Table 2.

Referral criteria for outpatient palliative care.

International Consensus [66]	NCCN Referral Criteria [72]
Development	Development
International Delphi consensus panel	Modified based on NCCN recommendations
Pilot tested in outpatient settings	Pilot tested in outpatient and inpatient settings
Criteria	Criteria
Severe physical symptoms (e.g., pain, dyspnea or nausea scored 7–10 on a ten-point scale) Severe emotional symptoms (e.g., depression or anxiety scored 7–10 on a ten-point scale) Request for hastened death Spiritual or existential crisis Assistance with decision making or care planning Patient request Delirium Brain or leptomeningeal metastases Spinal cord compression or cauda equina Within 3 months of diagnosis of advanced or incurable cancer for patients with median survival of 1 year or less Diagnosis of advanced cancer with progressive disease despite second-line systemic therapy (incurable)	Presence of metastatic or locally advanced cancer [2 points] Functional status score, according to ECOG performance status score [0–4 points] Presence of one or more serious complications of advanced cancer usually associated with a prognosis of <12 months (e.g., brain metastases, hypercalcemia, delirium, spinal cord compression, cachexia) [1 point] Presence of one or more serious comorbid diseases also associated with poor prognosis (e.g., moderate-severe COPD or CHF, dementia, AIDS, end stage renal failure, end stage liver cirrhosis) [1 point] Presence of palliative care problems Symptoms uncontrolled by standard approaches [1 point] Moderate to severe distress in patient or family, related to cancer diagnosis or therapy [1 point] Patient/family concerns about course of disease and decision making [1 point] Patient/family requests palliative care consult [1 point] Team needs assistance with complex decision-making or determining goals of care [1 point]
Suggested threshold for referral	Suggested threshold for referral
Presence of any criterion above would indicate a patient is appropriate for a specialist palliative care referral	A total score of ≥5 indicates a patient is appropriate for a specialist palliative care referral

Abbreviations: AIDS—advanced immunodeficiency syndrome; CHF—congestive heart failure; COPD—chronic obstructive pulmonary disease; ECOG—Eastern Cooperative Oncology Group.