• J Pain Symptom Manage · Nov 2023

    Referral Criteria to Specialist Palliative Care for People with Advanced Chronic Kidney Disease: A Systematic Review.

    • Anna Collins, David Hui, Sara N Davison, Kathryn Ducharlet, Fliss Murtagh, Yuchieh Kathryn Chang, and Jennifer Philip.
    • Department of Medicine (A.C., K.D., J.P.), St Vincent's Hospital, University of Melbourne, Australia.
    • J Pain Symptom Manage. 2023 Nov 1; 66 (5): 541550.e1541-550.e1.

    ContextPeople with advanced chronic kidney disease (CKD) have significant morbidity, yet for many, access to palliative care occurs late, if at all.ObjectivesThis study sought to examine criteria for referral to specialist palliative care for adults with advanced CKD with a view to improving use of these essential services.MethodsSystematic review of studies detailing referral criteria to palliative care in advanced CKD conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline and registered (PROSPERO: CRD42021230751).Data SourcesElectronic databases (Ovid, MEDLINE, Ovid Embase, and PubMed) were used to identify potential studies, which were subjected to double review, data extraction, thematic coding, and descriptive analyses.ResultsSearches yielded 650 unique titles ultimately resulting in 56 studies addressing referral criteria to specialist palliative care in advanced CKD. Of 10 categories of referral criteria, most commonly discussed were: Critical times of treatment decision making (n = 23, 41%); physical or emotional symptoms (n = 22, 39%); limited prognosis (n = 18, 32%); patient age and comorbidities (n = 18, 32%); category of CKD/ biochemical criteria (n = 13, 23%); functional decline (n = 13, 23); psychosocial needs (n = 9, 16%); future care planning (n = 9, 16%); anticipated decline in illness course (n = 8, 14%); and hospital use (n = 8, 14%).ConclusionClinicians consider referral to specialist palliative care for a wide range of reasons, with many related to care needs. As palliative care continues to integrate with nephrology, our findings represent a key step towards developing consensus criteria to standardize referral for patients with chronic kidney diseases.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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