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Table 1 Screening tool

From: Identifying the need for specialized palliative care in adult cancer patients – development and validation of a screening procedure based on proxy assessment by physicians and filter questions

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  
  1. a ECOG Eastern Cooperative Oncology Group Performance Status