Criteria for referral to a hospital palliative care team in a cancer setting: a Delphi study of oncologists

Providing palliative care alongside cancer treatments enhances the quality of life and satisfaction with care for patients with cancer and their families. Determining the timing of referral can often be challenging, as oncologists typically make these decisions. We conducted a Delphi study to establish criteria for referring patients to hospital palliative care teams (HPCT). Eighty-five oncologists were presented with 22 criteria developed from literature synthesis, categorised into seven domains, for referral to HPCT. Consensus development was predetermined, with a score of ≥ 7, as agreed upon by over 80% of the participants. In the first round, 63 out of 85 participants (74%) responded, and in the second round, 41 out of 63 (65%) responded. During the initial round, consensus was reached on 14 out of 22 statements. Six statements were dropped, and two were revised for the next round. The final 14 criteria for HPCT referral were consolidated into ten criteria across five domains: (1) Cancer-related (stage 4 cancer, life expectancy of less than six months), (2) Treatment-related (failed two or more lines of treatment), (3) Symptom-related (ECOG ≥ 3, multiple symptoms including pain and comorbidities affecting patient quality of life, with scores of four or higher on the distress thermometer), (4) Patient preferences (requested palliative care, refused cancer-directed treatment, requested limitation of life-sustaining treatment), and (5) End-of-life care (perceived need for end-of-life care planning). Developing a palliative care referral criterion provides a structured foundation for identifying cancer patients who might benefit from HPCT referral. Additional empirical validation is required to improve its clinical relevance and outcomes.