Table 5 Proposed Referral Criteria for PC for Patients with Cancer and Heart Failure

Cancer

Heart

failure

Need-based criteria

Anxiety (severe)

(H)

Ng

Assistance with decision making or care planning

Brain or leptomeningeal metastases

Caregiving needs (family, caregiver limitations)

(G, GL, N, S)

Ha

Cognitive impairment

Communication barriers (language, physical)

(GL)

Deteriorating symptoms even with optimal therapy

(Ha)

Do-not-resuscitate order

Ha

Dyspnea (severe)

A, G

E

Fatigue (severe)

(S, G)

(Ng)

Financial hardship

Health system and informational needs

History of drug or alcohol abuse

Inadequate social support

Moderate to severe distress, delirium, depression

(A, H, G, GL, N,

S)

(Gr,

Ng)

Multiple adverse reactions to pain and symptom

management interventions

Older age (> 75 years)

(Gr)

Pain (including neuropathic)

Patient request for referral

Psychological distress/needs

Psychiatric disorder

Rapid escalation of opioid dose

Request for hastened death

(G, GL, H)

Severe physical symptoms

(A,G, H, S, N, C)

Ha

Secondary diagnosis of Alzheimer disease

Spiritual or existential crisis

(G, S, H)

Thoracentesis (multiple and recurrent episodes)

Gr

Time-based criteria

3 months of advanced cancer diagnosis for patients with a median survival of 1 year or less (≤1.5 years expected life

span)

(A, H)

(J)

Higher severity of illness

(Gr)

Limited treatment options, especially in patients receiving phase I therapy or anticancer therapy with a palliative intent

(G)

(Ng)

Illness trajectory criteria

Health care utilization (> 2 hospital admissions within the last 6 months)

(S, A)

(Gr, Ha)

Low KCCQ score

(Gr)

Poor prognosis despite second-line therapy

(H, N)

Serious comorbid conditions (acute renal failure)

(GL, N)

(Gr)

Worse performance status (NYHA IV)