Education and care-planning support only — does not replace clinical judgment or local protocols.

🩺 CP-END — End-of-Life Comfort Check

Symptoms at end of life. · Group D End of life · Links to: D1–D5

Original tool, not yet validated. Pilot and review with clinicians before clinical decisions. Supports, but does not replace, clinical judgment, validated scales and local policy.

Patient

Date/Time

Nurse

Item	0	1	2
Pain	0 · None	1 · Mild	2 · Severe
Breathlessness	0 · None	1 · Mild	2 · Severe
Agitation	0 · Calm	1 · Restless	2 · Distressed
Noisy secretions	0 · None	1 · Some	2 · Loud
Mouth care	0 · Moist, clean	1 · Dry	2 · Sore or cracked
Family coping	0 · Coping	1 · Struggling	2 · In crisis

⚠ Red flags — escalate at once regardless of score

No specific red flags listed — use clinical judgment.

Total: 0 — select a score for each item

Score	Level	Action
0–2	Comfortable	Continue comfort care
3–6	Some symptoms	As-needed medicines, palliative input
≥7	Distress	Urgent palliative review

Nursing notes / action taken

⬇ Blank form (PDF)