Table 3.

List of criteria and related score for the development of an outpatients palliative care referral tool

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

Legenda: ESAS Edmonton Symptom Assessment System

^a = Anaemia, high Creatininemia, high Bilirubinemia, high Calcemia and low Albuminemia level