Palliative Care Clinical Guideline
Definition : Palliative Medicine is specialized medical care for people living with serious illnesses . Regardless of the diagnosis , the focus is on providing patients with relief from the symptoms and stress of a serious illness . The goal is to improve quality of life for both the patient and the family . Palliative care is provided by a team comprised of doctors , nurses , and other skilled care providers who work with a patient ' s other doctors to provide an extra layer of support . Palliative care is appropriate at any age and at any stage in a serious illness , and can be provided together with curative treatments .
Patient presents with advanced illness conditions , such as :
· Patients with one or more major life threatening conditions
· Cancer ( progressing despite therapy or no therapy )
· CHF ( stage 4 , symptoms at rest or dobutamine or milrinone dependent )
· COPD ( with > 2 hospitalizations or previous ICU stay in prior 6 months )
· HIV + lymphoma
· Cirrhosis with recurring or progressive ascites requiring increase need for paracentesis
· Amyotrophic Lateral Sclerosis ( ALS )
· End Stage Renal Disease with intolerance or considering discontinuing dialysis ( burden outweighs benefit )
· Alzheimer ’ s disease with pneumonia / other sepsis = 1 > hospitalization in past 3 months
· Progressive organ failure
Evaluate for Signs of Decline as defined by following criteria :
· 2 or more hospitalization / or 6 Emergency Department ( ED ) visits in the last 12 months or
· 2 hospitalization or ED visits in the last 6 months or
· Progressive and significant decline in one or more Activities of Daily Living ( ADLs ), such as bathing , continence , dressing , eating , toileting , transferring or
· Nutritional decline indicated by albumin < 3g / d or 5 % weight loss over 6 months or
· For cancer , second-line chemotherapy agent
Additional Criteria :
· In or history of Nursing Home care
· Past Hospice enrollee
· Awaiting or ineligible for solid organ transplant or failed transplant
· Patient , family or physician uncertainty regarding prognosis
· Patient or family requests for futile care
· Patient , family or physician request information regarding hospice appropriateness
· Advance Care Planning and Goals of Care Discussions .
No
No Palliative Care Referral
Additional validation :
· Palliative Performance Score ( PPS ) < 60 ( page4 )
· Karnofsky Performance Status ( KPS ) < 60 ( page 3 )
No
Does the patient meet the criteria ?
Does the patient meet the additional criteria ?
Yes
Additional validation :
· Would you be surprised if the patient died in the next 12 month ?
Yes
No
Yes
Yes
Refer Patient to Palliative Care
* This guideline will provide recommendations for initiating steps in the outpatient setting to address patients with progressive or recurrent advanced illness or chronic debilitating conditions as well as provide criteria to warrant specially palliative service consultation . Benefits of palliative service consultation may include discussion of available resources for improved patient care .
March 2017