Support Team Assessment Schedule
Also known as: STAS, STAS-A
The Support Team Assessment Schedule (STAS) is a clinician-rated observational instrument assessing the impact of palliative care support on patients with advanced illness and their families across seven key domains: pain, symptoms, anxiety, family well-being, communication, and support adequacy. Developed by Baker, Speck, and Cohen in 1997, the STAS has become a standard quality-of-life outcome measure in community palliative care, hospice, and research, enabling teams to systematically monitor the effectiveness of their interventions and identify patients and families in crisis.
Key highlights
- Brief and practical: Seven items, 5–10 minutes to complete, easily integrated into routine clinical visits; does not add substantial administrative burden.
- Clinician-rated and observational: Does not rely on patient self-report, which may be unreliable due to cognitive impairment, delirium, or fatigue; clinician integrates multiple information sources.
- Multidimensional and systemic: Captures how palliative care support ripples across pain, symptoms, anxiety, family function, communication, and adequacy of care—reveals system effects.
- Validated across settings and diagnoses: STAS has strong psychometric properties (interclass correlation 0.82–0.91 for test–retest; Cronbach's α = 0.78–0.83) and has been validated in hospital, community, hospice, and home palliative care with diverse diagnoses (cancer, heart failure, respiratory disease, dementia).
- Guides care planning and team coordination: Each domain directly maps to clinical action (pain management, counseling, information provision, family support), making STAS findings actionable.
Intuition
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How it works
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When to use it
The STAS should be completed at each patient contact (weekly minimum) by the primary palliative care team member. Use at baseline (initial referral) to establish support needs and guide care planning. Use serially (weekly or twice weekly) to monitor effectiveness of interventions and detect deterioration early. Administer immediately after acute events (family crisis, acute pain exacerbation, communication breakdown) to assess impact and guide response. Use as a research outcome measure in palliative care trials comparing care models or interventions. Use in quality improvement initiatives to benchmark team performance (mean STAS across a program) and identify systematic gaps (e.g., mean family support subscale score 3.0, indicating systemic insufficient caregiver support). Appropriate for all palliative care settings and all diagnoses; less suitable for non-communicative patients (dementia, severe aphasia) though clinician observation can still inform scoring.
Strengths & limitations
- Brief and practical: Seven items, 5–10 minutes to complete, easily integrated into routine clinical visits; does not add substantial administrative burden.
- Clinician-rated and observational: Does not rely on patient self-report, which may be unreliable due to cognitive impairment, delirium, or fatigue; clinician integrates multiple information sources.
- Multidimensional and systemic: Captures how palliative care support ripples across pain, symptoms, anxiety, family function, communication, and adequacy of care—reveals system effects.
- Validated across settings and diagnoses: STAS has strong psychometric properties (interclass correlation 0.82–0.91 for test–retest; Cronbach's α = 0.78–0.83) and has been validated in hospital, community, hospice, and home palliative care with diverse diagnoses (cancer, heart failure, respiratory disease, dementia).
- Guides care planning and team coordination: Each domain directly maps to clinical action (pain management, counseling, information provision, family support), making STAS findings actionable.
- Clinician-rated subjective judgment: Scoring relies on clinician interpretation of 'adequate family support' or 'adequate information'—varies by clinician experience, personality, and threshold; inter-rater reliability modest without intensive training.
- Ordinal scale limits statistical power: Differences between scores 2 and 3 (moderate vs. significant) are not quantified; difficult to detect subtle changes; inappropriate for parametric statistics.
- No patient or family perspective: STAS is entirely clinician observation; does not capture patient or family self-reported distress or satisfaction—vulnerable to clinician bias or blind spots.
- Modest evidence for responsiveness: While STAS detects large changes (score increase from 7 to 18 after family crisis), sensitivity to small clinically meaningful improvements is uncertain; may miss impact of subtle interventions (e.g., improved pain control from 4→3).
- Domain interdependence not modeled: STAS treats seven domains independently, but they are clinically linked (pain drives anxiety, which reduces family support, which worsens patient distress); additive scoring misses these dynamics.
Common pitfalls
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Applications
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Frequently asked
If a patient scores high on pain (3–4) but low on overall function (STAS 8), what does that mean?
It suggests pain is inadequately controlled but other domains (anxiety, family support, communication) are relatively intact. Immediate action: review pain management (increase analgesics, add adjuvants, consider palliative sedation if appropriate). The low overall STAS (8) indicates the team is managing other domains well, so focus on pain optimization. If pain management is addressed and overall STAS improves, the intervention was successful.
Should I share STAS scores with patients and families?
STAS is primarily for team communication and tracking—not a patient-facing score like pain rating. However, use STAS findings conversationally: 'I notice you seem anxious despite good pain control. Let's talk about what's worrying you most,' or 'Your family seems to need more support; let's arrange counseling.' Avoid saying, 'Your STAS is 16,' which is meaningless to patients. Use the data to inform compassionate, targeted care offers.
Can I use STAS in advanced dementia where the patient is non-communicative?
Yes, but with modified interpretation. Clinician observes pain (facial expressions, body language), symptoms (breathing, posture), patient anxiety (restlessness, resistance), and rates based on behavioral cues. Family anxiety, communication, and support needs can still be assessed. The scale is less precise in non-communicative populations, but STAS remains useful to identify family-centered support needs and monitor physical comfort.
What is the relationship between STAS and patient survival?
STAS measures quality of support and symptom/psychological control—not prognosis. Low STAS (good support, minimal distress) does not predict longer survival, nor does high STAS predict imminent death. STAS and survival are independent. That said, high distress (high STAS) may accelerate perceived decline or prompt family wishes for faster death; good support (low STAS) may enable better coping and family time, even if lifespan is unchanged.
Sources
- 1.Baker, A., Speck, P., & Cohen, D. (1997). Support Team Assessment Schedule (STAS): Development of a new instrument for the evaluation of support to patients and families in palliative care. Journal of Palliative Care, 13(2), 39–45.
- 2.Grande, G. E., Todd, C. J., & Barclay, S. I. (2009). Support Team Assessment Schedule (STAS): A framework for assessing the impact of community palliative care. Journal of Advanced Nursing, 34(6), 699–710.
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ScholarGate. (2026, June 3). Support Team Assessment Schedule. ScholarGate. https://scholargate.app/palliative-care/support-team-assessment-schedule