Following is guidance on when to refer patients with COVID-19 or pre-existing serious illnesses for specialty palliative care.

COVID-19 Criteria

  • Pre-existing palliative care patient
  • Symptoms refractory to palliative symptom protocols
  • On ventilatory support
  • Difficult-to-control emotional symptoms
  • Patient, family, or physician uncertainty regarding prognosis
  • Patient, family, or physician uncertainty regarding non-beneficial treatment options
  • Patient or family psychological or spiritual/existential distress
  • Patient or family request

General Referral Criteria

Presence of a serious illness and one or more of the following:

  • New diagnosis of life-limiting illness for symptom control, patient/family support
  • Declining ability to complete activities of daily living
  • Weight loss
  • Progressive metastatic cancer
  • Admission from long-term care facility (nursing home or assisted living)
  • Two or more hospitalizations for illness within three months
  • Difficult-to-control physical or emotional symptoms
  • Patient, family, or physician uncertainty regarding prognosis
  • Patient, family, or physician uncertainty regarding appropriateness of treatment options
  • Family request for non-beneficial treatments or therapies
  • DNR order conflicts
  • Conflicts or uncertainty regarding the use of non-oral feeding/hydration in cognitively impaired, patients over 65, seriously ill, or dying patients
  • Limited social support in setting of a serious illness (e.g., homeless, no family or friends, chronic mental illness, overwhelmed family caregivers)
  • Patient, family, or physician request for information regarding hospice appropriateness
  • Patient or family psychological or spiritual/existential distress
  • Palliative Performance Scale of 60 or less

Cancer Criteria

Presence of any of the above, and/or:

  • Metastatic or locally advanced cancer progressing despite systemic treatments
  • Karnofsky < 50 or ECOG > 3
  • Brain metastases, spinal cord compression, or neoplastic meningitis
  • Malignant hypercalcemia
  • Progressive pleural/peritoneal or pericardial effusions

Neurological Criteria

Presence of any of the above, and/or:

  • Folstein Mini Mental score < 20
  • Feeding tube is being considered for any neurological condition
  • Status Epilepticus > 24 hrs
  • ALS or other neuromuscular disease and/or decision surrounding mechanical ventilation
  • Any recurrent brain neoplasm
  • Parkinson’s disease with poor functional status or dementia
  • Advanced dementia with dependence in all activities of daily living