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 | ||