How is the Palliative Performance Scale (PPS) score used to assess patient functional status and guide palliative care interventions?

Using the Palliative Performance Scale (PPS) Score

The Palliative Performance Scale (PPS) is a validated tool that assesses patient functional status across five domains (ambulation, activity level/evidence of disease, self-care, intake, and level of consciousness) and provides valuable prognostic information to guide palliative care interventions. 1, 2

Structure and Components of PPS

The PPS evaluates patients on a scale from 0% to 100% based on five key domains:

• Ambulation: Assessment of mobility and walking ability 2, 3
• Activity level/Evidence of disease: Evaluation of functional capacity and disease burden 2, 3
• Self-care abilities: Assessment of independence in activities of daily living 2, 3
• Oral intake: Evaluation of nutritional status and ability to eat/drink 2, 3
• Level of consciousness: Assessment of alertness and cognitive status 1, 3

Clinical Applications of PPS

PPS serves multiple purposes in palliative care:

• Prognostication: Lower PPS scores correlate with shorter survival times 3, 4

  • PPS 10%: Average survival ~1.88 days
  • PPS 20%: Average survival ~2.62 days
  • PPS 30%: Average survival ~6.70 days
  • PPS 40%: Average survival ~10.30 days
  • PPS 50%: Average survival ~13.87 days

• Communication tool: Provides standardized language for healthcare teams to discuss patient status 5

• Care planning: Helps determine appropriate level of care based on functional status 1, 6

  • Stable category: PPS 70-100%
  • Transitional category: PPS 40-60%
  • End-of-life category: PPS 10-30%

• Resource allocation: Assists in determining appropriate care settings and intensity of services 3, 5

Implementation in Clinical Practice

When implementing PPS in clinical practice:

• Serial assessments: Perform regular reassessments to track functional decline and adjust care plans accordingly 6

  • Declining PPS scores predict shorter survival and increased care needs 6, 4

• Integration with other tools: PPS can be used alongside other prognostic tools like the Palliative Prognostic Score (PaP) 1

• Decision support: Use PPS to guide discussions about goals of care and end-of-life planning 1

  • Lower PPS scores (10-30%) should trigger discussions about hospice care 1

Special Considerations

• Reliability: PPS has demonstrated good inter-rater reliability with intraclass correlation coefficients >0.93 5

• Validity: Content validity has been confirmed by palliative care experts who consider it a valuable clinical assessment tool 5

• Language adaptations: PPS has been translated and validated in multiple languages, including German 7

• Applicability: Effective for both cancer and non-cancer patients, though cancer patients typically show higher initial PPS scores 6

Common Pitfalls and Limitations

• Subjective elements: Some components require clinical judgment and may vary between assessors 5

• Training needs: Proper training is required to ensure consistent scoring 5

• Context sensitivity: PPS should be interpreted in the context of the patient's overall clinical picture and not used in isolation 1

• Dynamic nature: Single assessments have limited value; serial measurements provide more meaningful information 6