TABLE III.

Advance care planning guideline (summary) adopted by physicians at the Cancer Centre of Southeastern Ontario in May 2016

Patient parameter	Palliative care referral?	Goals of care and advance care planning discussion?	Comment
Patients with complex symptom burden from cancer or treatment-related toxicity, or both, with symptom severity scores greater than 4/10 that persist for more than 3 visits.	Yes	To be considered based on other prognostic parameters	Not all patients with complex symptom burden are in the late or incurable phases of their disease, but all patients will benefit from palliative care referral.
Patients whose physician answered “no” to the question “Would you be surprised if this patient died within the next 12 months?”	Yes	Yes	Goals of care and advance care planning discussions might not require palliative care referral; discussions could be handled by oncologists and documented appropriately in the patient’s chart. It is recommended that these be dynamic discussions, such that specific elements will have to be readdressed depending on changes in the health care status of the patient.
Patients with general indicators of decline such as ■decreasing activity, declining performance status (Palliative Performance Scale < 60%). ■increasing support needs. ■advanced progressive incurable disease with complex symptom burden. ■declining response to treatments, decreasing reversibility of disease process. ■multiple unplanned or crisis hospital admissions.	Yes	Yes	Goals of care and advance care planning discussions should be coordinated between the palliative care physician and the oncology most-responsible physician if the patient is still receiving disease-directed therapies.