The PPS performs well as a predictor of prognosis in a heterogeneous hospice population, and performs particularly well for nursing home residents and for patients with non-cancer diagnoses. The PPS should be useful in confirming hospice eligibility for reimbursement purposes and in guiding plans for hospice care.
This paper aims to reconcile the use of Palliative Performance Scale (PPSv2) for survival prediction in palliative care through an international collaborative study by five research groups. The study involves an individual patient data meta-analysis on 1,808 patients from four original datasets to reanalyze their survival patterns by age, gender, cancer status, and initial PPS score. Our findings reveal a strong association between PPS and survival across the four datasets. The Kaplan-Meier survival curves show each PPS level as distinct, with a strong ordering effect in which higher PPS levels are associated with increased length of survival. Using a stratified Cox proportional hazard model to adjust for study differences, we found females lived significantly longer than males, with a further decrease in hazard for females not diagnosed with cancer. Further work is needed to refine the reporting of survival times/probabilities and to improve prediction accuracy with the inclusion of other variables in the models. Resume / Cet article vise a reconcilier !'usage de l'echelle de performance en soins palliatifs [EPSP] comme facteur predlctlf de survie grace aun projet international commun auquel ont particlpe cinq groupes de recherche. Cette etude comporte une meta-analyse des donnees recueillies aupres des 1,808 patients provenant de quatre cohortes differentes. On a done refait I'analyse du pronostic de survie selon I'age, Ie genre, Ie stade de la maladie et Ie score initial de I'EPSP. Nos resultats revelent qu'il y a une relation importante entre I'EPSP et Ie facteur predictif de survie atravers I'ensemble des donnees des quatre groupes. Les courbes de survie Kaplan-Meier demontrent que chaque niveau de I'EPSP est distinct et que les plus hauts scores de I'EPSP sont assocles aune plus longue periods de survie. A I'aide du modele de hasard proportionnel de Cox, nous avons realuste les differences qui existaient entre les etudes et nous avons decouvert que les femmes, de tacon significative, vivent plus longtemps que les hommes. De plus, ces probabilites sont encore plus elevees chez les femmes n'ayant pas ete diagnostiquees du cancer. II nous faudra d'autres etudes pour perfectionner nos previsions sur Ie temps de survie/probabilite et pour ameliorer "exactitude des predictions tout en y ajoutant d'autres variables.
These results indicate that families feel they receive greater benefits from longer lengths of stay in hospice. Future efforts to define an "optimal" length of stay in hospice should consider patients' and families' perceptions of the benefits that hospice offers.
A B S T R A C T PurposeTo determine which hospice patients with cancer prefer to die at home and to define factors associated with an increased likelihood of dying at home. MethodsAn electronic health record-based retrospective cohort study was conducted in three hospice programs in Florida, Pennsylvania, and Wisconsin. Main measures included preferred versus actual site of death. ResultsOf 7,391 patients, preferences regarding place of death were determined at admission for 5,837 (79%). After adjusting for other characteristics, patients who preferred to die at home were more likely to die at home (adjusted proportions, 56.5% v 37.0%; odds ratio [OR], 2.21; 95% CI, 1.77 to 2.76). Among those patients (n ϭ 3,152) who preferred to die at home, in a multivariable logistic regression model, patients were more likely to die at home if they had at least one visit per day in the first 4 days of hospice care (adjusted proportions, 61% v 54%; OR, 1.23; 95% CI, 1.07 to 1.41), if they were married (63% v 54%; OR, 1.35; 95% CI, 1.10 to 1.44), and if they had an advance directive (65% v 50%; OR, 2.11; 95% CI, 1.54 to 2.65). Patients with moderate or severe pain were less likely to die at home (OR, 0.56; 95% CI, 0.45 to 0.64), as were patients with better functional status (higher Palliative Performance Scale score: Ͻ 40, 64.8%; 40 to 70, 50.2%; OR, 0.79; 95% CI, 0.67 to 0.93; Ͼ 70, 40.5%; OR, 0.53; 95% CI, 0.35 to 0.82). ConclusionIncreased hospice visit frequency may increase the likelihood of patients being able to die in the setting of their choice.
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