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Table 1 Screening tool
| Items | Possible points | Points patient | |
|---|---|---|---|
| Diagnosis: metastatic or locally advanced cancer | 2 | ||
| Functional status score: ECOGa | 0–4 | ||
| Fully active, able to carry on all pre-disease performance without restriction | 0 | ||
| Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature | 1 | ||
| Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours | 2 | ||
| Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours | 3 | ||
| Completely disabled; cannot carry on any selfcare; totally confined to bed or chair | 4 | ||
| one or more serious complications of advanced cancer usually associated with a prognosis of < 12 months (e.g. brain metastases, hypercalcemia, delirium, spinal cord compression, cachexia) | 1 | ||
| one or more serious comorbid diseases also associated with poor prognosis of < 12 months (e.g. moderate-severe COPD or CHF, dementia, AIDS, end stage renal failure, end stage liver cirrhosis) | 1 | ||
| Palliative care problems: | 1 each | ||
| Symptoms uncontrolled by standard approaches | |||
| Moderate to severe distress in patient or family, related to diagnosis or therapy (personal purposes/expectations, educative or informational needs, cultural factors affecting the treatment) | |||
| Patient/family concerns about course of disease and decision making (including realisation of power of attorney/patient decree) | |||
| Patient/family requests palliative care consultation team | |||
| Team needs assistance with complex decision making or determining goals of care (e.g. value/risks of treatment, desire to die) | |||
| Prolonged length of stay (> average length of stay) | |||
| Total score | 0–14 | ||
