Predicting Survival with the Palliative Performance Scale in a Minority-Serving Hospice and Palliative Care Program

Abstract

Palliative Performance Scale (PPS) scores have shown potential for prognosticating survival in Caucasian samples, but have not been studied for prognostic value in cancer patients from minority groups. Using data obtained from a retrospective chart audit of 492 cancer patients admitted over an 18-month period to a minority-serving home-based hospice and palliative care program, we examined the relationship between PPS scores and length of survival (survival days). Patients with PPS scores of 10% to 30% had fewer survival days than those with scores of 40% and those with scores of 50% to 100% (median = 6, 19, and 34 days, respectively; F = 25.02, P < 0.001). A PPS score of 40% serves as a reliable inclusion criterion for a study requiring two weeks for completion, while 50% to 100% is required for a three-week study. Findings from a predominantly minority sample are similar to those from predominantly Caucasian samples. KeywordsPalliative Performance Scale; prognostication; survival; minorities; hospice; palliative carePrognosticating the length of time that a person with terminal cancer will survive is important for implementing feasible research studies that will have generalizable findings and contribute to effective end-of-life care (1,2). Unfortunately, predicting survival is not easy (3), even after admission to hospice or palliative care programs. Palliative Performance Scale (PPS) scores have shown potential for prognosticating survival in predominately Caucasian samples, but have not been studied for prognostic value in cancer patients from racial and ethnic minority groups. From an instrument validity perspective, it is important to establish that the PPS prognosticates survival in racial and ethnic minority groups as well as it does for racial majority groups, but previous research studies included few cancer patients from racial and ethnic minority groups.Address correspondence to: Diana J. Wilkie, PhD, RN, FAAN, Department of Medical-Surgical Nursing (MC 802), College of Nursing, University of Illinois at Chicago, 845 South Damen Avenue, Room 660, Chicago, IL 60612-7350, USA, E-mail: E-mail: diwilkie@uic.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Although many cancer patients die soon after enrollment in hospice, the number of days they survive (survival days) varies greatly. Using Medicare data from 1990 with a sample of 6,451 patients, of whom 92% were Caucasian and 80% were diagnosed with cancer, investigators (4) found that the median survival after hospice enrollment was 36 days but that 16% of patients died within seven days and 15% liv...

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“…5 As a measure of functional status, we included the Palliative Performance Scale (PPS), which has been widely studied as a predictor of survival in hospice and palliative care populations. [5][6][7][8] The PPS is scored from 0 to 100 in 10-point increments to create an 11-point scale in which higher numbers correspond to better functional status. We also considered clinical variables that have not been studied as predictors of prognosis in this population, but which are plausibly associated with poor survival.…”

Evaluation of the symptoms and treatment prescribed to hospitalized patients

“…18 In a study by Weng et al, which assessed the relationship between PPS and days survived by patients with cancerous diseases, the survival rate found was lower: PPS≤30% -6 days, PPS=40% -19 days, 50%≥PPS -34 days. 19 In view of these results, it can be suggested that the PPS scale is used routinely as a predictive prognosis factor. The prognostic evaluation is important for the implementation of PC and, consequently, for adequate control of the symptoms of patients, with subsequent improvement of their quality of life.…”

“…The prognostic evaluation is important for the implementation of PC and, consequently, for adequate control of the symptoms of patients, with subsequent improvement of their quality of life. [18][19][20] An important piece of data noted in this study was that patients with mild symptoms presented worsening of such in the second assessment conducted by the researcher. This fact allows us to deduce that these symptoms are poorly diagnosed and, thus, poorly controlled.…”

“…4,9 Another tool is the Palliative Performance Scale (PPS) that was created to measure the patient's functional status and validated as one of the weapons for prognosis prediction. [17][18][19] It is based on five dimensions: ambulation, activity and evidence of disease, self-care, intake and level of consciousness. This score ranges from 0 to 100 in intervals of 10 points, with higher scores representing a better performance status.…”

Change in Palliative Performance Scale (PPS) Predicts Survival in Patients with Terminal Cancer

“…Such prognostic factors provide more accurate clinical information about patients to their physicians. Among them, Palliative Performance Scale (PPS) is one of most commonly used tool to evaluate patient' (10), numerous studies showed prognostic value of PPS (7,(11)(12)(13)(14)(15). PPS consisted of five parameters (ambulation, activity and evidence of disease, self-care, intake, and level of consciousness) which are mainly focused on patient's physical function.…”