For people affected by life-limiting illness, assessing and maintaining optimal function at each stage of an illness can ensure a better quality of life, reduce distress and, possibly, the need for extensive hospitalisation.[1-4] In palliative care even the smallest improvements in functional status can be viewed very positively by the person with a life-limiting illness and their family / carers.[3, 5]
In selecting a tool for assessing function it is essential that it is relevant to the person’s care goals.[6] Therefore, it is important to understand:
- The person’s preferences and goals in relation to their function[7]
- The trajectory of a person’s illness, and the anticipated progression of potential clinical complications.[8, 9]
Once goals of care are identified, consider the following questions to guide your selection of a method for assessing function:[6, 10, 11]
- Does the assessment method measure cognitive, behavioural, psychological or social aspects of function
- Is this assessment consistent with the person’s goals
- Does the assessment method require the person’s self-report or can it be generated by a proxy (caregiver or clinician)
- Is the assessment method practical and feasible for this person’s circumstances
- Is the assessment method sensitive enough to pick up changes in a person’s function?
Functional status can be used by combining both clinical assessment and a self-report from the person with a life-limiting illness. Two validated tools that assess function and performance in the palliative care setting include:[6, 10, 11]
- The Resource Utilisation Groups – Activities of Daily Living (RUG-ADL)
- The Australian-modified Karnofsky Performance Status (AKPS)
Functional assessment using the RUG-ADL and AKPS provides a clinical picture of the person’s level of dependency, the resources required to provide care and, in the community setting, can indicate carer burden.[10]
To learn more about these tools, click on the link to watch this Palliative Care Outcomes Collaboration (PCOC) video:
RUG-ADL and AKPS Functional Assessment Tools
Thinking Points
Review the Resource Utilisation Groups – Activities of Daily Living (RUG-ADL) tool that is a part of the Palliative Assessment and Clinical Response form.
- What are the dimensions of functional status that are assessed by the tool?
- What advantages and limitations would this assessment tool have in practice?
References
- Rome, R.B., et al., The Role of Palliative Care at the End of Life. The Ochsner Journal, 2011. 11(4): p. 348-352.
- Therapeutic Guidelines Ltd, Pain: management in palliative care. 2019: Melbourne.
- Therapeutic Guidelines Ltd, Principles of symptom management in palliative care. 2018: Melbourne.
- Therapeutic Guidelines Ltd, Advance Care Planning. 2018: Melbourne.
- Taylor, D.H., Jr., et al., The effect of palliative care on patient functioning. Journal of palliative medicine, 2013. 16(10): p. 1227-1231.
- 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.
- Schellinger, S.E., et al., Patient Self-Defined Goals: Essentials of Person-Centered Care for Serious Illness. The American journal of hospice & palliative care, 2018. 35(1): p. 159-165.
- Murray, S.A., et al., Palliative care from diagnosis to death. BMJ, 2017. 356.
- Lloyd, A., et al., Physical, social, psychological and existential trajectories of loss and adaptation towards the end of life for older people living with frailty: a serial interview study. BMC Geriatrics, 2016. 16(1): p. 176.
- Palliative Care Outcomes Collaboration. PCOC Assessment Tools. 2019 [cited 2019 Febraury 2]; Available from: http://www.pcoc.org.au/.
- Palliative Care Outcomes Collaboration. PCOC Clinical Manual 2018 [cited 2019 31 January]; Available from: https://ahsri.uow.edu.au/content/groups/public/@web/@chsd/@pcoc/documents/doc/uow129133.pdf.