|
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
| |
