Table 2

Category 3 of the NECPAL CCOMS-ICO tool: disease-specific indicators

Cancer (one single criterion)
  • Confirmed diagnosis of metastatic cancer who present low response or contraindication of specific treatment, progressive outbreak during treatment or metastatic affectation of vital organs

  • Significant functional deterioration (palliative performance status <50%)

  • Persistent, troublesome symptoms, despite optimal treatment of underlying condition(s)

Chronic pulmonary disease (two or more criteria)
  • Breathlessness at rest or on minimal exertion between exacerbations

  • Difficult physical or psychological symptoms despite optimal tolerated therapy

  • FEV1 <30% or criteria of restricted severe deficit: FVC <40%/DLCO <40%

  • Accomplishment of oxygen therapy at home criteria

  • Recurrent hospital admissions (>3 admissions in 12 months due to exacerbations)

Chronic heart disease (two or more criteria)
  • Heart failure NYHA stage III or IV, severe valve disease or inoperable coronary artery disease

  • Shortness of breath at rest or minimal exertion

  • Difficult physical or psychological symptoms despite optimal tolerated therapy

  • Ejection fraction severely affected (<30%) or severe pulmonary hypertension (>60 mm Hg)

  • Renal failure (GFR <30 L/min)

  • Repeated hospital admissions with symptoms of heart failure/ischaemic heart disease (>3 last year)

Serious chronic liver disease (one single criterion)
  • Advanced cirrhosis: stage Child C, MELD-Na Score >30 or with one or more of the following medical complications: diuretic-resistant ascites, hepatorenal syndrome or upper gastrointestinal bleeding due to portal hypertension with failed response to treatment

  • Hepatocellular carcinoma: present, in stage C or D (BCLC)

Serious chronic renal disease (one single criterion)
  • Serious renal failures (GFR <15) in patients to whom substitutive treatment or transplant is contraindicated

Chronic neurological diseases (1): CVA (one single criterion)
  • During acute and subacute phases (<3 months poststroke): persistent vegetative or minimal conscious state >3 days

  • During the chronic phase (>3 months poststroke): repeated medical complications (aspiration pneumonia, pyelonephritis, recurrent febrile episodes, pressure ulcers stages 3–4 or dementia with severe criteria poststroke)

Chronic neurological diseases (2): motor neuron diseases, multiple sclerosis and Parkinson (two or more criteria)
  • Progressive deterioration in physical and/or cognitive function despite optimal therapy

  • Complex and difficult symptoms

  • Speech problems with increasing difficulty communicating

  • Progressive dysphagia

  • Recurrent aspiration pneumonia, breathless or respiratory failure

Dementia (two or more of the following criteria)
  • Severity criteria: GDS/FAST 6c or more.

  • Progression criteria: loss of two or more ADLs in the last 6 months, despite adequate therapeutic intervention or difficulty swallowing, or denial to eat, in patients who will not receive enteral or parenteral nutrition

  • Use of resources criteria: multiple admissions (>3 in 12 months, due to concurrent processes—aspiration pneumonia, pyelonephritis, sepsis, etc—that cause functional and/or cognitive decline)

  • ADL, activities of daily living; BCLC, Barcelona clinic liver cancer; CVA, cerebrovascular accident; DLCO, diffusing capacity of the lung for carbon monoxide; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; GFR, glomerular filtration rate; NYHA, New York Heart Association.