What criteria should I use to determine when to refer a patient to specialist palliative care services?

Criteria for referral to specialist palliative care services include:

• When a problem or symptom occurs that is outside the expertise of the primary care team, such as complex symptom management or psychological distress requiring specialist intervention, a referral should be made promptly NICE CKS.
• Persistent or difficult-to-manage symptoms that do not respond to standard treatments, including physical symptoms like pain, breathlessness, or nausea, warrant specialist palliative care input NICE CKS,NICE CKS.
• Significant psychological distress in the patient or their carers, including anxiety, depression, or severe mental health problems, should prompt referral to specialist psychological or palliative care services NICE CKS.
• When the patient is approaching the end of life, especially if they have advanced, progressive, incurable conditions, general frailty with increased risk of dying within 12 months, or life-threatening acute conditions, referral to specialist palliative care is appropriate to support holistic needs assessment and advance care planning NICE NG142.
• When there is uncertainty about treatment options or the need to consider complex decisions such as deactivation of implantable devices or adjustment of medications for symptom relief, specialist palliative care or relevant specialists should be involved NICE CKS.
• When multidisciplinary team involvement is required to coordinate complex care needs, including community, hospice, or hospital-based specialist palliative care teams NICE CKS,NICE CKS.

Early involvement of specialist palliative care services is encouraged to ensure symptom control, psychological support, advance care planning, and coordination of care, rather than delaying referral until symptoms become unmanageable NICE CKS,NICE NG142.