Palliative Performance Scale (PPS): A New Tool

TLDR

Initial uses of the PPS in Victoria include communication, workload analysis, admission/discharge profiling, and possible prognostication. The PPS, a modification of the Karnofsky Scale, is introduced as a new tool to measure physical status in palliative care and may serve as a basis for comparing home drug costs and studying treatment effects across performance levels. The study assessed 119 home patients (73 % with PPS 40–70 %) and 213 hospice admissions (83 % with PPS 20–50 %) while ongoing validity and reliability testing is underway. Among 129 unit deaths, median survival increased with higher PPS: 1.88 days at 10 %, 2.62 days at 20 %, 6.70 days at 30 %, 10.30 days at 40 %, and 13.87 days at 50 %; only two patients with PPS ≥ 60 % died in the unit.

Abstract

The Palliative Performance Scale (PPS), a modification of the Karnofsky Performance Scale, is presented as a new tool for measurement of physical status in palliative care. Its initial uses in Victoria include communication, analysis of home nursing care workload, profiling admissions and discharges to the hospice unit, and, possibly, prognostication. We assessed 119 patients at home, of whom 87 (73%) had a PPS rating between 40% and 70%. Of 213 patients admitted to the hospice unit, 175 (83%) were PPS 20%-50% on admission. The average period until death for 129 patients who died on the unit was 1.88 days at 10% PPS upon admission, 2.62 days at 20%, 6.70 days at 30%, 10.30 days at 40%, 13.87 days at 50%. Only two patients at 60% or higher died in the unit. The PPS may become a basis for comparing drug costs at home and for studying the effects of treatments (e.g. hypodermoclysis) at various levels of physical performance. Validity and reliability testing are currently being undertaken.