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 | 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 | 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 | PRFS/ECOG, Functional Status, Ontario Health (Cancer Care Ontario) | |
Eastern Cooperative Oncology Group Performance Status | 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) | 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 | Ontario Palliative Care Network | |
Making Decisions About Your Care: Patient Resource | 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 | Frequently asked questions, Ontario Palliative Care Network | |
Approaches to Goals of Care | 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 | 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 | 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 |