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Original research
Consensus palliative care referral criteria for people with chronic obstructive pulmonary disease
  1. Jennifer Philip1,2,3,4,
  2. Yuchieh Kathryn Chang5,
  3. Anna Collins1,
  4. Natasha Smallwood6,7,8,
  5. Donald Richard Sullivan9,
  6. Barbara P Yawn10,
  7. Richard Mularski11,
  8. Magnus Ekström12,
  9. Ian A Yang13,14,
  10. Christine F McDonald15,
  11. Masanori Mori16,
  12. Pedro Perez-Cruz17,
  13. David M G Halpin18,
  14. Shao-Yi Cheng19,
  15. David Hui5
  1. 1 Department of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
  2. 2 Department of Medicine, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
  3. 3 Palliative Care, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
  4. 4 Department of Palliative Care, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
  5. 5 Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  6. 6 The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
  7. 7 Monash University, Clayton, Victoria, Australia
  8. 8 Alfred Hospital, Melbourne, Victoria, Australia
  9. 9 Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, USA
  10. 10 Department of Family and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
  11. 11 Kaiser Permanente Bernard J Tyson School of Medicine, Portland, Oregon, USA
  12. 12 Department of Clinical Sciences Lund Respiratory Medicine, Lund University, Lund, Sweden
  13. 13 The University of Queensland, Brisbane, Queensland, Australia
  14. 14 The Prince Charles Hospital, Chermside, Queensland, Australia
  15. 15 Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Victoria, Australia
  16. 16 Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
  17. 17 Sección de Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
  18. 18 College of Medicine and Health, University of Exeter Medical School, Exeter, UK
  19. 19 Department of Family Medicine, National Taiwan University, Taipei, Taiwan
  1. Correspondence to Professor Jennifer Philip; jphilip{at}unimelb.edu.au

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.

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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.