The Palliative Performance Scale Applied in High-Care Residential Hospice: A Retrospective Study

Jansen, Wim J J; S, Buma; Gootjes, J.; Zuurmond, W. W. A.; Pérez, Roberto; Loer, Stephan A.

doi:10.1089/jpm.2013.0645

Cited by 12 publications

(20 citation statements)

References 11 publications

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“…The PPSv2 is a modified version of the Karnofsky performance scale and is used to measure functional status in palliative care 11,12 and predict survival among terminally ill patients. The PPSv2 is a modified version of the Karnofsky performance scale and is used to measure functional status in palliative care 11,12 and predict survival among terminally ill patients.…”

Section: Introductionmentioning

confidence: 99%

“…Palliative Performance Scale Version 2 (PPSv2) has been widely utilized across palliative care patient populations, yet limited data are available on its prognostic value in patients with heart failure. The PPSv2 is a modified version of the Karnofsky performance scale and is used to measure functional status in palliative care 11,12 and predict survival among terminally ill patients. 13 Two systematic literature reviews report that the PPSv2 is highly predictive of survival in mixed palliative care populations.…”

Section: Introductionmentioning

confidence: 99%

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Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

et al. 2019

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Aims Estimating survival is challenging in the terminal phase of advanced heart failure. Patients, families, and health‐care organizations would benefit from more reliable prognostic tools. The Palliative Performance Scale Version 2 (PPSv2) is a reliable and validated tool used to measure functional performance; higher scores indicate higher functionality. It has been widely used to estimate survival in patients with cancer but rarely used in patients with heart failure. The aim of this study was to identify prognostic cut‐points of the PPSv2 for predicting survival among patients with heart failure receiving home hospice care. Methods and results This retrospective cohort study included 1114 adult patients with a primary diagnosis of heart failure from a not‐for‐profit hospice agency between January 2013 and May 2017. The primary outcome was survival time. A Cox proportional‐hazards model and sensitivity analyses were used to examine the association between PPSv2 scores and survival time, controlling for demographic and clinical variables. Receiver operating characteristic curves were plotted to quantify the diagnostic performance of PPSv2 scores by survival time. Lower PPSv2 scores on admission to hospice were associated with decreased median (interquartile range, IQR) survival time [PPSv2 10 = 2 IQR: 1–5 days; PPSv2 20 = 3 IQR: 2–8 days] IQR: 55–207. The discrimination of the PPSv2 at baseline for predicting death was highest at 7 days [area under the curve (AUC) = 0.802], followed by an AUC of 0.774 at 14 days, an AUC of 0.736 at 30 days, and an AUC of 0.705 at 90 days. Conclusions The PPSv2 tool can be used by health‐care providers for prognostication of hospice‐enrolled patients with heart failure who are at high risk of near‐term death. It has the greatest utility in patients who have the most functional impairment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

et al. 2019

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“…For example, Maltoni et al 20 reported three categories (PPS 10-20%, PPS 30-50%, PPS ‡60%). Of the 13 studies, the 6 remaining 2,5,12,13,23,24 reported the initial PPS scores as discrete variables, which had different ranges of PPS scores (e.g., PPS 10-70%, PPS 40-90%). Of the six studies, two studies 2,5 reported PPS ranging from 10% to 70%, while the four remaining studies reported various ranges.…”

Section: Pps Scores At Baselinementioning

confidence: 99%

“…Accurate survival prognostication enables patients and their families to make better decisions about goals of care and to prepare for the end of life. 1,2 It is also important for healthcare providers to proactively refer patients for hospice care at the appropriate time. 1 A clear prognosis helps hospice organizations better allocate the intensity of palliative care services, including end-of-life treatments.…”

Section: Introductionmentioning

confidence: 99%

“…The Palliative Performance Scale (PPS) 4 is a reliable and valid tool that has been used to measure functional perfor-mance of, 2,7 and to predict survival among, palliative care cancer patients. 6,[10][11][12][13] The PPS is a modification of the Karnofsky Performance Scale, 8 which was originally developed for cancer patients and later adapted to be more generalizable to other end-of-life diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Using the Palliative Performance Scale to Estimate Survival for Patients at the End of Life: A Systematic Review of the Literature

Baik

Russell

Jordan

et al. 2018

Journal of Palliative Medicine

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Prognoses Associated With Palliative Performance Scale Scores in Modern Palliative Care Practice

Bischoff,

Patel,

Boscardin

et al. 2024

JAMA Netw Open

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ImportanceThe Palliative Performance Scale (PPS) is one of the most widely used prognostic tools for patients with serious illness. However, current prognostic estimates associated with PPS scores are based on data that are over a decade old.ObjectiveTo generate updated prognostic estimates by PPS score, care setting, and illness category, and examine how well PPS predicts short- and longer-term survival.Design, Setting, and ParticipantsThis prognostic study was conducted at a large academic medical center with robust inpatient and outpatient palliative care practices using electronic health record data linked with data from California Vital Records. Eligible participants included patients who received a palliative care consultation between January 1, 2018, and December 31, 2020. Data analysis was conducted from November 2022 to February 2024.ExposurePalliative care consultation with a PPS score documented.Main Outcomes and MeasuresThe primary outcomes were predicted 1-, 6-, and 12-month mortality and median survival of patients by PPS score in the inpatient and outpatient settings, and performance of the PPS across a range of survival times. In subgroup analyses, mortality risk by PPS score was estimated in patients with cancer vs noncancer illnesses and those seen in-person vs by video telemedicine in the outpatient setting.ResultsOverall, 4779 patients (mean [SD] age, 63.5 [14.8] years; 2437 female [51.0%] and 2342 male [49.0%]) had a palliative care consultation with a PPS score documented. Of these patients, 2276 were seen in the inpatient setting and 3080 were seen in the outpatient setting. In both the inpatient and outpatient settings, 1-, 6-, and 12-month mortality were higher and median survival was shorter for patients with lower PPS scores. Prognostic estimates associated with PPS scores were substantially longer (2.3- to 11.7-fold) than previous estimates commonly used by clinicians. The PPS had good ability to discriminate between patients who lived and those who died in the inpatient setting (integrated time-dependent area under the curve [iAUC], 0.74) but its discriminative ability was lower in the outpatient setting (iAUC, 0.67). The PPS better predicted 1-month survival than longer-term survival. Mortality rates were higher for patients with cancer than other serious illnesses at most PPS levels.Conclusions and RelevanceIn this prognostic study, prognostic estimates associated with PPS scores were substantially longer than previous estimates commonly used by clinicians. Based on these findings, an online calculator was updated to assist clinicians in reaching prognostic estimates that are more consistent with modern palliative care practice and specific to the patient’s setting and diagnosis group.

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The Palliative Performance Scale Applied in High-Care Residential Hospice: A Retrospective Study

Abstract: Although 77 patients passed away within a period of 3 months, PPS levels at admission varied from 10% to 70%. Fifty-six percent of all patients had a PPS level of 40% or less. Regarding survival, three significant PPS profiles, consisting of two or more PPS levels could be distinguished.

Cited by 12 publications

References 11 publications

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

Using the Palliative Performance Scale to Estimate Survival for Patients at the End of Life: A Systematic Review of the Literature

Prognoses Associated With Palliative Performance Scale Scores in Modern Palliative Care Practice

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