Table 1.

Five-Item Palliative Care Screening Tool

Screening Items	Points
1. Presence of metastatic or locally advanced cancer	2
2. Functional status score, according to ECOG performance status score	0-4
3. Presence of one or more serious complications of advanced cancer usually associated with a prognosis of < 12 months (eg, brain metastases, hypercalcemia, delirium, spinal cord compression, cachexia)	1
4. Presence of one or more serious comorbid diseases also associated with poor prognosis (eg, moderate-severe COPD or CHF, dementia, AIDS, end stage renal failure, end stage liver cirrhosis)	1
5. Presence of palliative care problems
Symptoms uncontrolled by standard approaches	1
Moderate to severe distress in patient or family, related to cancer diagnosis or therapy	1
Patient/family concerns about course of disease and decision making	1
Patient/family requests palliative care consult	1
Team needs assistance with complex decision making or determining goals of care	1
Total	0-13

Abbreviations: CHG, congestive heart failure; COPD, chronic obstructive pulmonary disease; ECOG, Eastern Cooperative Oncology Group.