Victoria Hospice offers the following useful clinical tools to help health care professionals in their assessment or treatment of patients facing advancing illness, death or bereavement. The Palliative Performance Scale and Bowel Performance Scale have been validated, while the others should be considered 'working forms.'
If you wish to print any of these tools, please fill out our: Reprint and Use Premissions Request Form
If you have any questions please contact Brittany Clark at [email protected]
Bereavement Risk Assessment Tool [PDF]
The Bereavement Risk Assessment Tool, or BRAT, is a psychosocial assessment tool used by care team members to communicate personal, interpersonal and situational factors that may place a caregiver or family member at greater risk for a significantly negative bereavement experience. This information can be collected prior to the death of the patient and used to inform the care team of any immediate concerns regarding caregivers or family members, and may also facilitate the allocation of scarce bereavement services after the death.
This tool is shown as a sample only and is not be used without complete instructions and permission. For complete instructions and permission please purchase the Bereavement Risk Assessment Tool Manual with electronic files, which are available in our Publications for Professionals online store.
Palliative Performance Scale
The Victoria Hospice Palliative Performance Scale (PPS, version 2) is an 11-point scale designed to measure patients' performance status in 10% decrements from 100% (healthy) to 0% (death) based on five observable parameters: ambulation, ability to do activities, self-care, food/fluid intake, and consciousness level.
Bowel Performance Scale [PDF]
Psychosocial Assessment Tool [PDF]
Respiratory Congestion Scale [PDF]
10 Steps to Better Prognostication [PDF]
Relationship Management [PDF]