eTable 4. Factors influencing the complexity of the patient’s situation and available instruments for assessment.

Factor influencing complexity	Available instruments
1. Patient’s problems and needs	E.g.. Minimal Documentation System (MIDOS 2). Edmonton Symptom Assessment System (ESAS/ revised version ESAS-r). Palliative Care Outcome Scale (POS). Distress Thermometer with problem list
2. Strains on relatives	E.g.. Zarit Burden Interviews (ZBI). DEGAM Burden Scale for Family Caregivers (BSFC)
3. Functional status	Functional status especially regarding activity. self-care. and self-determination. e.g.. Australian modified Karnofsky Performance Status (AKPS). Eastern Cooperative Oncology Group (ECOG). activities of daily living (ADL). Barthel index
4. Disease state:	Description
a) Stable	Symptoms relieved. patient’s needs satisfied by management plan. stable family situation
b) Unstable	Significant new problems or rapid worsening of significant old problems within a few days. amendment of treatment plan required urgently or less urgently in order to satisfy patient’s needs
c) Deteriorating	Symptoms worsening incrementally or continually over a period of weeks or development of new but anticipated problems over a period of days/weeks necessitating adjustment and regular review of management plan. with increasing strain on family and/or social/practical stresses
d) Dying (terminal)	Likelihood of death within next few days; necessity for regular—usually daily—review of management plan and provision of regular support for family

(Source: German S3 Guideline on Palliative Care of Adult Patients With Incurable Cancer [2])