A systematic review of needs-based triggers for palliative care for early referral of older people with non-cancer conditions

Abstract

Background: Older people with non-cancer disease are less likely to be referred to palliative care services due to the inherent uncertain disease trajectory and a lack of standardised referral criteria. For older people with non-cancer conditions where prognostic estimation is unpredictable, needs-based criteria are likely more suitable. Eligibility criteria for participation in clinical trials on palliative care could inform a needs-based criteria. This review aimed to identify and synthesise eligibility criteria for trials in palliative care to construct a needs-based set of triggers for timely referral to palliative care for older people severely affected by non-cancer conditions.Methods: Systematic review. Data sources were Medline, Embase, CINAHL, PsycINFO, CENTRAL, and ClinicalTrials.gov. were searched in September 2018 as well as hand searches. We included randomised controlled trials, including cluster randomised, pilot, and feasibility trials. We selected studies that reported the set of triggers for palliative care involvement for older people with non-cancer conditions, where >50% of the population was aged >65 years. The methodological quality of the included studies was assessed using the Cochrane Collaboration's tool for assessing risk of bias.Results: 16 randomised controlled trials out of 6,732 papers were identified. We identified six major domains of trial eligibility criteria in three categories, time-based, needs-based, and medical history-based criteria. Needs-based criteria were composed of symptoms, functional status, and quality of life criteria. The major trial eligibility criteria were diagnostic criteria (n = 15 [94%]), followed by physical and psychological symptoms, medical history-based criteria, respectively (n = 9 [56%]). Conclusion: For older people with non-cancer conditions, decisions about providing palliative care should be based on the present needs related to symptoms, functional status, and quality of life. Future research should investigate if the set of needs-based criteria can be used in clinical care to identify older people with non-cancer conditions likely to benefit from palliative care and acceptability of the referral criteria for older adults and their families.