An overwhelming lack of consensus exists on when to involve specialist palliative care in the care of people with dementia, a new review has found.
The investigators’ analysis of referral criteria from 59 published studies identified an array of reasons for referring people with dementia to specialist end-of-life care, which they classified under 13 themes.
The most commonly discussed criterion was “dementia stage,” found in 73% of articles, followed by new diagnosis of dementia, medical complications of dementia, prognosis, and physical symptoms, reported the authors.
When using dementia stage as a trigger for referrals, advanced dementia was the reason for referral in 84% of the articles. Complicating factors that triggered referral, meanwhile, were pneumonia, falls and/or fracture, and decubitus ulcers. For those who recommended prognosis as a referral trigger, the time frame varied from less than two years of life expectancy to less than six months of life expectancy.
Notably, three articles recommended the “surprise question” as a potential trigger for referral. The question,“Would I be surprised if this patient died in the next 12 months?” is sometimes used by clinicians to identify patients at high risk of death who might benefit from palliative care.
The diversity of recommendations highlights not only the many reasons to involve specialist palliative care, but an overarching need to identify timely, standardized referral triggers, the authors concluded.
“Given the growing recognition of unmet supportive and palliative care needs in patients with dementia, a set of consensual referral criteria may facilitate timely specialist palliative care referral to enhance patient and caregiver outcomes,” said senior author David Hui, M.D., MSc, of the University of Texas MD Anderson Cancer Center.
The study was published in the Journal of the American Geriatrics Society.
