Table 1

Comparison of identification tools

RADPAC2021Residential home palliative care tool22SPICT23Early identification tool for palliative care patients24PIG29NECPAL-CCOMS-ICO30QUICK GUIDE31
Patient groupCancer
COPD
Heart failure
Nursing home residents with non-malignant diseasesAllAllAllAllAll
Surprise question included++++++
General indicators
 Functional
status
Karnofsky
Progressive decline in functioning, bed ridden
Documented trajectory of declineIn bed >50% of the day
Needs help with personal care
Karnofsky
Dependent in two or more activities of daily living
Decreasing activities, increasing need for supportBarthel, ECOG (Eastern Cooperative Oncology Group), Karnofsky
Loss from two or more basic daily life activities Clinical impression of deterioration
Patient expressed need
In bed >50% of the day
MRC breathlessness scale 4/5 (REF), NYHA grade ¾ (REF), WHO performance grade 3/4 (REF)
 Weight loss>10% in 6 months>10% in 6 months5–10% in 3–6 months>10% in 1 yearNot discussed>10% in 6 months>10% in 3–6 months
 Hospital
admissions
>3 per yearMultiple last 6 months>2 in last 6 monthsProlonged or repeatedRepeated/unplanned crisis admissionsTwo or more emergency admissions in the last year>2 in last 6 months
 OtherPatient gives signals that end of life nearsMedical crisis requires end of life to be discussedLiving in nursing home
Care at home
Patient request for palliative care
Risk of dying from acute deterioration
Persistent troublesome symptoms
Family or patient express frustration because the patient no longer returns to baselineAdvanced disease, comorbidity, decreasing response to treatments, choice of no further treatment, albumen <25 g/L, eligible for DS1500 payment (allowance from the British government)At least two of the following in previous 6 months: pressure sores, systemic infections, acute confusional syndrome, persistent dysphagia, >2 falls. Emotional distress/psychological symptoms
≥2 comorbidities
One or more life-threatening illness
Burden of illness (physical, psychological, financial, other)
Disease-specific indicators provided for:COPD
Heart failure
Cancer
Not discussedCOPD, cancer, heart and vascular disease, kidney disease, liver disease, dementia/frailty, neurological diseasesAdvanced stage of:
AIDS, cancer, CHF, COPD, dementia
Cancer, organ failure (COPD, heart failure, renal disease, general neurological diseases, motor neurone disease, Parkinson's disease, MS) frailty, stroke and dementiaOncology, chronic pulmonary or cardiac diseases, chronic neurological disorders, liver diseases and dementia,
geriatric syndromes
COPD, cancer, heart and vascular disease, kidney disease, liver disease, dementia/frailty, neurological diseases
Setting/usePrimary care/GPNursing homes (primary care)Primary care/GP
Hospital setting
Primary care/GPPrimary care/GP Primary care/GP
Hospital setting
Primary care/GP
Definition used for palliative careApproach to improve quality of life of patients and their relatives suffering progressive chronic illnessesCare for patients with treatment goals directed towards relief of symptoms, with life expectancy less than 6 monthsCare for patients with chronic illnesses nearing end of life, with the aim to optimal quality of life. In patients at risk of deteriorating and dyingCare for people with advanced, chronic, progressive diseases who are at high risk for death in the next yearCare for patients with chronic illnesses nearing end of life, with the aim to optimal quality of life. In patients who are expected to die within 6–12 monthsCare for advanced chronic conditions, improving quality of life with a life expectancy less than 1 yearCare to improve quality of life and support those who care for the patient, in patients with a life-limiting, incurable condition with a life expectancy of 6–12 months
  • CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; GP, general practitioner; MRC, Medical Research Council; NYHA, New York Heart Association; PIG, Prognostic Indicator Guide; RADPAC, RADboud indicators for Palliative Care needs; SPICT, Supportive and Palliative Care Indicators Tool.