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

Baik, Dawon; Russell, David; Jordan, Lizeyka; Dooley, Frances; Bowles, Kathryn H.; Creber, Ruth Masterson

doi:10.1089/jpm.2018.0141

Cited by 69 publications

(57 citation statements)

References 32 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. 14,15,16 The relationship between a lower PPSv2 score and shorter length of survival has been reported most commonly for patients with cancer. 14,15,16 The relationship between a lower PPSv2 score and shorter length of survival has been reported most commonly for patients with cancer.…”

Section: Introductionmentioning

confidence: 99%

“…13 Two systematic literature reviews report that the PPSv2 is highly predictive of survival in mixed palliative care populations. 14,15,16 The relationship between a lower PPSv2 score and shorter length of survival has been reported most commonly for patients with cancer. 17 To our knowledge, this is the first study to use the PPSv2 to estimate survival time among home hospice heart failure patients.…”

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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“…According to our multinomial logistic regression model, the most consistent predictor of complex and highly complex situations is the performance status; thus, PPS values <40% increase the likelihood of moderate or high levels of complexity by 8 and 10 times, respectively. This association is a novel finding; to our knowledge, the previous use of PPS has mainly been limited to the initial assessment for an end-of-life prognosis and for the prediction of survival [ 30 , 31 ]. However, we believe this finding is logical and consistent with the fact that the sudden appearance of disabling functional impairment is the most frequent element of complexity among the patients studied.…”

Section: Discussionmentioning

confidence: 99%

Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis

Carrasco-Zafra

García

Ocaña-Riola

et al. 2020

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The current treatment approach for patients in palliative care (PC) requires a health model based on shared and individualised care, according to the degree of complexity encountered. The aims of this study were to describe the levels of complexity that may be present, to determine their most prevalent elements and to identify factors that may be related to palliative complexity in advanced-stage cancer patients. An observational retrospective study was performed of patients attended to at the Cudeca Hospice. Socio-demographic and clinical data were compiled, together with information on the patients’ functional and performance status (according to the Palliative Performance Scale (PPS)). The level of complexity was determined by the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal©) and classified as highly complex, complex or non-complex. The impact of the independent variables on PC complexity was assessed by multinomial logistic regression analysis. Of the 501 patients studied, 44.8% presented a situation classed as highly complex and another 44% were considered complex. The highly complex items most frequently observed were the absence or insufficiency of family support and/or caregivers (24.3%) and the presence of difficult-to-control symptoms (17.3%). The complex item most frequently observed was an abrupt change in the level of functional autonomy (47.6%). The main factor related to the presence of high vs. non-complexity was that of performance status (odds ratio (OR) = 10.68, 95% confidence interval (CI) = 2.81–40.52, for PPS values < 40%). However, age was inversely related to high complexity. This study confirms the high level of complexity present in patients referred to a PC centre. Determining the factors related to this complexity could help physicians identify situations calling for timely referral for specialised PC, such as a low PPS score.

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“…It was developed from the Karnofsky Performance Scale [22]. It is oriented on physical functions and activities and can be used for prognostication and planning care [23]. Patients' performance is scored by percentage in 11 categories from fully ambulatory and healthy (100%) to death (0%).…”

Section: Methodsmentioning

confidence: 99%

Psychometric properties of the Czech Integrated Palliative Outcome Scale: reliability and content validity analysis

et al. 2020

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Background: Outcome measurement is an essential part of the evaluation of palliative care and the measurements need to be reliable, valid and adapted to the culture in which they are used. The Integrated Palliative Outcome Scale (IPOS) is a widely used tool for assessing personal-level outcomes in palliative care. The aim of this study was to provide Czech version of IPOS and assess its psychometric properties. Methods: Patients receiving palliative care in hospice or hospitals completed the IPOS. The reliability of Czech IPOS was tested with Cronbach alpha (for internal consistency), the intraclass correlation coefficient for total IPOS score and weighted Kappa (for test-retest reliability of individual items). Factor analysis was used for elucidating the construct (Exploratory Factor Analysis). Convergent validity was tested with correlation analysis (Spearman correlation) in a part of the sample, who completed also the Edmonton Symptom Assessment System (ESAS) and the Palliative Performance Scale (PPS). Results: The sample consisted of 140 patients (mean age 72; 90 women; 81% oncological disease). The Cronbach alpha was 0.789; intraclass correlation was 0.88. The correlations of IPOS with ESAS was R = 0.4 and PPS R = − 0.2. Exploratory factor analysis revealed a 2-factor solution on our data. The first factor covers emotional and information needs and the second factor covers physical symptoms. Conclusion: Czech IPOS has very good reliability regarding both internal consistency and test-retest reliability. Together with an item analysis results, we can conclude that the Czech adaptation of the tool was successful. The convergent validity needs to be assessed on the larger sample and the proposed 2-factor internal structure of the questionnaire has to be confirmed by using CFA.

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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

Abstract: 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.

Cited by 69 publications

References 32 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

Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis

Psychometric properties of the Czech Integrated Palliative Outcome Scale: reliability and content validity analysis

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