This review provides a broad overview on the prognostic value of the PPS tool for survival among multiple patient populations across care settings. Consistent reporting of PPS scores would facilitate the comparison of survival estimates across end-of-life diagnoses.

Children who undergo a prolonged stay within the intensive care unit require adequate sedation and analgesia. During the recovery phase there will need to be a period of sedation withdrawal to prevent occurrence of an abstinence syndrome. We present a strategy developed within our hospital for managing this process which uses the resource of the Pain Service, along with guidelines to help prevent the development of withdrawal, and a plan for managing any signs of abstinence which occur.

Objective: To identify sociodemographic and clinical factors predicting live discharge among home hospice patients with heart failure, and relate these findings to perspectives among healthcare providers about challenges to caring for these patients. Background: Hospice patients with heart failure are frequently discharged from hospice prior to death (“live discharge”). However, little is known about the factors and circumstances associated with live discharge among patients with heart failure. Methods: Quantitative analyses of patient medical records (N=1,498) and qualitative interviews with healthcare providers (N=19) at a not-for-profit hospice agency in New York City. Results: 30% of home hospice patients with heart failure experienced a live discharge, most frequently due to 911 calls that led to acute hospitalization. The odds of acute hospitalization were greater for younger (Age 18–74: [AOR]=2.10; 95% Confidence Interval [CI]=1.34–3.28), Black (AOR=2.06; CI=1.31–3.24) or Hispanic (AOR=2.99; CI=1.99–4.50), and higher-functioning patients (Palliative Performance Scores of 50–70%: AOR=5.68; CI=3.66–8.79). Qualitative interviews with healthcare providers highlighted the unique characteristics of heart failure (e.g., sudden changes in patients’ condition), the importance of patients’ understanding of hospice and their own prognosis, and the role of socio-cultural and family context in precipitating and potentially preventing live discharge (e.g., absence of social supports in the home). Conclusions— Live discharge from hospice, especially due to acute hospitalization, is common with heart failure. Greater attention is needed to patients’ knowledge of and readiness for hospice care, especially among younger and diverse populations, and to factors related to the social and family context in which hospice care is provided.

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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