The NECPAL tool (differences from the PIG and SPICT tools highlighted in bold)
| Surprise question | Would you be surprised if this patient dies within 1 year? | |
| Need, demand and choice | Any request to limit the treatments or palliative care from patient, family, or team members? | |
| General clinical indicators (severe, progressive, sustained) | Nutritional decline | Weight/albumin |
| Functional decline | KPS or Barthel | |
| Geriatric syndromes (advanced frailty) | Pressure ulcers | |
| Infections | ||
| Disphagia | ||
| Delirium | ||
| Falls | ||
| Severe psychological adjustment difficulties | Numerical verbal scale/HADS test | |
| Comorbidity | ≥2 chronic diseases | |
| Use of resources | ≥2 urgent admissions in 12 months | |
| Or increase in need/demand for care | ||
| Specific indicators | Cancer, COPD, heart, hepatic or renal failure, neurological, stroke, dementia | |
COPD, chronic obstructive pulmonary disease; HADS, Hospital Anxiety and Depression Scale; KPS, Karnofsky Performance Score; NECPAL, Necesidades Paliativas [Palliative Needs]; PIG, Prognostic Indicator Guidance; SPICT, Scottish Prognostic Indicator Tool.