Who can you refer?
All healthcare professionals working with those who have a life-limiting condition are involved in providing palliative care. For many people with life-limiting conditions, palliative care delivered by their usual treating team is sufficient to meet their needs.
Useful guidance in relation to determining a patient’s need for Specialist Palliative care (SPC) is available in Palliative Care Needs Assessment Guidance (see resources). This guidance has been prepared by the National Clinical Programme for Palliative Care within the Clinical Strategy and Programmes Division of the HSE.
National eligibility criteria for referral to specialist palliative care services:
Patients with both:
- An advanced, life limiting condition.
- Current and anticipated complexities relating to symptom control, end of life care planning or other physical, psychosocial or spiritual care needs that cannot reasonably be met by the current care provider(s).
- It is recognised that there are “grey areas” and individual referrals may be discussed with the local Specialist Palliative Care team so as to assess their appropriateness. Assessment is conducted by the SPC team who are always available to advise or support other professionals in their delivery of palliative care.
- Referrals may be made to the most appropriate part of the specialist palliative care service (community, hospice or hospital-based) according to the patient’s needs at the time of referral. Once the patient has accessed one of these services, the specialist palliative care service will support the individual to move between service settings as their needs or condition changes (e.g. a patient who initially is referred to the hospital-based palliative care service may later be transferred to community palliative care).
I’m referring to the
Community Palliative Care Team (CPCT)
I’m referring to the
Specialist Palliative Care In-Patient Unit
Discharge from Specialist Palliative Care Services
Specialist palliative care needs can change over time. Frequently the progressive nature of the disease necessitates increasing SPC input. However, in some patients needs may decrease or stabilise such that they no longer require specialist palliative care. In the latter group it is appropriate to consider discharge with ongoing care from other health care providers. Such decisions will be made following multi-professional discussion, with the patient and family being involved in the discharge process. The patient, the referring team and all relevant health care professionals will be advised of the decision to discharge in advance. It is important to note that patients can be re-referred should they develop specialist palliative care needs once more.
A patient may be discharged from specialist palliative care if:
- There is a change in disease status such that the patient no longer has any specialist palliative care needs e.g.
- Investigations reveal less advanced disease than previously thought
- Following response to treatment
- Disease evident as only slowly progressive
- There is symptomatic improvement such that the patient no longer has SPC needs.
- Rehabilitation goals have been achieved.
- Following initial assessment, it is determined that the patient does not have SPC needs and that ongoing needs are more appropriately met by other health care agencies.
- The patient, following informed discussion, requests discharge from SPC services.
- The patient or family persistently prevent effective specialist palliative care input e.g. restricting access for assessment. The SPC team are, however, always available to offer support to involved healthcare professionals.
When a patient is discharged from the specialist palliative care service, their General Practitioner, hospital team and other professionals as appropriate are informed in writing. Patients can be re-referred at any time by their GP or hospital or Primary Care team.