Center to Advance Palliative Care

Local circumstances appear to dictate the answer to your question. I do not know of any programs that require a palliative care consult for every hospice patient(or potential hospice patient). However, if a patient's eligibility for or acceptance of hospice is unclear, either a palliative care or a pre-hospice consult may be appropriate.

In several sites with which we are familar, physicians who assume both palliative care and hospice roles have done a fine job educating referral sources about when and how best to use them by being readily available, clear about the benefits and constraints of both the palliative care and hospice service models, and willing to accept referrals for either/both. For example, when a referring doctor is hospice-averse or unclear about a patient/family's goals of care, a pallative care consult often works well and may or may not ulitmately lead to a hospice transition. Or when a hospice referral is made but the patient is either not eligible or does not chose to elect hospice care, palliative care may be the most appropriate intervention. Or - as is often the case, a palliative care provider can help facilitate the hospice choice when it is the best option.

The combination of roles you describe presents yout physicians with a unique opportnity to encourage/support decision-making focused on getting the right care to the right patient at the right time.

I have not seen guidelines specific to these circumstance. However, other resondents may have language to share.

Amber B. Jones
CAPC Hospice Liaison Consultant