October 2024
Palliative care referral for people with COPD: consensus criteria developed
By Rebecca Jenkins
A global expert group has defined a set of consensus criteria to identify people with chronic obstructive pulmonary disease (COPD) who would benefit from specialist outpatient palliative care.
People with advanced COPD and their carers had substantial palliative care needs, but referral to palliative care services tended to be infrequent and delayed, the international expert panel wrote in Thorax.
The group of 57 leaders in the fields of respiratory medicine and palliative and primary care collated existing evidence and then used a Delphi approach of iterative assessments to reach consensus on 17 major criteria, each of which should prompt referral to specialist outpatient palliative care.
Most of the criteria related to psychosocial distress or health service use and some to physician estimate of prognosis/function, the experts noted.
The criteria closely mirrored the triggers for referral to palliative care specialist clinicians suggested in recent European and US guidelines, they added, including refractory severe breathlessness, need for lung transplantation assessment, intensive care unit admission, and unmet physical, psychological, social or spiritual needs.
However, the panellists also identified novel criteria, such as caregiver distress, a request for a hastened death/assisted suicide, poor performance status and physician estimated prognosis of six months or less. They also agreed on 30 minor criteria, which should prompt referral if present in combination with one other minor criterion.
‘The development of these consensus criteria represents the first step towards improving the standardisation of clinical care, offering an important foundation towards reducing variation in palliative care access, and hence improving equity for people with COPD,’ the experts wrote.
‘Evaluation of the feasibility of these criteria in practice is required to improve standard ised palliative care delivery for people with COPD.’
Study panellist Professor Christine McDonald, Professor of Respiratory Medicine at the University of Melbourne, said there was a clear need to provide more palliative care to patients with advanced COPD.
‘The criteria could be used in practice now, but this is a first step towards standardisa tion of clinical care, and ideally these criteria for referral will be refined over time,’ she told Medicine Today.
Professor McDonald, who is also Director of the Department of Respiratory and Sleep Medicine at Austin Hospital, Melbourne, added there was an important role for the GP, as the patient’s primary point of call, in referring for palliative care and it was vital there was dialogue between them, the patient and the treating physician.
‘In our hospital, GPs can refer directly to a “Hospital at Risk” program where a range of clinicians see patients with severe disease or multiple comorbidities, and they can refer direct to palliative care in the community and/or the hospital,’ she said.
‘What we don’t have, as yet, is an integrated respiratory/ palliative care outpatient clinic, which I think would be an advantage.’