Abstract 1450P
Background
Globally, referral of cancer patients for palliative care is often patchy and delayed. A recent review synthesized the barriers to timely engagement of the palliative care team: absence of dedicated palliative teams, stigma with referral, presuppositions of oncologists, lack of clarity in referral criteria, etc. Guidelines from international societies like NCCN, WHO, ESMO may not completely apply to the Indian setting due to social differences and heterogenous health care systems. Our aim was to understand the views of our oncologists and use that to develop local referral guidelines for palliative care.
Methods
The setting was a chain of nine tertiary care private hospitals in North India. A preliminary list of 22 “Criteria for referral to Palliative Care” was created after discussing the relevant published literature and guidelines by the study team. This list was then sent to consultant oncologists (n=85) who were invited to take part in two rounds of modified Delphi method to achieve a consensus. Level of agreement to each statement was on a Likert scale of 1 “strongly disagree” to 9 “strongly agree”. Consensus was decided a priori as a score of ≥ 7 by more than 80% of the respondents.
Results
Consensus was achieved for 14 of the referral criteria in the first round. Of the remaining eight criteria, six were dropped, and two were revised and sent for the second round. Both the revised criteria in the second round did not achieve consensus. Response rates for round one was (63/ 85) 74% and round two was (41/ 85) 48%. Criteria for referral of cancer patients to palliative care include stage 4 cancer, brain or leptomeningeal disease, failed second or more lines of treatment, multiple comorbidities/symptoms affecting further cancer directed treatment/ QOL, life expectancy < 6 months, ECOG≥3, pain, high symptom burden, distress score ≥ 4/10, family/ patient’s request for palliative care, or hastened death, refusal to treatment and patients requiring end of life care planning.
Conclusions
Using the modified Delphi method, we achieved consensus among our oncologists on the criteria for referral to palliative care. These would now be part of institutional guidelines and would initiate discussions for appropriate palliative care referrals.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.