Clinical Reference
Quick-reference guide for clinical use of the PCRES.
PCRES at a Glance
These thresholds are proposed interpretation aids for clinical exploration while formal validation is in progress. They are not diagnostic cutoffs or stand-alone decision rules.
Domain Summary
| Domain | Items | What It Captures | Flag |
|---|---|---|---|
| A. Identity & Self-Continuity | 1–4 | Does the patient still feel like themselves? | ≤50% → Warning (proposed) |
| B. Real-World Cognition | 5–9 | Can they function cognitively in daily life? | ≤50% → Warning (proposed) |
| C. Emotional Regulation | 10–13 | Are they experiencing dysregulation? | ≤50% → Warning (proposed) |
| D. Grief & Loss | 14–17 | Are they grieving lost abilities? | ≤50% → Monitor (proposed) |
| E. Neurofatigue | 18–22 | Is fatigue disproportionate and limiting? | ≤50% → Warning (proposed) |
| F. Social Connection | 23–26 | Are they withdrawing socially? | ≤50% → Warning (proposed) |
| G. Medical-Experience Gap | 27–30 | Do they feel heard by their medical team? | ≤50% → Alert (proposed) |
| H. Hope & Agency | 31–35 | Do they see a path forward? | ≤35% → Priority flag (proposed) |
Scoring
Likert Scale
Reverse-Scored Items
The following items are reverse-scored (formula: 4 − value):
Items 2, 3, 10, 11, 12, 13, 14, 15, 16, 20, 21, 25, 26
After reverse scoring, higher scores = better across all domains.
Domain Score Calculation
Domain maximums:
Total Score
Sum of all 35 items after reverse scoring. Range: 0–140. Convert to percentage: (total / 140) × 100.
Threshold Rationale
Proposed thresholds were selected using a conservative clinical rationale: a score at or below 50% of the domain maximum represents a patient responding below the neutral midpoint on average — indicating that negative experiences are more common than positive ones within that domain. The 35% Priority threshold for Domain H (Hope and Agency) is set more conservatively because of its relationship to potential acute safety risk, and because calibrating conservatively minimizes false negatives in an instrument that has not yet undergone full criterion validity testing. Both thresholds will be empirically calibrated against clinical outcomes data in Phase 3.
Proposed Flag-Triggered Actions
Use these thresholds as structured prompts for follow-up, not as validated decision rules. Low Hope & Agency should prompt broader mood and safety assessment, but the PCRES is not a stand-alone suicide screen.
| Flag Level | Meaning | Recommended Action |
|---|---|---|
| Priority flag (H ≤ 35%, proposed) | Hope critically low | Administer the Columbia Suicide Severity Rating Scale (C-SSRS) or equivalent validated suicide risk instrument before the patient leaves the clinical encounter. The PCRES Domain H flag is a routing signal, not a risk determination. Free C-SSRS materials: cssrs.columbia.edu |
| Alert (G ≤ 50%, proposed) | Therapeutic alliance at risk | Explore patient’s experience of care; adjust communication approach |
| Warning (any domain ≤ 50%, proposed) | Clinical attention may be warranted | Domain-specific conversation; consider targeted referral |
| Monitor (D ≤ 50%, proposed) | Grief present | Normalize grief response; assess if it is progressing or stuck |
| Total ≤ 41% (proposed) | Comprehensive review | Multi-domain intervention plan; consider neuropsych referral |
| Global QoL ≤ 3/10 (proposed) | Poor self-rated recovery | Explore discrepancy between clinical and patient assessment |
Proposed Domain-Specific Actions
These actions are proposed guideposts to support clinical exploration while validation is ongoing.
Identity & Self-Continuity ≤ 50%
Neuropsychology referral; explore identity disruption; assess for adjustment disorder
Real-World Cognition ≤ 50%
Formal neuropsychological testing; cognitive rehabilitation referral; compensatory strategy education
Emotional Regulation ≤ 50%
Screen for PTSD/adjustment disorder; differentiate from depression; consider therapy referral
Grief & Loss ≤ 50%
Normalize grief response; assess if progressing or stuck; support group referral; avoid premature pathologizing
Neurofatigue ≤ 50%
Rule out medical causes (thyroid, anemia, medication effects); energy management education; occupational therapy
Social Connection ≤ 50%
Caregiver burden assessment; social work referral; support group; explore barriers to connection
Medical-Experience Gap ≤ 50% (Alert, proposed)
Therapeutic alliance may be compromised; explore patient’s experience of their care; adjust communication; consider whether patient feels heard
Domain G measures a recovery-relevant construct distinct from patient satisfaction. Post-operative information sufficiency predicts patient behavior, self-efficacy, and return-to-function. Patients who do not understand what they experienced, what to expect, or what is normal are more likely to catastrophize symptoms and fail to follow recovery protocols. Domain G captures the patient’s subjective experience of coherence between what they were told and what they are living — a recovery variable with direct behavioral consequences.
Hope & Agency ≤ 35% (Priority flag, proposed)
Administer the Columbia Suicide Severity Rating Scale (C-SSRS) or equivalent validated suicide risk instrument before the patient leaves the clinical encounter. The PCRES Domain H flag is a routing signal, not a risk determination. Free C-SSRS materials: cssrs.columbia.edu.
Clinical Note Template
Copy and paste into your clinical note:
PCRES administered [date]. Domains: A-__% B-__% C-__% D-__% E-__% F-__% G-__% H-__%.
Total: __%. Global QoL: __/10.
Flags: [none / list flags].
Clinical action: [describe action taken or planned].
Downloads
Related resources: Online Assessment | Provider Setup & QR Code | Screening & Assessment Guide | Three-Dimensional Framework