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.
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 | Prompt same-day mood and safety assessment; use clinical judgment for suicide screening or urgent referral |
| 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
Hope & Agency ≤ 35% (Priority flag, proposed)
Prompt same-day mood and safety assessment; use clinical judgment for suicide screening, safety planning, and urgent referral.
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