Medical referral criteria for palliative care in adults: a scoping review

Abstract

Palliative care (PC) is focused on the relief of serious suffering due to severe illness. The Polish health care reimbursement system limits the access to PC to a so-called "basket" of recipients with life-limiting incurable diseases (mainly cancer), not responding to disease-modifying therapy. This scoping literature review was aimed to define the criteria of medical referral for PC in the context of the interpretation of the terms life-limiting illness and disease-modifying therapy, which may aid in increasing the number of appropriate referrals and patients receiving optimal treatment. The PubMed and Google Scholar databases (2011-2021) were searched using the following terms: referral, eligibility, admission as well as life-limiting, end-stage and palliative care. Of 790 rertrieved articles, 103 studies met the inclusion criteria. Two groups of referral criteria were found: disease- or prognosis-based and needs-based. The first group was focused on a survival prognosis of 6 to 12months, while the second encompassed the presence of severe, complex, or persistent symptoms or health problems not responding to optimal treatment. Numerous examples of disease-modifying treatments for specific advanced diseases were found. The discriminants characterizing life-limiting diseases in individual cases should preferably be used in clusters to accurately screen for PC eligibility. Equally important as limited survival prognosis is the presence of severe, complex, and persistent symptoms or problems occurring despite optimal treatment and general care. Based on the reviewed literature, the national reimbursement program should be urgently extended to cover more patients who are eligible and could benefit from specialist PC. Additionally, the importance of general PC should be universally acknowledged.