Objective People with advanced chronic obstructive pulmonary disease (COPD) have substantial palliative care needs, but uncertainty exists around appropriate identification of patients for palliative care referral. We conducted a Delphi study of international experts to identify consensus referral criteria for specialist outpatient palliative care for people with COPD. Methods Clinicians in the fields of respiratory medicine, palliative and primary care from five continents with expertise in respiratory medicine and palliative care rated 81 criteria over three Delphi rounds. Consensus was defined a priori as ≥70% agreement. A criterion was considered ‘major’ if experts endorsed meeting that criterion alone justified palliative care referral. Results Response rates from the 57 panellists were 86% (49), 84% (48) and 91% (52) over first, second and third rounds, respectively. Panellists reached consensus on 17 major criteria for specialist outpatient palliative care referral, categorised under: (1) ‘Health service use and need for advanced respiratory therapies’ (six criteria, eg, need for home non-invasive ventilation); (2) ‘Presence of symptoms, psychosocial and decision-making needs’ (eight criteria, eg, severe (7–10 on a 10 point scale) chronic breathlessness); and (3) ‘Prognostic estimate and performance status’ (three criteria, eg, physician-estimated life expectancy of 6 months or less). Conclusions International experts evaluated 81 potential referral criteria, reaching consensus on 17 major criteria for referral to specialist outpatient palliative care for people with COPD. Evaluation of the feasibility of these criteria in practice is required to improve standardised palliative care delivery for people with COPD. Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (JP), upon reasonable request.

中文翻译：

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慢性阻塞性肺疾病患者的共识姑息治疗转诊标准


目的 晚期慢性阻塞性肺疾病 （COPD） 患者有大量的姑息治疗需求，但在适当确定患者以进行姑息治疗转诊方面存在不确定性。我们对国际专家进行了一项 Delphi 研究，以确定 COPD 患者专科门诊姑息治疗的共识转诊标准。方法 来自五大洲的呼吸医学、姑息治疗和初级保健领域具有呼吸医学和姑息治疗专业知识的临床医生在三轮德尔菲评估中对 81 项标准进行了评分。共识被先验定义为 ≥70% 的一致性。如果专家认可仅满足该标准就证明姑息治疗转诊是合理的，则认为该标准为“主要”。结果 57 名小组成员在第一轮、第二轮和第三轮的回应率分别为 86% （49） 、 84% （48） 和 91% （52）。小组成员就专科门诊姑息治疗转诊的 17 项主要标准达成共识，分类为：（1） “卫生服务使用和高级呼吸治疗的需求”（6 项标准，例如，需要家庭无创通气）;（2） “存在症状、社会心理和决策需求”（八项标准，例如，严重（10 分制中的 7-10 分）慢性呼吸困难）;（3） '预后估计和体能状态'（3 项标准，例如，医生估计的预期寿命为 6 个月或更短）。结论 国际专家评估了 81 项潜在的转诊标准，就 COPD 患者转诊至专科门诊姑息治疗的 17 项主要标准达成共识。需要评估这些标准在实践中的可行性，以改善 COPD 患者的标准化姑息治疗服务。数据可根据合理要求提供。 支持本研究结果的数据可应合理要求从通讯作者 （JP） 处获得。