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- Multiple hospitalizations, emergency department visits, or increased use of other health care services
- Serial physician assessments, laboratory or x-ray studies consistent with progressive illness
- Changes in minimal data set (MDS) for patients in long-term care facilities
- Progressive deterioration of the patient while receiving home health care
Declining functional status as defined by:
- For patients with malignant diseases:
- Palliative Performance Status (PPS) or the Karnofsky Performance Status (KPS) < or = 50 or Eastern Cooperative Oncology Group (ECOG) > or =3
- PPS < or = 60 or ECOG > or =2 with symptoms
- Decline in PPS of at least 20 units in 2-3 months
- For patients with nonmalignant diseases:
- Dependence in at least 3/6 activities of daily living
- PPS or KPS < or = 50
Declining nutritional status as defined by:
- Unintentional weight loss > or = 10% of normal body weight and /or BMI <22
Intangible factors
- Patient’s personal goals, approach to his or her disease, treatment
- Burden of investigation and treatment versus potential gain for the patient
