Synopsis
Identify people who would benefit from palliative care on the basis of unmet need and deteriorating health, respond to urgent reversible problems, and coordinate proportionate generalist or specialist support without waiting for a precise prognosis.
- Palliative care is active care directed at quality of life, symptom relief, communication and support; it can begin while disease-directed treatment continues.
- Need, not diagnosis or estimated survival, is the first-line trigger. Advanced heart, lung, neurological, renal and liver disease can create needs comparable with metastatic cancer.
- Look for general deterioration, disease-specific progression, escalating service use, persistent symptoms, weight or function loss, treatment intolerance and caregiver strain.
Key red flags
New limb weakness, sensory change or sphincter dysfunction in cancer may indicate metastatic spinal cord compression and needs urgent pathway activation.
Exhaustion, poor health, competing responsibilities, anticipatory grief or inability to provide overnight care can threaten both patient safety and caregiver wellbeing.
Investigation priorities
Elicit physical, psychological, social, information, practical, cultural, spiritual and caregiver concerns in the patient's preferred order.
Management branches
Progression, functional decline, repeated crisis or a clinician, patient or carer concern suggests unmet palliative need.
- Ask permission for a holistic conversation, establish immediate priorities and assess symptoms, function, understanding, supports and caregiver capacity.
- Treat urgent reversible problems and start core generalist measures while deciding whether complexity or instability requires specialist palliative input.