Every patient has the right to effective treatment and management for pain and symptoms. In addition to palliative outcomes and profile programs, PCOC uses five clinical assessment tools to help identify and manage these common symptoms.
Two types of forms are available for use in PCOC’s outcomes program:
- An easy-to-use form called the PCOC assessment and clinical response form. This form contains PCOC’s validated measures, and prompts to aid a clinical response. Download the PCOC Assessment and Clinical Response form (docx)
- A brief form to capture patient’s details. This includes episodes of care. Three versions of this form are available. The version to use depends on the setting of care and model of palliative care being provided.
- Download the Inpatient episode form (docx) for services with dedicated palliative care beds. This form is for services that provide care to patients admitted for care to a designated palliative care bed. A guide to completing this Inpatient designated bed episode form is available to download (docx)
- Download the Inpatient consult episode form (docx) for services that provide a palliative care consult service in hospitals. This form is called the In-hospital palliative care consult/liaison patient episode form). A guide to completing this Inpatient consult form is available to download (docx)
- Download the Community patient episode form (docx) when providing palliative care to patients residing in the community, including patients seen in their homes. A guide to completing the Community patient episode form is available to download (docx)
Lanyard cards for PCOC services are also available free of charge. These lanyard card resources can easily be attached to the cords or straps used to hold identification cards. Contact us for lanyard cards.
PCOC’s palliative care profile program
The Profile of palliative care form is the only form to use for the profile program. This easy-to-use form is to be used for those referred for a palliative care assessment.
This brief form allows you to capture, analyse and use referral and demographic information. This information is used to produces a profile report for your service. PCOC provides assistance to services to use these reports.
The profile form is used for one-off assessments. If you intend to assess the patient more than once, then use the episode form instead.
PCOC assessment tools
PCOC’s model relies on the use of five tools. These five tools help assess the characteristics and needs of patients. All of the tools are validated. They perform well in terms of their measurement properties. They perform well within the clinical settings. They are easy to use as part of routine care. Each tool has been used with hundreds of thousands of patients over the last decade.
- Palliative Care Phase
- Symptom Assessment Scale (SAS)
- Palliative Care Problem Severity Scale (PCPSS)
- Australia-modified Karnofsky Performance Status (AKPS) Scale
- Resource Utilisation Group - Activities of Daily Living (RUG-ADL)
What is the Palliative Care Phase?
The palliative care phase identifies a clinically meaningful period in a patient’s condition. The palliative care phase is determined by a holistic clinical assessment, which considers the needs of the patients and their family and carers. A change in palliative care phase represents a change in the person’s clinical condition and/or a change in the patient’s carers or family. These changes lead to a change in the patient’s care plan. Five palliative care phases (pdf) are possible. A patient may move back and forth between phases. A structured phase algorithm (pdf) can help guide healthcare professionals to determine the correct phase. Palliative care phase has a long history of development (pdf). Its development commenced in the 1990s. The palliative care community has described phase as an important tool. This is because it can help develop a common palliative care language across countries. Phase is used in Australia, Germany, Great Britain, Ireland, Taiwan and Singapore.
The PCOC Symptom Assessment Scale (SAS) is a patient-rated tool to measure the amount of distress caused by seven of the most common symptoms in palliative care. Staff need to know how bothered, worried or distressed patients are by each of the symptoms in order to effectively manage what matters to patients. The measure is easy to use and brief. Staff ask patients to rate their distress relating to each of the seven symptoms on a scale from 0 to 10, 0 being distress-free and 10 being severe distress.
- Download the SAS Form, English and coloured version (docx)
- Download the SAS Form, English and black/white (docx)
- Download the Talking about your symptoms SAS flyer (pdf)
- Contact us to request an order of the SAS Visual Aid Ruler (translated versions available)
Translated SAS form:
- Download the SAS form in Arabic (pdf)
- Download the SAS form in Chinese (simplified) (pdf)
- Download the SAS form in Chinese (traditional) (pdf)
- Download the SAS form in Croatian (pdf)
- Download the SAS form in Greek (pdf)
- Download the SAS form in Hindi (pdf)
- Download the SAS form in Italian (pdf)
- Download the SAS form in Macedonian (pdf)
- Download the SAS form in Russian (pdf)
- Download the SAS form in Serbian (pdf)
- Download the SAS form in Somali (pdf)
- Download the SAS form in Spanish (pdf)
- Download the SAS form in Tagalog (pdf)
- Download the SAS form in Vietnamese (pdf)
The PCPSS is completed by clinicians. PCPSS measures the severity of symptoms. The tool can be used for initial screening, symptom management and ongoing coordination of palliative care. Four palliative care domains are assessed through PCPSS: pain, psychological/spiritual, other symptoms and family/carer. Each domain is rated on a four-point scale with 0=absent, 1 =mild, 2 =moderate and 3 =severe.
- Download the PCOC assessment and clinical response form (which contains the PCPSS, pdf)
The RUG-ADL is a four-item scale. RUG-ADL measures functional status. It measures motor function in relation to activities of daily living (ADL). Four ADLs are examined: bed mobility, toileting, transfers and eating. RUG-ADL helps identify the assistance a patient needs to carry out these ADLs. RUG-ADL helps identify the resources that the patient needs. When assessments are completed, the assessment is based on what the person does, not what they are capable of doing.
Functional status is different to performance in that functional measures examine what the person does, not how they perform. Compared to other tools that measure function, the RUG-ADL is a measure particularly useful in palliative care. This is because ADLs are hierarchical. The RUG-ADL items (e.g. toileting, transfer) are the four items that a patient will lose last as they deteriorate and approach death.
- Download the PCOC assessment and clinical response form (which contains the RUG-ADL, pdf)
The AKPS scale is a measure of the patient’s performance across the dimensions of activity, work and self-care. The AKPS results in a single score between 0 and 100. For PCOC, the scores from 10 through to 100 are reported. AKPS is completed by a clinician. It is based on observations of a patient’s ability to perform common tasks relating to activity, work and self-care.
- Download the PCOC assessment and clinical response form (which contains the AKPS, pdf)
Frequently asked questions about the PCOC Assessment and Clinical Response Form
- What’s in the PCOC Assessment and Clinical Response Form?
- Why use the form?
- Can I use part of the form or just a few of the measures?
- What support is available to help me with this form and in using the measures?
For ease of use, the PCOC tools are collated into one, easy-to-use form. This means the form includes the five essential, brief, validated clinical assessment tools.
The five tools within the form help identify and manage common symptoms. Using the form helps ensure that assessments are routinely completed as a suite at each occasion of assessment. The form helps guarantee that the assessment scores are documented and recorded at point of care.
PCOC’s five tools form a package of measures. Each tool performs a specific function to help improve outcomes in patients and carers. You are able to use a selection of PCOC measures, and not all. However using the five measures together may mean that outcomes in your service are more likely to improve more quickly. Also, the information you receive from your PCOC reports will be more useful in driving improvements in outcomes. Completing the five measures will allow you to benchmark with other like services. Completing the five measures together will also result in a more comprehensive picture of each patient’s needs.
A free program of education of education is available for services registered with PCOC. This program is designed to help services implement the measures and drive quality improvements.
A range of useful resources are also available free of charge to PCOC’s community of practice. Guidance on embedding the assessments into routine practice is available. The use of this guidance helps ensure that these measures become part of routine care.
PCOC improvement facilitators are also available and ready to help with using the form and the measures within your service. Contact us for more information.
Frequently asked questions about PCOC’s palliative care profile program
- What’s the purpose of PCOC’s palliative care profile program?
- What is the benefit of the profile program for services?
- When should the profile form be used?
- In what setting should I use the profile program form?
- What help can I get in using the form or implementing the profile program?
The profile program identifies the profile of those that may benefit from palliative care.
Together with PCOC’s outcomes program, the profile program helps identify whether needs are being met.
The profile program helps understand the demand for palliative care in a service. This is achieved through identifying the characteristics of those that need palliative care and the number that need it. The program allows for understanding how the needs of patients in your service change over time and service activity.
The profile form is used routinely at the point of care. It is used for one-off assessments. If you intend to assess the patient more than once, use the episode form instead.
PCOC improvement facilitators (IFs) can help with using the form. The IFs can help with implementing the profile program within your service. A free education program is available. Contact us for more information.
© PCOC UOW 2020. The intellectual property associated with a suite of resources on this website is owned by the Palliative Care Outcomes Collaboration (PCOC), University of Wollongong. PCOC has placed resources in the public domain and is happy for others to use them without charge, modification or development. These resources cannot be modified or developed without the consent of the University.
PCOC is a national palliative care project funded by the Australian Government Department of Health.