CRITERIA | MEASURE/TOOL | CUT OFF/SCORING | EVALUATOR | MAXIMUM SCORE |
---|---|---|---|---|
Performance Status | ECOG | 0 = 0 points 1 = 1 point 2 = 2 points 3 = 3 points 4 = 4 points | Physician during visit | 4 |
Prognosys | Clinical evaluation | 0-3 moths = 2 points 3-12 months = 1 point > 12 months = 0 points | Physician during visit | 2 |
Decision making/ Communication issue | when the oncologist has to inform the patient about: change of therapy, discontinuation of active treatment | change of therapy = 1 point discontinuation of active treatment = 2 point | Physician during visit | 2 |
Physical symptoms | ESAS (11 items; no anxiety and depression) | 0.5 points each symptom≥5 | Nurse/case manager before visit | 5.5 |
Psychological symptoms | ESAS (anxiety and depression only) | at least one ≥5 = 1 point | Nurse/case manager before visit | 1 |
Social Problems | Items from Distress Termometre | at least two = 1 point | Nurse/case manager before visit | 1 |
Serious Comorbidities | Charlson comorbidity Items (but tumour) | None = 0 points One or Two = 1 point >Two = 2 points | Team (before and/or during visit) | 2 |
Other Relevant Conditions | Clinical evaluation | Team (before and/or during visit) | 6 | |
Brain metastase | Yes = 1 point No = 0 points | |||
Bone metastases | Yes = 1 point No = 0 points | |||
Abnormal blood levelsa | Yes = 1 point No = 0 points | |||
Neoplastic effusion | Yes = 1 point No = 0 points | |||
Cognitive impairment/ delirium | Yes = 1 point No = 0 points | |||
Other syndrome or complication due to cancer | Yes = 1 point No = 0 points | |||
Patient or caregiver request | Patient or caregiver require access to palliative care | Yes = 1 point No = 0 points | Team (before and/or during visit) | 1 |
24.5 |