Article Text
Abstract
Objective People with advanced chronic obstructive pulmonary disease (COPD) have substantial palliative care needs, but uncertainty exists around appropriate identification of patients for palliative care referral.
We conducted a Delphi study of international experts to identify consensus referral criteria for specialist outpatient palliative care for people with COPD.
Methods Clinicians in the fields of respiratory medicine, palliative and primary care from five continents with expertise in respiratory medicine and palliative care rated 81 criteria over three Delphi rounds. Consensus was defined a priori as ≥70% agreement. A criterion was considered ‘major’ if experts endorsed meeting that criterion alone justified palliative care referral.
Results Response rates from the 57 panellists were 86% (49), 84% (48) and 91% (52) over first, second and third rounds, respectively. Panellists reached consensus on 17 major criteria for specialist outpatient palliative care referral, categorised under: (1) ‘Health service use and need for advanced respiratory therapies’ (six criteria, eg, need for home non-invasive ventilation); (2) ‘Presence of symptoms, psychosocial and decision-making needs’ (eight criteria, eg, severe (7–10 on a 10 point scale) chronic breathlessness); and (3) ‘Prognostic estimate and performance status’ (three criteria, eg, physician-estimated life expectancy of 6 months or less).
Conclusions International experts evaluated 81 potential referral criteria, reaching consensus on 17 major criteria for referral to specialist outpatient palliative care for people with COPD. Evaluation of the feasibility of these criteria in practice is required to improve standardised palliative care delivery for people with COPD.
- Palliative Care
- Referral and Consultation
Data availability statement
Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (JP), upon reasonable request.
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Data availability statement
Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (JP), upon reasonable request.
Footnotes
Correction notice This article has been corrected since it was published Online First. An author's affilation has been amended.
Contributors JP was the guarantor of this article. JP and AC had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. JP, AC, DH and YKC were responsible for study conception design and development of the study protocol. All authors (JP, AC, DH, YKC, NS, DRS, BPY, RM, ME, IAY, CFMcD, MM, PP-C, DMGH, S-YC) were responsible for survey development, testing, data collection and interpretation. All authors (JP, AC, DH, YKC, NS, DRS, BPY, RM, ME, IAY, CFMcD, MM, PP-C, DMGH, S-YC) were involved in writing and final approval of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The views expressed in this article are those of the authors and do not necessarily represent the views of the US Department of Veterans Affairs or the US government.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.