Original Research Background. The Diagnostic Tool for Complexity in Palliative Care (Pal-Cx) is designed to determine which patients benefit from a referral to a specialized palliative care (PC) team, is based on the degree of complexity, and has been validated in Spain. This work describes the first steps of the Spanish tool's validation process into the English language and cultural context.Research Objectives. 1) Forward and backward translation and cross-culture adaptation of the tool; 2) Pilot project to assess feasibility, content and apparent validity of diagnostic tool.Methods. Four bilingual translators performed forward/backward translation of the Spanish tool to English while content experts assessed tool validity. Clinicians (n¼33) completed an online survey with a Likert scale ranging from 1 to 5; (1 ¼ ''strongly disagree'' and 5 ¼ ''totally agree'') to test apparent validity and feasibility. Mean, frequencies, SD and Cronbach's alpha were calculated using SAS version 9.4 (Cary, NC). { Results. We obtained content validity through literature review and feedback from PC experts. The multidisciplinary PC clinicians (30 physicians, 2 nurses, 1 medical student; 17 females (52%); mean age 39.54, SD 10.33) completed the pilot study. We found a high agreement (Cronbach's alpha .77 raw and .79 standardized) regarding the relevance and acceptance of the tool. Cronbach's Alpha with deleted variables ranged from .74 to .82 for standardized variables and .74 to .80 for raw variables. Conclusion.Study findings provide evidence that the Pal-Cx translated well, showed content and apparent validity, and demonstrated feasibility.