This collection of tools is a one-stop shop for interdisciplinary teams caring for patients living with a serious illness. The tools and resources on this page can be used to screen for, assess, document, and manage the palliative needs of patients and their caregivers. Teams will also find guidance on how to support team health, promote role clarity, and improve practice efficiency.

What’s in the Toolkit

A collection of tools that clinicians can use to assess and track functional status of patients with serious illness.

Palliative Performance Scale

Assesses the patient's functional abilities including ambulation, activity level, self-care ability, intake and consciousness.

ECOG Performance Status

Assess disease progression, impact on activities of daily living, and appropriate treatment and prognosis.

Validated symptom assessment tools clinicians can use to assess and track symptom burden in serious illness.

Revised Edmonton Symptom Assessment System (ESAS-r)

Assesses for nine symptoms experienced by patients with serious illness and quantifies their severity. Alberta Health Services.

Condensed Memorial Symptom Assessment Scale (CMSAS)

Measures the frequency, severity, and distress associated with 32 symptoms.

Pain Assessment Questions
MEMBERS ONLY locked

Recommended assessment questions to typify pain and inform pain management for patients with serious illness. Center to Advance Palliative Care, 2015.

Pain Assessment and Documentation Tool (PADT)

Validated instrument to assess pain intensity and impact on function over time.

Opioid Risk Tool (ORT)

Validated 5-question assessment tool designed to predict which patients are at risk for opioid substance use disorder.

Wong-Baker FACES Pain Rating Scale

Illustrated pain scale for patients with cognitive impairment and children.

Pain Assessment in Advanced Dementia (PAINAD)

Tool to assess pain in cognitively impaired patients.

A collection of tools to assist clinicians in the assessment of the psychological and social impact of serious illness on their patients, and their caregivers.

NCCN Distress Thermometer

Assessment tool for symptom burden and impact on quality of life. National Comprehensive Cancer Network (NCCN), 2016.

PHQ-4 Validated Screening Tool for Anxiety and Depression

Brief (4-question) screening tool for anxiety and depression.

PHQ-9: Validated Screening Tool for Depression

Used to screen, diagnose and measure the severity of depression.

GAD-7 Anxiety Scale

Measure for assessing generalized anxiety disorder.

Spiritual Screening Tool

Assessment for suffering, distress, disconnection, or spiritual pain. Supportive Care Coalition.

Zarit Burden Interview (ZBI-12)

Self-reported caregiver assessment.

CMS Accountable Health Communities Screening for Health-Related Social Needs

Identifies unmet need in housing, food, transportation, utilities, and safety. Developed by CMS for the Accountable Health Communities model.

A collection of tools to aid clinicians in the screening, assessment, and staging of patients with dementia.

Pain Assessment in Advanced Dementia (PAINAD)

Tool to assess pain in cognitively impaired patients.

AD8 Dementia Screening

Screens for early dementia, which is often missed by common assessment tools such as the Mini-Mental Status Examination.

FAST Scale

For staging and prognosis after a dementia diagnosis.

Dementia Care Resources for Caregivers

Print or email this handout of caregiver resources for education and support.

Tips for Communicating with People Living with Dementia
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Guidelines for clinicians and caregivers. Center to Advance Palliative Care, 2018.

Dementia Care Resources for Caregivers

Print or email this handout of caregiver resources for education and support.

A collection of tools to assist clinicians with the safe and effective use of opioids to relieve suffering for patients with serious illness.

Pain Assessment Questions
MEMBERS ONLY locked

Recommended assessment questions to typify pain and inform pain management for patients with serious illness. Center to Advance Palliative Care, 2015.

Pain Assessment and Documentation Tool (PADT)

Validated instrument to assess pain intensity and impact on function over time.

Opioid Risk Tool (ORT)

Validated 5-question assessment tool designed to predict which patients are at risk for opioid substance use disorder.

Wong-Baker FACES Pain Rating Scale

Illustrated pain scale for patients with cognitive impairment and children.

Equianalgesic Conversion Table

Depicts the relative potencies of commonly prescribed opioids compared to oral morphine.

Prescribing Opioids: A Pocket Reference

Opioid pocket reference for providers including safe starting doses, equianalgesic chart, and standard dosing strengths. Center to Advance Palliative Care, 2019.

Starting Doses in the Opioid-naïve Patient
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Safe starting doses for the opioid-naïve patient.

Analgesics Fact Sheet

When to use - and when to avoid - 6 classes of analgesics including acetaminophen, NSAIDs, opioids, antiepileptics, antidepressants, and corticosteroids. Center to Advance Palliative Care, updated 2018.

Opioid Treatment Agreement
MEMBERS ONLY locked

Shared by Optio Health Services.

HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics

U.S. Department of Health and Human Services. October 2019.

Constipation Protocol

Sample protocol for managing constipation. Organizations can create similar protocols in collaboration with referring clinicians and pharmacists. Lee Health, 2013.

A collection of tools and technical assistance to help clinicians improve communication with patients and families living with serious illness.

Communication Phrases in Palliative Care
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Phrases to use when talking to members/patients and their families about prognosis, advance planning, and quality of life.

Advance Care Planning Conversations: Key Takeaways
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Stepwise approach to discussing advance care planning with patients or surrogates. Center to Advance Palliative Care and VitalTalk, 2015.

Conducting a Family Meeting: Key Takeaways
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Stepwise approach that any clinician can use to improve family meetings. Center to Advance Palliative Care and VitalTalk, 2015.

Delivering Serious News: Key Takeaways
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Stepwise approach for conversations with patients about serious news. Center to Advance Palliative Care and VitalTalk, 2015.

Discussing Prognosis: Key Takeaways
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Stepwise approach for discussing prognosis with patients and families. Center to Advance Palliative Care and VitalTalk, 2015.

Clarifying Goals of Care: Key Takeaways
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Stepwise approach to conversations with patients about their goals of care. Center to Advance Palliative Care and VitalTalk, 2019.

Discussing Your Patient's Dementia Diagnosis Key Takeaways
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Stepwise approach for discussing a dementia diagnosis with patients and caregivers. Center to Advance Palliative Care, 2018.

Communicating About What to Expect as Dementia Progresses: Key Takeaways
MEMBERS ONLY locked

Key takeaways and list of available community resources for people living with dementia and their caregivers.

A Guide for Conducting an ICU Family Meeting When the Patient Is Unable to Participate
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Communication framework for discussing goals of care with families of patients in the ICU.

Template notes for documenting patient care.

Pain Assessment and Documentation Tool (PADT)

Validated instrument to assess pain intensity and impact on function over time.

Palliative Care Progress Note
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An effective progress note based on the core domains of palliative care is one of your best marketing tools. There's no better way to effectively show referral sources what palliative care can do. Sample document shared by Carle Foundation Hospital, 2017.

Inpatient Initial Social Work Note
MEMBERS ONLY locked

Shared by Hospital of University of Pennsylvania.

Social Work Consultation Note
MEMBERS ONLY locked

Shared by Central Baptist Hospital.

Consent Agreement
MEMBERS ONLY locked

Sample consent agreement required for CCM and CCCM billing. ResolutionCare, 2018.

Informed Consent
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Shared by Interim HealthCare/CarePoint.

Palliative Care Consent Form Example
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Form utilized by our providers during the first visit to inform and document patient and family HIPPA and billing responsibilities. Palliative Care Associates, a program of Hospice and Palliative Care of Greensboro, August 2018.

Sample Treatment Agreement/Informed Consent Form
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Documentation of patient and clinician goals and expectations for safe and effective opioid treatment.

Rounding tool, triage system, and team meeting guide to support an efficient, high-functioning team.

Daily Team Meetings: Triage System

Guidelines for effective team meeting management.

Quick Tips #5: Running Effective Interdisciplinary Team Patient Care Meetings
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Best practices in efficient, effective IDT meetings. Center to Advance Palliative Care, 2018.

Billing Outpatient Tip Sheet
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Quick reference to help clinicians with clinic based outpatient billing and coding. Center to Advance Palliative Care, 2019.

Billing Home Tip Sheet
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Quick reference to help clinicians with home based billing and coding. Center to Advance Palliative Care, 2019.

Billing Inpatient Tip Sheet
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Quick reference to help clinicians with inpatient billing and coding. Center to Advance Palliative Care, 2019.

Northwell Home Care Network Geriatrics and Palliative Team Feedback Survey

Sample geriatrics and palliative team survey to assess patient satisfaction.

Four Seasons Compassion for Life Palliative Care Patient Satisfaction Survey

Sample survey to assess palliative care patient satisfaction.

Bluegrass Palliative Care Experience of Care Survey

Sample palliative care patient experience survey.