Revisiting the Palliative Performance Scale: Change in scores during disease trajectory predicts survival

Abstract

Background:

The Palliative Performance Scale (PPS) on admission is a predictor of survival. However, it is not highly discriminating for mid-range scores. ‘PPS Change’ between two time points considers the disease trajectory, and may improve the scale’s utility.

Aim:

The aim of this study is to determine if a change in PPS scores between two significant time points predicts survival.

Design:

This prospective cohort study examined ‘Change on Admission’, ‘Change at Week 1’, and ‘Change at Week 2’. We followed patients until death or 6 months, whichever was earlier. Cox regressions were used to determine if the Change scores were predictors of survival, adjusting for age, sex, diagnosis category, Charlson Index, and Do-Not-Resuscitate order.

Setting/Participants:

The sample consisted of patients referred to the palliative care service.

Results:

All three Change scores were independent predictors of survival. The greater the change, the poorer the prognosis. At week 1, when compared to ‘PPS Change ≤ 10%’, ‘Change 11% –30%’ and ‘Change > 30%’ increased the hazard ratios by 1.70 (95% CI 1.10–2.63) and 3.14 (95% CI 1.77–5.59), respectively. At week 2, when compared to ‘PPS Change ≤ 10%’, ‘Change 11% –30%’ and ‘Change > 30%’ increased the hazard ratios by almost 3- and 8-fold, respectively. The same magnitude of Change scores also has higher hazard ratios as patients’ hospitalization progressed.

Conclusions:

The magnitude of change in PPS score during the disease trajectory is associated with one’s survival and is a potentially useful prognostication tool. Further research is needed to extend on our work.