Your clinical judgment is paramount. To assist in your assessment, if your patient exhibits ONE or MORE of the following CORE and disease-specific indicators, a hospice referral is probably appropriate.
Another key indicator: Would you be surprised if this patient died within the next year? If not, then a referral may be the best course, for the patient and the family.
CORE Indicators
- Physical decline
- Weight loss
- Serum Albumin <2.5 gm/dl
- Not responding to nutritional support
- Frequent ER visits or hospitalizations related to primary dx or multiple co-morbidities
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Amyotrophic Lateral Sclerosis (ALS)
- Needs assistance with ADL’s
- Barely intelligible speech
- Difficulty swallowing
- Significant dyspnea
- Declines feeding tube
- Declines ventilator support
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Cancer
- Widespread invasion or metastases
- Progression despite medical intervention
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Congestive Heart Failure
- Optimally treated with diuretics & vasodilators
- NYHA Class IV
- Ejection Fraction =<20%
- History of cardiac arrest
- Treatment-resistant arrhythmias
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COPD
- Dyspnea at rest
- Recurrent pulmonary infections and/or exacerbations
- Unintentional weight loss
- Resting tachycardia >100/min
- FEV1 <30% predicted
- O2 sat = or < 88% in room air
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Alzheimer's Disease
FAST Score of 7:
- Limited ability to speak (1-5 words/day)
- Non-ambulatory (cannot walk w/o personal assistance)
- Dysphagia
- Not responding to nutritional support
- Weight loss
Co-morbidities:
- Aspiration
- Pneumonia
- Urosepsis
- Decubiti
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HIV/AIDS
- CD4 level is at or <25 cells/ml
- Persistent viral load >100,000 copies/ml
- Not responsive to antiretrovirals
- Nonadherence to antiretrovirals
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Liver Disease
- Prothrombin time INR >1.5
- Serum albumin <2.5gm/dl
- Ascites despite maximum therapy
- Peritonitis
- Hepatorenal syndrome
- Hepatic encephalopathy refractory to treatment
- Recurrent variceal bleeding
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Renal Disease
- Creatinine clearance <10cc/min
- Serum creatinine >8.0mg/dl
- Declines dialysis
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Stroke and Coma
- Poorly responsive or comatose
- Dysphagia with very limited intake
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