Consensus palliative care referral criteria for people with idiopathic pulmonary fibrosis: an international Delphi study

BACKGROUND: People living with idiopathic pulmonary fibrosis (IPF) often experience rapid disease progression and high burden of distressing symptoms. Timely referral to specialist palliative care for people with IPF is uncommon. OBJECTIVES: This study aims to establish consensus on criteria that would prompt a referral to specialist palliative care for people living with IPF. METHODS: An international Delphi study was conducted over 3 online rounds between April and July 2025 to identify consensus among expert clinicians and researchers on the referral criteria for specialist palliative care for people living with IPF. Consensus was defined a priori as agreement of at least 70%. A focus group of people with lived experience of IPF or specialist palliative care was conducted to provide feedback on the relevance and acceptability of the putative referral criteria. RESULTS: Up to 46 expert panelists participated in the Delphi study. Panelists included physicians (78%-83%) and nurses (15%-20%) with specialist qualifications in respiratory (80%-84%) or palliative medicine (31%-35%). Consensus was reached on 17 major criteria and 40 minor criteria relating to "hospital utilization," "respiratory therapies," "symptom distress," "comorbidities," "exacerbation of IPF," "time-based factors," and "psychosocial factors." Focus group participants (n = 6) broadly concurred with the agreement rates from the panelists, albeit often leaning toward earlier indicators than those which reached final consensus as major criteria. CONCLUSIONS: Consensus referral criteria for specialist palliative care referral in IPF are presented, which emphasize comprehensive needs assessment and open communication between clinicians and patients. Future work is needed to examine the implementation of these criteria in clinical respiratory care.