A Delphi survey of an international, multidisciplinary panel of clinicians with expertise in the care of people with dementia and palliative care has been undertaken, looking at referral critieria, which had been generated from previous systematic reviews.
There was very good response to the survey – 92.1%, 92,1% and 95.2% in the three rounds and the following criteria were agreed by consensus:
• Disease based
◦ Rapidly progressive dementia
◦ Comorbidities
▪ Withdrawal / de-escalation of life prolonging interventions, 2 or more episodes of aspiration pneumonia, feeding tube
◦ Hospital use
▪ ICU admission, 2 or more emergency room visits, 2 or more hospitalisations in last 3 months
• Needs based
◦ Symptom distress
▪ Severe physical / spiritual/ emotional / behavioural symptoms
◦ Psychosocial factors/ decision making
▪ Hospice discussion/ referral, patient or family request, patient/family decline acute care, request for hastened death
The authors plan to test and validate these criteria to develop a clearer assessment process.
Comments:
This study provides areas of assessment that may help health care professionals assess people with dementia who would benefit from specialist palliative care, so that their quality of life can be maintained and plans can be made for end of life care
Key Points:
People with dementia often have palliative care needs
Criteria have been suggested for specialist palliative care referral
criteria include type of dementia, comorbidities and symptom issues
References:
Chang YK, Philip J, van der Steen JT et al. Referral criteria for specialistic palliative care for patients with dementia. JAMA Open Network 2025; 8 (5): e2510298. Doi: 10.1001/jamanetworkopen.2025.10298.
Publish on behalf of the Scientific Panel Palliative Care.