Prognostication in Hospice Care: Can the Palliative Performance Scale Help?

Abstract

Background: Accurate prognostication of the trajectory of an illness provides multiple benefits in end-of-life care. Prognostic information facilitates more realistic decision making regarding ongoing treatment, fosters risk–benefit considerations of specific interventions, and contributes to appropriate utilization of health care services. Objective: The Palliative Performance Scale (PPS) has been used as a tool for measurement of functional status in palliative care. This study explores the application of the PPS as a tool for projecting length of stay until death or discharge in a home-based hospice program. Methods: Records of 396 patients admitted to a large community-based hospice program between January 1, 2001, and March 31, 2001, were reviewed. PPS scores were evaluated for their predictive ability related to length of hospice survival and consideration for hospice discharge. Other variables analyzed included diagnosis, presence of comorbidities, and age. Results: PPS scores were associated with length of survival. Negative-change scores were predictive of patient decline toward death, while stable PPS ratings over time resulted in discharge consideration. The tool as used by this hospice was not highly discriminating between the 30% to 40% scores or the 50% to 70% scores. Conclusion: The PPS scores are associated with patient length of survival in a hospice program and can be used in evaluating hospice appropriateness.