Core Modules

module 3 | Activity 4: Assessment tools

Numerous assessment tools exist to assist in the measurement and monitoring of symptoms and their impact.[1] These tools should be used appropriately and not as a substitute for a comprehensive, holistic assessment. Tools should be reliable, valid, evidence-based and not adapted to meet local needs unless they are revalidated within that population or setting.[2]

Using validated assessment tools promotes:[3-6]

  • A level of security and understanding for the person, their family and carers that:
    • the multidimensional aspects of symptoms are being thoroughly considered on a regular basis
    • care is consistent and coordinated
  • A systematic approach to assessing the multidimensional nature of symptoms
  • A cohesive language of reporting between health professionals, which provides an accurate and concise picture of the person’s symptoms and comfort level.

Assessment tools can be designed to:

  • Assess multiple symptoms eg, the Symptom Assessment Scale (SAS).[7] These tools are useful in routine practice for screening to identify people experiencing symptoms.
  • Identify specific needs within a domain in order to provide relevant care/services eg, The FICA Spiritual History Tool.[8]
  • Guide the assessment of a specific symptom eg, the brief pain inventory.[9] These tools enable a more comprehensive assessment to identify causes and effects of individual symptoms.

Assessment and reassessment are core elements of the person’s care as outlined in the following figure:[6]

Palliative assessment tool examples

The Palliative Care Outcomes Collaboration (PCOC) is a national program that facilitates the use of standardised clinical assessment tools to measure and benchmark outcomes in palliative care. Palliative care assessment tools commonly used throughout Australia are summarised in the following table:

Assessment Tool Purpose
Palliative Care Problem Severity Score (PCPSS) Clinician rated score of palliative care concerns that provides a summary measure of concerns in four domains: pain, other symptoms, psychological / spiritual and family / carer.[10]
Symptom Assessment Scale (SAS) The SAS is rated by the person with a life-limiting illness, rather than a clinician. It assesses the degree of distress relating to seven common symptoms and identifies the person’s priorities relating to specific symptoms.[7, 11]
Functional Assessment in Palliative Care (RUG-ADL) This four-item scale measures motor function with activities of daily living: bed mobility, toileting, transfer and eating. Assessment is based on what the person does, not what they are capable of doing. It provides information on functional status, the assistance the person requires to carry out these activities and the resources needed for their care.[12]
Australia-modified Karnofsky Performance Status (AKPS) The AKPS is a single score between 10 and 100 assigned by a clinician based on observations of a person’s ability to perform common tasks relating to activity, work and self-care.[12]
  1. What can the Symptom Assessment Scale (SAS) and Palliative Care Problem Severity Score (PCPSS) tell us about Herbert’s breathlessness?
    • Comment on whether these tools assesses the multiple dimensions of the symptom
    • Comment on how these tools assesses the individual’s experience of the symptom
    • What advantages and limitations would these assessment tools have in practice? Provide reasons for your answer.
  2. What assessment tools can you use to assess a person’s psychological wellbeing?
  1. Therapeutic Guidelines Ltd, Principles of symptom management in palliative care. 2018: Melbourne.
  2. McIlfatrick, S. and F. Hasson, Evaluating an holistic assessment tool for palliative care practice. J Clin Nurs, 2014. 23(7-8): p. 1064-75.
  3. CareSearch. Assessment Tools. Patient Management 2017  March 27, 2017 ]; Available from: https://www.caresearch.com.au/caresearch/tabid/748/Default.aspx.
  4. Bostanci, A., P. Hudson, and J. Philip, Clinical tools to assist with specialist palliative care provision. 2012.
  5. Rawlings, D., et al., Using palliative care assessment tools to influence and enhance clinical practice. Home Healthcare Nurse, 2011. 29(3): p. 139-145.
  6. Palliative Care Outcomes Collaboration. PCOC Assessment Tools. 2019  [cited 2019 Febraury 2]; Available from: http://www.pcoc.org.au/.
  7. Palliative Care Outcomes Collaboration. Symptom Assessment Scale (SAS). 2016  3 March 2017]; Available from: http://ahsri.uow.edu.au/pcoc/sas/index.html.
  8. Borneman T., Ferrell, B., Puchalski C. Evaluation of the FICA tool for Spiritual Assessment, Journal of Pain and Symptom Management 2010. 40(2): 163-173. [cited 20 Jan 2020]; Available from: https://prc.coh.org/pdf/EvalFICA.pdf
  9. Philip, J., et al., Concurrent validity of the modified Edmonton Symptom Assessment System with the Rotterdam Symptom Checklist and the Brief Pain Inventory. Supportive Care in Cancer, 1998. 6(6): p. 539-541.
  10. Palliative Care Outcomes Collaboration. Palliative Care Problem Severity Score (PCPSS). 2016  3 March 2017]; Available from: http://ahsri.uow.edu.au/pcoc/pcpss/index.html.
  11. Palliative Care Outcomes Collaboration, Symptom Assessment Scale (SAS) Video. 2016.
  12. Palliative Care Outcomes Collaboration. Functional Assessment in Palliative Care (RUG-ADL & AKPS). 2016  [cited 2017 March  3]; Available from: http://ahsri.uow.edu.au/pcoc/functionalassessment/index.html.