-term care facility (nursing home or assisted living)
- Two or more hospitalizations for illness within three months
- Difficult-to-control physical or emotional symptoms
- Patient, family, or physician uncertainty regarding prognosis
- Patient, family, or physician uncertainty regarding appropriateness of treatment options
- Family request for non-beneficial treatments or therapies
- DNR order conflicts
- Conflicts or uncertainty regarding the use of non-oral feeding/hydration in cognitively impaired, patients over 65, seriously ill, or dying patients
- Limited social support in setting of a serious illness (e.g., homeless, no family or friends, chronic mental illness, overwhelmed family caregivers)
- Patient, family, or physician request for information regarding hospice appropriateness
- Patient or family psychological or spiritual/existential distress
- Palliative Performance Scale of 60 or less
Cancer Criteria
Presence of any of the above, and/or:
- Metastatic or locally advanced cancer progressing despite systemic treatments
- Karnofsky < 50 or ECOG > 3
- Brain metastases, spinal cord compression, or neoplastic meningitis
- Malignant hypercalcemia
- Progressive pleural/peritoneal or pericardial effusions
Neurological Criteria
Presence of any of the above, and/or:
- Folstein Mini Mental score < 20
- Feeding tube is being considered for any neurological condition
- Status Epilepticus > 24 hrs
- ALS or other neuromuscular disease and/or decision surrounding mechanical ventilation
- Any recurrent brain neoplasm
- Parkinson’s disease with poor functional status or dementia
- Advanced dementia with dependence in all activities of daily living