Table 1 Application of WHO screening principles to QoL assessments in palliative care

The disease, condition

The problem (the QoL impairment)

1. The condition should be an important health problem, in terms of prevalence (e.g. breast cancer) or for the serious consequences if not early discovered and treated (e.g. phenylketonuria).

1. The problem should be a serious condition for the patient either in terms of prevalence (e.g. pain, depression) and/or distress for the patient (e.g. itch, hiccup) or the result of late detection and management of the problem (e.g. a new or unusual distressing symptom occurred over the disease trajectory).

2. There should be a recognizable latent or early symptomatic stage.

2. The problem should be highly unlikely to be reported by all the patients or recognized by the professional if not actively assessed.

3. The natural history of the condition, including development from latent to declared disease, should be adequately understood.

3. The trajectory of the problem should be sufficiently understood to assure a timely assessment to anticipate and appropriately address the problem.

The diagnostic test

The assessment tool

1. There should be a suitable test or examination

1. A validated, reliable and sensitive-to-change tool for detecting and measuring the problem should be available.

2. There should be acceptable for the population

2. The tool should be practical, easy to use and questions must not be distressing for the patients.

The treatment

The treatment - intervention

1. There should be an accepted treatment for patients with recognized disease.

1. There should be an appropriate treatment/intervention for patients with the recognized problem.

The screening programme

The clinical intervention focused on QoL assessment

1. There should be an agreed policy on whom to treat as patients

1. There should be an agreed policy on which a problem (or a problem with a certain degree of impairment) has to be addressed with appropriate treatment or intervention.

2. Facilities for diagnosis and treatment should be available.

2. There should be the possibility to appropriately administer the tool, including professionals trained with the procedure.

3. The treatment-intervention for patients with QoL impairments should be available, including professionals trained for the treatment-intervention.

3. The cost of case-finding (including diagnosis and treatment of patient diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole

4. The cost of problem-finding (including all the steps from the administration of the tool until the end of the treatment – intervention delivered) should be economically justified.

4. Case-finding should be a continuing process and not a “once and for all” project.

5. QoL assessment should be a continuing process and not a “once and for all” project.