Identifying automatic criteria for specialist pediatric palliative care referrals in oncology: a scoping review

The early integration of specialized pediatric palliative care (SPPC) is an accepted standard in pediatric oncology. However, many children are referred to SPPC services late in their cancer journey or not at all. Adult oncology studies suggest that the implementation of lists of automatic referral criteria can be effective in prompting timely palliative care referrals. We sought to identify, describe and compare criteria in the existing pediatric research literature that can be used to prompt SPPC referrals for children with cancer. We conducted a scoping review that included a comprehensive literature search of OVID MEDLINE®, Embase, CINAHL and Web of Science databases from 2010 to June 2023. We included studies describing the development, implementation or assessment of lists of criteria or screening scales; qualitative studies or surveys describing perspectives on referral criteria; and palliative care program descriptions or reports that provided referral criteria. Studies were excluded if the population was exclusively older than 19 years, the article was unavailable in English or criteria were not published in English. Pairs of reviewers screened articles and extracted data. We extracted lists of individual criteria and selected criteria that were included in screening scales. We then used a thematic approach to describe and group criteria. We included 30 publications. We identified 35 criteria that were published individually or as part of screening scales. We compared criteria and grouped them into seven thematic categories: diagnosis-related (e.g. metastatic cancer diagnosis), prognosis-related (e.g. relapsed disease), complication-related (e.g. multi-organ failure), therapy-related (e.g. phase I study enrollment), symptom-related (e.g. uncontrolled symptoms), psychosocial (e.g. poor coping) and care-provision-related criteria (e.g. need for home care). We collated a comprehensive list of SPPC referral criteria relevant to children with cancer. This list can inform the development of SPPC referral guidelines for children with cancer to ensure SPPC access is timely and equitable.