Palliative Performance Scale

Summary

The Palliative Performance Scale (PPS), developed by Jennifer Smith, is a valuable diagnostic tool used in hospice and palliative care to assess patients’ eligibility and predict their survival time. It evaluates functional status, disease burden, self-care, oral intake, and level of consciousness. The scale ranges from 100% (full functionality) to 0% (death), helping clinicians make informed decisions about care. PPS scores and changes over time are highly predictive of survival, aiding timely hospice referrals and ensuring appropriate treatment plans. This tool simplifies prognosis evaluation and helps optimize care for terminally ill patients.

Takeaways

• 😀 The Palliative Performance Scale (PPS) is a crucial diagnostic tool used in hospice and palliative care to assess patient eligibility and predict length of stay.
• 😀 To qualify for hospice care, a patient must have a life expectancy of less than six months, as determined by the physician and hospice medical director.
• 😀 The PPS evaluates several domains, including ambulation, activity level, disease extent, self-care, oral intake, and level of consciousness.
• 😀 The PPS score is divided into categories from 0% (death) to 100% (full functionality), providing a range of functional independence levels.
• 😀 A change in PPS scores between two time points (e.g., admission and two months later) can indicate the rate of functional decline and predict survival outcomes.
• 😀 A larger change in PPS scores (greater than 30%) is highly predictive of a bad outcome and indicates a more rapid deterioration of health.
• 😀 The PPS is valuable for determining prognosis, treatment goals, and resource allocation for terminally ill patients.
• 😀 It helps empower patients and caregivers by providing a clear understanding of the patient's functional status and expected decline.
• 😀 The PPS tool is simple to use, with clear instructions and definitions, and does not require additional training for healthcare providers.
• 😀 The PPS has been correlated with survival time, showing that a lower PPS score on admission generally predicts a shorter survival time.
• 😀 The tool is designed to be user-friendly, with a computerized system where hospice providers can easily select the appropriate boxes for each patient.

Q & A

What is the Palliative Performance Scale (PPS)?

The PPS is a diagnostic tool used in hospice and palliative care to assess the functional status of a patient. It helps determine eligibility for hospice care and predicts the length of stay, as well as the patient's survival prognosis.

Why is the PPS important in hospice care?

The PPS is crucial for determining a patient's prognosis, enabling timely hospice referral and ensuring the patient receives the maximum benefit from hospice care. It helps physicians make decisions regarding treatment goals and resource allocation.

How does the PPS help with prognostication?

The PPS evaluates a patient's functional status, including ambulation, self-care, oral intake, and level of consciousness. By tracking changes in these areas, it provides a way to predict survival and the rate of functional decline, aiding in clinical decision-making.

What is the correlation between PPS score and survival time?

A lower PPS score at admission generally correlates with a shorter predicted survival time. Higher PPS scores indicate longer survival time. For example, a score of 10% suggests very limited function and a shorter survival, whereas a score of 70% indicates more independence and a longer life expectancy.

How does a change in PPS score influence survival predictions?

A change in the PPS score of more than 30% within a few months is highly predictive of a poorer outcome and faster decline in health. Smaller changes (less than 10%) are associated with more stable health conditions.

What are the five key domains evaluated by the PPS?

The five domains assessed by the PPS are ambulation, activity level, self-care, oral intake, and level of consciousness. These domains help evaluate a patient's functional status and provide a more comprehensive view of their condition.

What is the scale range of the PPS, and what does it represent?

The PPS scale ranges from 0% to 100%. A score of 100% represents full functionality, while a score of 10% indicates minimal oral intake and full dependence, with 0% representing death.

How is the PPS score used to assess a patient's condition over time?

The PPS score is typically taken at admission and then periodically reassessed to track changes in the patient's condition. These assessments help clinicians understand the rate of decline and predict how quickly the patient might deteriorate.

How does the PPS evaluate a patient's level of ambulation?

The PPS evaluates ambulation by categorizing patients into levels such as full ambulation, reduced ambulation, mainly in bed, or totally bedbound. This helps determine the patient's functional independence and the degree of assistance they require.

Can you explain how the PPS score changes based on dietary intake?

The PPS adjusts the score based on the patient's oral intake. If a patient has normal or reduced intake, their score remains higher, while minimal intake or reliance on others for feeding can lower their PPS score.