Palliative Care Toolkit

These best-practice tools from around the world support primary care providers with palliative care delivery. They are organized according to the 3-step model of best practice proposed by the Gold Standards Framework used in the United Kingdom.

Step 1: Identify

Identify if the patient would benefit from palliative care earlier in their illness trajectory. The Tools to Support Earlier Identification for Palliative Care recommends tools that can be used to determine when to introduce palliative care. Among these, the most commonly used tools in Ontario are:

Tool Name Link Type Description, Source
Supportive & Palliative Care Indicator Tool HTML SPICT, University of Edinburgh
Gold Standard Framework Prognostic Indicator Guide PDF Adapted for Ontario use by Mississauga Halton Palliative Care Network
Risk Evaluation for Support: Prediction for Elder-life in the Community Tool HTML RESPECT, Project Big Life
Hospital 1-year Mortality Risk HTML HOMR, BMJ Quality & Safety journal article

Step 2: Assess

Assess the person’s current and future needs and preferences across all domains of care. Include validated screening tools, an in-depth history, physical examination and relevant laboratory and imaging tests.

Screening Tools

Use validated screening tools to identify if the patient, their family or caregiver have any needs that require urgent intervention. Type and timeliness of screening will depend on the severity, urgency and complexity of the symptoms or needs identified.

Tool Name Link Type Description, Source
Edmonton Symptom Assessment System PDF ESAS, depression, anxiety, and wellbeing, Ontario Health (Cancer Care Ontario)
Palliative Performance Scale HTML PPS, Functional Status, Victoria Hospice
Palliative Prognostic Index HTML Morita T, Tsunoda J, Inoue S, Chihara S. The palliative prognostic index: a scoring system for survival prediction of terminally ill cancer patients. Supportive Care in Cancer 1999; 7: 128-33.
Clinical Frailty Scale HTML CFS, Functional Status, Geriatric Medicine Research, Dalhousie University
Patient Reported Functional Status PDF PRFS/ECOG, Functional Status, Ontario Health (Cancer Care Ontario)
Eastern Cooperative Oncology Group Performance Status PDF ECOG, National Palliative Care Research Centre
Distress Thermometer and Problem List HTML National Comprehensive Cancer Network
Changes in health, End-stage disease and Signs and Symptoms (CHESS) scale and the Personal Severity Index (PSI) PDF RAI-MDS

Holistic Assessment

Explore symptoms and needs across all domains in more detail through history and examination. Specific details on domains of issues associated with illness and bereavement are described on page 5 of Canadian Hospice Palliative Care Association’s Model to Guide Hospice Palliative Care (2013) [PDF]. Continue to screen regularly for distress and other needs.

Tool Name Link Type Description, Source
InterRAI Suite of Assessment Instruments HTML Includes Home Care, Palliative Care, Community Health Assessment, CHESS-MDS, DIVERT, eScreener
Psychosocial Assessment HTML INCTR Handbook
Patient Dignity Question HTML Dignity In Care
Patient Dignity Inventory HTML Dignity In Care
FICA Spiritual History Tool HTML GW School of Medicine & Health Sciences
HOPE Questions for Spiritual Assessment HTML Anandarajah, G., & Hight, E. (2001). Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. American family physician, 63(1), 81. See section on HOPE Questions

Conversation and Consent Tools

Use the results of screening and assessment to prompt further discussions about a person’s wishes, values, beliefs, understanding of wellness and any illnesses, and goals for current and future care. These conversations are ongoing and should be revisited regularly.

Tool Name Link Type Description, Source
Person-Centred Decision-Making: Resource for Healthcare Providers PDF Ontario Palliative Care Network
Making Decisions About Your Care: Patient Resource PDF Ontario Palliative Care Network
Advance Care Planning Workbook: Ontario Version HTML Speak Up Ontario
The Substitute Decision Maker Hierarchy HTML Speak Up Ontario
Advance Care Planning, Goals of Care, and Treatment Decisions & Informed Consent PDF Frequently asked questions, Ontario Palliative Care Network
Approaches to Goals of Care PDF Ontario Palliative Care Network

Step 3: Plan and Manage

Plan and collaborate ongoing care to address needs identified during the assessment. This includes prompt management of symptoms and coordination with other care providers.

Tool Name Link Type Description, Source
Inter-professional Palliative Symptom Management Guidelines HTML BC Centre for Palliative Care
Symptom Management Guides HTML Ontario Health (Cancer Care Ontario)
Cancer Pathway Maps HTML Ontario Health (Cancer Care Ontario)
Hospice Palliative Care Program Symptom Guidelines - Psychosocial Care PDF Fraser Health Authority
Trauma-Informed Care Awareness HTML Enclara Pharmacia
Clinical Practice Guidelines for the Psychosocial and Bereavement Support of Family Caregivers of Palliative Care Patients PDF Centre for Palliative Care, Australia
Pallium Palliative Pocketbook HTML Available in hard copy, or eBook, Pallium
Ontario Drug Benefit Formulary/Comparative Drug Index HTML See Part VI-B Facilitated Access to Palliative Care Drug Products, Ministry of Health