Core Modules

module 4 | Activity 7: Assessing and maintaining function

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

Review the Resource Utilisation Groups – Activities of Daily Living (RUG-ADL) tool that is a part of the Palliative Assessment and Clinical Response form.

  1. What are the dimensions of functional status that are assessed by the tool?
  2. What advantages and limitations would this assessment tool have in practice?
  1. Rome, R.B., et al., The Role of Palliative Care at the End of Life. The Ochsner Journal, 2011. 11(4): p. 348-352.
  2. Therapeutic Guidelines Ltd, Pain: management in palliative care. 2019: Melbourne.
  3. Therapeutic Guidelines Ltd, Principles of symptom management in palliative care. 2018: Melbourne.
  4. Therapeutic Guidelines Ltd, Advance Care Planning. 2018: Melbourne.
  5. Taylor, D.H., Jr., et al., The effect of palliative care on patient functioning. Journal of palliative medicine, 2013. 16(10): p. 1227-1231.
  6. Palliative Care Outcomes Collaboration. Functional Assessment in Palliative Care (RUG-ADL & AKPS). 2016  [cited 2017 March  3]; Available from:
  7. 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.
  8. Murray, S.A., et al., Palliative care from diagnosis to death. BMJ, 2017. 356.
  9. 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.
  10. Palliative Care Outcomes Collaboration. PCOC Assessment Tools. 2019  [cited 2019 Febraury 2]; Available from:
  11. Palliative Care Outcomes Collaboration. PCOC Clinical Manual 2018  [cited 2019 31 January]; Available from: