Abstract
Background: To systematically review the literature for the most suitable trigger criteria for referral to specialist palliative care services in life-limiting and life-threatening neurologic and neurosurgical conditions.
Methods: Literature searches were conducted in Ovid MEDLINE and EMBASE (1990 – December 2020). To be included, studies must have trigger/referral criteria clearly outlined, a >75% non-oncology neurosciences population, and consensus or guidelines documents regarding palliative neurosciences or trigger/referral criteria. We excluded studies that had an oncological or non-neurosciences population as the main focus of study, trigger and referral criteria not clearly outlined, and no primary or duplicative data. The protocol was registered with PROSPERO (CRD4202013579), and PRISMA guidelines were followed. The American Academy of Neurology Clinical practice guidelines process manual was used to assess for risk of bias.
Results: Our search identified 1748 publications, of which 22 articles met the eligibility criteria. Studies were considered in two main groups: A) studies designed specifically to identify trigger criteria for referral to specialised neuropalliative care services (n=9), and B) studies that retrospectively reported the reason for referral to specialised palliative care or reflected a consensus statement amongst people with advanced neurologic illness (n=13). Overall, the results suggest that several published referral triggers for specialized neuropalliative care are based on expert consensus. However, there is a growing body of literature providing evidence-based condition-specific triggers for multiple sclerosis, parkinsonism, ALS and dementia.
Discussion: There is a growing body of research that outlines evidence-based referral triggers for neuropalliative care. The ambiguity of nomenclature surrounding referral triggers in the current literature and field of neuropalliative care was a limitation to this study. We suggest that condition-specific triggers are likely to be the most effective for identifying the appropriate patients and timing for referral to specialist palliative care.
- Received September 2, 2021.
- Accepted January 10, 2022.
- © 2022 American Academy of Neurology
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