Patient Guidelines for Palliative Care

Palliative medicine is specialized medical care for people with serious illnesses. It provides patients with relief from the symptoms, pain and stress of a serious illness—whatever the diagnosis.

Here are some of the guidelines to determine if your patient could benefit from palliative care.

Team, patient and/or family needs help with complex decision-making and determination of goals of care:

  • Uncertainty of prognosis
  • Uncertainty of appropriateness of therapy options
  • Uncertainty of end-of-life status and/or hospice appropriateness

Conflicts over care exist:

  • Patient and/or family request care that team feels is “futile”
  • DNR order conflicts
  • Conflict over use of artificial nutrition and hydration in cognitively impaired, seriously ill or dying patient
  • Family distress impairing surrogate decision-making

Presence of threshold situation predictive of further deterioration:

  • New diagnosis of life-limiting illness
  • Declining function with decreased ability to complete activities of daily living
  • Unrelenting, unexplained weight loss
  • Hospital admission from long term care facility

Patient has unacceptable and uncontrolled symptoms for >24 hours:

  • Pain
  • Dyspnea
  • Delirium
  • Nausea
  • Emotional or spiritual suffering or distress

Hospital/emergency department admissions:

  • Patient has presented to the emergency department more than once in one month for the same diagnosis
  • Patient has had >2 hospital admissions within 3 months for the same diagnosis
  • Patient has a hospital stay of >5 days without evidence of clinical improvement
  • Patient has prolonged ICU stay, or >2 ICU transfers on same admission, without evidence of clinical improvement
  • Patient in ICU setting with multiorgan failure

Ventilators:

  • Prolonged or failed attempt to wean from ventilator
  • Consideration of rapid weaning from ventilator with expected patient death
  • Consideration of transfer of ventilator-dependent patient to long-term ventilation facility

Other clinical guidelines that could prompt a palliative care consultation:

  • Metastatic cancer with failure of multiple regimens of treatment
  • Neurologic complications of cancer
    • Brain metastases
    • Spinal cord compression
    • Carcinomatous meningitis
  • Advanced lung disease with frequent exacerbations
  • Advanced cardiac disease requiring consideration of LVAD or IV pressors
  • Advanced renal disease with deterioration despite dialysis
  • Neurodegenerative disease considering feeding tubes or ventilator support
  • Anoxic encephalopathy
  • Stroke with resultant function decreased by 50 percent, considered life-limiting
  • Catastrophic multiple trauma

Learn if VITAS can help you care for your patient.

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