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Clinical tools and assessments

Every patient has the right to effective treatment and management of pain and other symptoms. To support this, the Palliative Care Outcomes Collaboration (PCOC) uses a suite of clinical assessment tools that help identify, monitor and manage these common issues experienced by people receiving palliative care. 

Documents:

PCOC’s palliative care clinical manual is designed for palliative care healthcare professionals. It aims to help embed the use of the PCOC assessment tools and data items into routine clinical practice. Embedding PCOC into routine clinical practice is key. This is because PCOC can help drive improvements and shape models of care. The manual includes: definitions (assessment tools and data items), forms for palliative care assessment, and information on the PCOC benchmarks and outcome measures.

Resources:

PCOC Version 3: Lanyards and SAS Rulers can be ordered free of charge by completing the form using the link below:

Forms:

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. You can use these forms depending on whether it is a SAS first of Phase first assessment. 
  • 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.

PCOC assessment tools

The PCOC model is built around five core clinical tools. These tools provide a structured way to assess patient needs, track changes over time, and guide clinical decision-making. They are designed to be simple, practical and easily integrated into routine care. 
Version 4 of PCOC introduced two important additions: 

  • ESAS-PCOC, an expanded symptom assessment system
  • Delirium measures, including clinician- rated presence of delirium and patient- rated distress related to delirium 

The PCOC Assessment Tools 

  • Presence of delirium and distress from delirium 
    Clinician-rated identification of delirium and patient-reported distress levels, enabling early recognition and management.
  • Symptom Assessment Scales (SAS/ ESAS-PCOC) 
    Patient reported measure of symptoms across multiple domains, supporting ongoing monitoring and communication 
  • Palliative Care Problem Severity Scale (PCPSS) 
    Clinician-rated assessment of key problem areas, including pain, other symptoms, psychological/spiritual issues, family family/carer concerns
  • Australia-modified Karnofsky Performance Status (AKPS) 
    A measure of functional performance that reflects a patient’s ability to carry out daily activities.
  • Resource Utilisation Group - Activities of Daily Living (RUG-ADL) 
    A structured assessment of dependency in essential daily tasks, informing care planning and resource needs.
  • Palliative Care Phase 
    A clinical classification that captures the patient’s current stage of care needs, guiding team priorities and interventions. Phase is informed by completion of the assessment tools. 

Presence of delirium

This item captures the clinician’s recognition of delirium and asks the question, is delirium present? (Yes/No).  If delirium status is uncertain, the clinician should consider using a validated delirium assessment tool (e.g., delirium assessment tools 4AT, CAM, Nu-DESC) 

Delirium Score 

This item identifies the patient-rated level of distress associated with delirium symptoms experienced over the past 24 hours on a 0-10 scale. This measure reflects the patient’s subjective experience of how distressing the effects of delirium are. It provides insight into the impact of delirium on the patient’s wellbeing and helps guide the clinical response to reduce distress and improve comfort. 

Key Resources:

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.

Key resources:

 Translated SAS form:

ESAS-PCOC uses a 0–10 numerical rating scale to measure patient reported symptom and problem severity. It includes 11 common symptoms and problems, with the option to record one additional ‘other symptom’. The measure is easy to use and informs health professionals of what symptoms and problems are most bothersome for the patient. Health professionals use the tool to ask patients to rate the severity of the 11 symptoms and problems on a scale of 0-10-0 being absent/best possible, 10 being severe/worst possible. 

Key resources:

Translated ESAS-PCOC forms:

COMING SOON!

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.

Key resources:

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.

Key resources:

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.

Key resources:

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.

Key resources:

Assessment and Response Protocol

PCOC’s assessment and response protocol provides guidance on how to use PCOC’s tools. The protocol also helps with responding to needs identified in assessments. The differences between anticipatory and responsive care are explained. Assessment and response resources, such as forms and lanyards, are included. Tips on how to embed palliative care assessments and outcomes into routine practice are featured. This includes guidance on how to integrate PCOC into orientation and education procedures within services.

Download PCOC's Assessment and Response Protocol

Clinical Protocol

Central to the PCOC outcomes program is a framework and protocol for routine clinical assessment and response.  There are three key resources that help with this: 
    1. PCOC's guide to implement, embed and sustain the PCOC program,
    2. PCOC's assessment and response protocol, and
    3. PCOC's palliative care clinical manual.

 These resources:

    • are applicable in any setting of care where palliative care is delivered, although a specific clinical manual is available for long-term care settings, such as residential aged care;
    • create a clinical language via validated assessment tools;
    • support consistency in responding to identified needs by recommending actions for each assessment tool;
    • help ensure healthcare professionals have access to consistent information to plan and deliver care.

This resource provides step-by-step guidance to assist palliative care services to develop a plan for implementing PCOC, or to monitor and evaluate progress and identify areas for improvement. It also includes a readiness assessment.

Download 'Implementing PCOC: a guide for services (PDF: 1,137 KB)

palCentre is a new data entry software, customised for use by PCOC services.

palCentre allows services to enter data for analysis and reporting and promotes consistent terminology, processes and protocols among services participating in PCOC.

palCentre features include: 

  • a user-friendly interface for entering patient and assessment information
  • printable reports to track the patient’s journey
  • a streamlined process of data extraction and submission to the Secured Online Submission platform
  • the ability to review patients currently under the care of the service

Access the palCentre User Guide

PCOC’s palliative care clinical manual is designed for palliative care healthcare professionals. It aims to help embed the use of the PCOC assessment tools and data items into routine clinical practice. Embedding PCOC into routine clinical practice is key. This is because PCOC can help drive improvements and shape models of care. The manual includes: definitions (assessment tools and data items), forms for palliative care assessment, and information on the PCOC benchmarks and outcome measures.

Download the PCOC VERSION 3: Palliative Care Clinical Manual (PDF: 2,017 KB

Download the PCOC VERSION 4: Palliative Care Clinical Manual (PDF: 2,017 KB