# Automatic palliative care referral triggered by diagnosis, not by decline

Source: https://onco.cc/ideas/idea-acc-automatic-early-palliative-triggers/  
OnCo record `idea-acc-automatic-early-palliative-triggers` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Palliative care given from the start of treatment for advanced cancer improves quality of life and may extend it. Instead of waiting for an oncologist to remember, the system should refer automatically when the diagnosis is recorded.

## Summary

Temel and colleagues showed in 2010 that early palliative care in metastatic lung cancer improved quality of life, mood, and survival, and subsequent trials confirmed benefits across cancers. Referral remains late and inconsistent. Electronic triggers (stage IV diagnosis of defined cancers, second-line therapy start, unplanned admission) that generate a default referral unless declined would make early integration the norm.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Automatic triggers will raise the proportion of patients with metastatic lung, pancreatic, and gastric cancer seen by palliative care within eight weeks of diagnosis from under 30% to above 75%, and reduce chemotherapy in the last 14 days of life.
- Rationale: Default enrolment outperforms clinician-initiated referral in every domain where it has been tested; the evidence for early palliative care is Level 1.
- Proposed test: A stepped-wedge trial across 15 centres with time to palliative contact, end-of-life quality indicators, and patient-reported quality of life as endpoints.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Temel et al., NEJM 2010: https://www.nejm.org/doi/full/10.1056/NEJMoa1000678

## Connected records

- cancers: [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Pain relief and palliative care are unavailable to most](https://onco.cc/bottlenecks/b-palliative/)
- key papers: [Temel: early palliative care alongside chemotherapy improved quality of life, mood and survival in lung cancer](https://onco.cc/key-papers/paper-temel-early-palliative-care-nejm-2010/)
- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)

---
JSON: https://onco.cc/api/v1/entities/idea-acc-automatic-early-palliative-triggers.json