The Karnofsky Performance Status Scale (KPS) is widely used to quantify the functional status of cancer patients. However, limited data exist documenting its reliability and validity. The KPS is used in the National Hospice Study (NHS) as both a study eligibility criterion and an outcome measure. As part of intensive training, interviewers were instructed in and tested on guidelines for determining the KPS levels of patients. After 4 months of field experience, interviewers were again tested based on narrative patient descriptions. The interrater reliability of 47 NHS interviewers was found to be 0.97. The construct validity of the KPS was analyzed, and the KPS was found to be strongly related (P < 0.001) to two other independent measures of patient functioning. Finally, the relationship of the KPS to longevity (r = 0.30) in a population of terminal cancer patients documents its predictive validity. These findings suggest the utility of the KPS as a valuable research tool when employed by trained observers.

Standard functional assessment instruments often fail to capture subtle impairment in community-dwelling older persons. To create a scale to measure function at the Advanced Activities of Daily Living (AADL) level, we chose three questions to separate a community sample into four levels: frequent vigorous exercisers (8.0%), frequent long walkers (10.8%), frequent short walkers (23.7%), and nonexercisers (57.5%). These levels of exercise formed a hierarchical scale that correlated positively in a graduated manner with progressively advanced social activities of daily living, current health status, and mental health. At 1-year follow-up, 20% of persons declined in exercise level, 63% showed no change in exercise level, and 17% improved their exercise level. Changes in exercise level in both directions were associated with changes in mental health status. The Advanced Activities of Daily Living scale may be a sensitive measure of earlier functional decline, but longer follow-up will be necessary to determine its clinical usefulness.

Organizational factors may influence compliance with treatment guidelines and be useful in improving the quality of care.

This research utilizes retrospective, self-report data collected from a nonprobability sample of women recently diagnosed with nonrecurrent, early-stage breast cancer to better understand how the treatment decision-making process varies with patient age. Three important areas--context, decision-making style, and influencing factors--are examined using bivariate and multivariate analyses. Findings indicate that although patients recalled similar contextual attributes, they reported attitudes, behavior, and considerations that differed by age. Older women were less likely than their younger counterparts to have desired participation in therapy selection, sought out medical information, or considered the possibility of recurrence when making treatment decisions.