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CCS & ADS: Communication Capacity Scale & Agitation Distress Scale

2001

Two paired observer-rated measures for communication capacity and agitation distress in terminally ill cancer patients with delirium. They quantify selected consequences and symptoms; they are not delirium screening tools.

At a glance

Purpose
Measurement of delirium severity
Population
Adult
Setting
Palliative care
Time
under 5-10 min; ADS uses the most severe presentation across a 12-hour observation period

Format: CCS contains five ratings and yields 0-17; ADS contains six ratings and yields 0-18 from the worst presentation across observation. The complete rating anchors should be obtained from the publication or NIDUS card.

Primary validation papers

1 identified diagnostic-accuracy paper

Other forms of validation are described in the evidence section. What is counted?

Large-scale clinical implementation

Not yet reviewed.

A focused implementation review has not yet been completed for this profile.

Training and instructions

Public training resources have not yet been confirmed in this review. Check the linked developer or original source for instructions.

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Tool and original sources

This record describes a method rather than a downloadable bedside form. The main source is linked below.

NIDUS information cards ↗

Original paper

  • Original paperMorita T, Tsunoda J, Inoue S, Chihara S, Oka K. Communication Capacity Scale and Agitation Distress Scale to measure the severity of delirium in terminally ill cancer patients: a validation study. Palliative medicine. 2001;15(3):197-206. doi: 10.1191/026921601678576185. PMID: 11407191.

    This paper reports the original validation of CCS & ADS. It is the main source for the method, its intended use and the evidence available at publication.

    Open PubMed ↗
No eligible DTA study identifiedCore instrument family
Classification

Classification

Measurement of delirium severityMonitoring for new onset delirium

A tool may belong to more than one category. Select a linked category to see other relevant profiles.

Evidence

Diagnostic-accuracy evidenceNo eligible DTA study identified

Reported sensitivity and specificity

;
Sensitivity
;
Specificity

Severity scales; internal consistency alpha 0.91 and 0.96 (n=30).

More evidence and citation details
Full name
Communication Capacity Scale & Agitation Distress Scale
Also known as
CCS, ADS, Communication Capacity Scale, Agitation Distress Scale
Evidence summary
single-psychometric-validation
Reference standard
Palliative-care physician DSM-IV delirium diagnosis at first assessment; delirium diagnosed only from medication use was counted as absent
Citation
Morita T, Tsunoda J, Inoue S, Chihara S, Oka K Communication Capacity Scale and Agitation Distress Scale to measure the severity of delirium in terminally ill cancer patients: a validation study Palliative medicine. 2001;15(3):197-206. PMID 11407191
Download RIS ↗ Download BibTeX ↗

Primary validation studies

Distinct primary publications from the current diagnostic-accuracy audit. Reviews and repeated evaluations within one paper are not counted again. Overlapping cohorts have not all been reconciled. Read the counting rules and limitations.

Open 1 identified paper
  1. Hamano J, Morita T, Ozawa T, Shishido H, Kawahara M, Aoki S, Demizu A, Goshima M, Goto K, Gyoda Y, Hashimoto K, Otomo S, Sekimoto M, Shibata T, Sugimoto Y, Matsunaga M, Takeda Y, Nagayama J, Kinoshita H (2015). Validation of the Simplified Palliative Prognostic Index Using a Single Item From the Communication Capacity Scale. Journal of pain and symptom management.

    Reference category: other comparator or secondary accuracy evidence.

Copyright and reuse
Information checked
2026-07-19

Instrument-specific terms apply. See the access and copyright policy or send a correction.

Base clinical review: 2026-07-29. Instrument description source check: 2026-09-05. Scope and limitations.