Table 3 List of criteria and related score for the development of an outpatients palliative care referral tool

Performance Status

ECOG

0 = 0 points

1 = 1 point

2 = 2 points

3 = 3 points

4 = 4 points

Physician during visit

4

Prognosys

Clinical evaluation

0-3 moths = 2 points

3-12 months = 1 point

> 12 months = 0 points

Physician during visit

2

Decision making/

Communication issue

when the oncologist has to inform the patient about: change of therapy, discontinuation of active treatment

change of therapy = 1 point discontinuation of active treatment = 2 point

Physician during visit

2

Physical symptoms

ESAS (11 items; no anxiety and depression)

0.5 points each symptom≥5

Nurse/case manager before visit

5.5

Psychological symptoms

ESAS (anxiety and depression only)

at least one ≥5 = 1 point

Nurse/case manager before visit

1

Social Problems

Items from Distress Termometre

at least two = 1 point

Nurse/case manager before visit

1

Serious Comorbidities

Charlson comorbidity Items (but tumour)

None = 0 points

One or Two = 1 point

>Two = 2 points

Team (before and/or during visit)

2

Other Relevant Conditions

Clinical evaluation

Team (before and/or during visit)

6

Brain metastase

Yes = 1 point

No = 0 points

Bone metastases

Yes = 1 point

No = 0 points

Abnormal blood levels^a

Yes = 1 point

No = 0 points

Neoplastic effusion

Yes = 1 point

No = 0 points

Cognitive impairment/ delirium

Yes = 1 point

No = 0 points

Other syndrome or complication due to cancer

Yes = 1 point

No = 0 points

Patient or caregiver request

Patient or caregiver require access to palliative care

Yes = 1 point

No = 0 points

Team (before and/or during visit)

1

24.5