Conditions that may prompt palliative care planning:

Palliative care / Hospice
Debility/failure to thrive /
  • >than 3 chronic conditions in a client >75 years
  • Functional decline
  • Weight loss
  • Client/family desire for low-yield therapy
  • Increased frequency of outpatient visits, ED visits and hospitalizations
  • Assisted living/long-term care
/
  • Documentation of clinical progression of disease
  • ECOG of 3 or more
  • No desire for aggressive treatment
  • Not a candidate for aggressive treatment
  • Frequent visits to ED or hospitalizations

Cancer /
  • Uncontrolled symptoms due to cancer or treatments
  • Introduced at time of diagnosis – if disease is likely incurable
  • Introduced when disease progresses despite therapy
/
  • Any client with metastatic or inoperable cancer

Heart disease /
  • Stage III or IV heart failure despite optimal medical management
  • Angina refractory to medical or interventional management
  • Frequent ED visits or hospitalization
  • Frequent discharges from implanted defibrillators despite optimal device and antiarrhythmic management
/
  • Heart failure symptoms at rest
  • Ejection fraction <20%
  • New dysrhythmia
  • Cardiac arrest or syncope
  • Frequent ED visits for symptoms

Pulmonary disease /
  • Oxygen dependant O2 sats <88% on room air
  • Unintentional weight loss
  • Dyspnea with minimal to moderate exertion
  • Other pulmonary diagnosis, e.g., pulmonary fibrosis, pulmonary hypertension
/
  • Dyspnea at rest
  • Signs or symptoms of right sided heart failure
  • O2 sats > 88%
  • PCO2 >50
  • Unintentional weight loss

Dementia /
  • Refractory behavioral problems
  • Feeding problems-weight loss
  • Caregiver stress-support needed
  • Frequent ED visits
  • Increased concerns about safety
/
  • Unable to walk, bathe, or dress self without assistance
  • Incontinence
  • <6 intelligible words
  • Frequent ED visits

Liver disease /
  • Increase need for paracentesis for removal of ascitic fluid
  • Increased confusion-hepatic encephalopathy
  • Increased safety concerns
  • Symptomatic disease
/
  • INR greater than 5
  • Albumin less than 2.5
  • Refractory ascites
  • SBP
  • Jaundice
  • Malnutrition and muscle wasting

Renal disease /
  • Dialysis
  • Stage IV or V kidney disease
/
  • Not a candidate for dialysis
  • Creatinine clearance <15ml/ min
  • Serum creatinine >6.0

Neurological /
  • Stroke
  • Parkinson’s
  • ALS
  • MS
/
  • Frequent ED visits
  • Albumin <2.5
  • Unintentional weight loss
  • Decubitis ulcers
  • Homebound/bed confined

Resource: ICSI Health Care Guidelines: Palliative Care May 2008

LIFECAREMEDICALCENTER

POLICY & PROCEDURE

DEPARTMENT:LifeCare Palliative Care

SUBJECT:Choosing palliative care versus hospice care

Prepared by:S. Elyk-Prevost/J. Pahlen

Approved by:

Policy: It is difficult to determine whether or not a client/patient/resident is a candidate for hospice orpalliative care. Attached is a guideline to assist providers in determining which area of care is best suited for individual clients/patients/residents.

Procedure:

  1. A client/patient/resident presents with a new or established diagnosis of a progressive, debilitating, potentially life limiting illness.
  2. The care provider will evaluate the client/patient/resident’s needs, goals and wishes. The evaluation should include assessment of:
  3. Physical symptoms, does the client/patient/resident meet the criteria for palliative care or hospice?
  4. Client/patient/resident’s wishes; does the client/patient/resident want comfort care or curative care
  5. Cultural aspects of care
  6. Psychological aspect of care
  7. Social, spiritual and religious aspects of care
  8. Ethical and legal aspects of care
  9. Care of the imminently dying client/patient/resident
  10. Refer to appropriate care- palliative care or hospice

Original Date:COPIES ROUTED TO:

Reviewed/revised: