Defining “early palliative care” for adults diagnosed with a life-limiting illness: A scoping review

Abstract Background: Palliative care is for people suffering from life-limiting illnesses that focuses on providing relief from symptoms and stress of illness. Previous studies have demonstrated that specialist palliative care consultation delivered earlier in the disease process can enhance patients’ quality of life, reduce their symptom burden, reduce use of hospital-based acute care services and extend their survival. However, various definitions exist for the term early palliative care (EPC). Objective: To investigate how EPC has been defined in the literature for adults with life- limiting illnesses. Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and the follows the Joanna Briggs Institution methodology for scoping reviews. Results: We identified 116 articles between 2008-2020 which met inclusion criteria. Five categories of operational definitions for EPC emerged: 1) time-based (time from advanced cancer diagnosis to EPC initiation); 2) prognosis-based (prognosis or the ‘surprise question’); 3) location-based (access point within the healthcare system such as outpatient setting); 4) treatment-based (physician’s judgement or prior to specific therapies); and 5) symptom-based (using symptom intensity questionnaires). Many studies included patients with cancer (n=78), with the most common definition category being time-based (n =41). Amongst studies focusing on multiple or non-cancer diagnoses (n=38), the most common definition category was symptom-based (n =13). Conclusion: Our findings provide a useful reference point for those seeking to understand the scope and breadth of existing EPC definitions in cancer and non-cancer illnesses and contemplate their application within clinical practice