✅ SPECIFIC NECPAL CRITERIA

SPECIFIC NECPAL CRITERIA SEVERITY / PROGRESSION / AVANCED DISEASE  (1)(2)(3)(4)

Cancer

• Metastatic or advanced locoregional Cancer in progression
• Persistent or uncontrolled or refractory Symptoms despite treatment

Chronic Lung disease

• Shortness of breath at rest on minimal exertion
• Confined to home with severe limitation
• Spirometric Criteria of severe obstruction (VEMS <30%) o criteria severe restrictive (CV <40% / DLCO <40%)
• Gasomètric Criteria chronic oxigen therapy at home
• Need of continous corticotherapy
• Associated Symptomatic Heart Failure

Chronic Heart disease

• Shortness of breath at rest on minimal exertion
• Heart failure NYHA estadi III ò IV, non-surgical severe valvular disease or nonsurgical advanced coronary disease
• Ecocardiography basal: FE <30% o HTPA severe (PAPs > 60)
• Associated Renal failure (FG <30 l / min)

Dementia

• GDS ≥ 6c
• Progression of functional, nutritional, and/or cognitive declines

Frailty

• Frailty index ≥ 0.5 (Rockwood K et al, 2005)
• Comprehensive Geriatric Assessment suggesting advanced frailty (Stuck A et al, 2011)

Chronic Vascular Neurological Disease (stroke)

• In acute phase (< 3 months after stroke): low consciousness state
• In chronic phase (< 3 months after stroke) repeated medical complications (or severe dementia)

Chronic Neurological Diseases: Motor neuron, MS, ALS, Parkinson

• Progression of functional, nutritional, and/or cognitive declines
• Complex or resistant symptoms
• Persistent dysphagia
• Increasing comunication difficulties
• Frequent aspiration pneumonias, dyspnea or respiratory failure

Chronic Liver Disease

• Advanced cirrosis Child C. Refractory ascites, hepato-renal syndrom and/or upper digestive bleeding despite treatment.
• Hepatic carcinoma stage C or D

Chronic Renal Disease

• Severe renal failure (GF < 15), patients with no indication or not accepting transplant or dialysis
• End of dialysis or transplant failure

(1) Use validated tools for severity and/or prognosis according to experience and evidence(2) In all cases, assess emotional distress or functional impact in patients (and family) as a criteria of palliative needs(3) In all cases, assess ethical dilemas in decisión-making(4) Include always association with multimorbidity    

 Source:NECPAL CCOMS-ICO Tool and Program©http://ico.gencat.cat/en/professionals/serveis_i_programes/observatori_qualy/eines_de_suport/eines/instrument_i_programa/