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Serial Palliative Performance Scale Assessment in a University General Hospital: A Pilot Study.

Rafael Barone de Medeiros1, Ana Maria Nunes de Faria Stamm1, Rachel Duarte Moritz1

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Summary

Serial Palliative Performance Scale (PPS) assessments effectively predict functional decline in cancer and noncancer patients. These assessments aid in prognosis and end-of-life decision-making for patients receiving palliative care.

Keywords:
Palliative Performance Scaleend of lifepalliative careprognosis

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Area of Science:

  • Palliative Care
  • Oncology
  • Geriatrics

Background:

  • Serial Palliative Performance Scale (PPS) assessments are crucial for predicting functional decline and prognosis in diverse patient populations.
  • These assessments support informed end-of-life decision-making for both cancer and noncancer patients.

Purpose of the Study:

  • To evaluate the utility of serial Palliative Performance Scale (PPS) assessments in tracking functional status.
  • To assess patients managed collaboratively by a palliative care team (PCT).

Main Methods:

  • A prospective cohort pilot study involving 64 cancer and noncancer inpatients from 2012-2016.
  • PPS scores were recorded at three stages: prehospital, initial PCT assessment, and outcome (discharge, transfer, or death).
  • Functional performance was categorized as stable (70-100%), transitional (40-60%), or end-of-life (10-30%).

Main Results:

  • Mean PPS scores significantly decreased across the three assessment stages (60.5% to 25.9%, p < 0.001).
  • Both cancer and noncancer patients showed functional decline during hospitalization, with cancer patients having higher initial scores.
  • A negative correlation was observed between time intervals and PPS scores (Pearson -0.4 to -0.6, p < 0.01).
  • Patients in the end-of-life PPS category experienced earlier mortality.

Conclusions:

  • Serial PPS assessments are feasible and reliably predict functional decline in hospitalized cancer and noncancer patients.
  • Functional status deteriorates throughout hospitalization for both patient groups.
  • The PPS scale effectively identifies patients at higher risk of imminent mortality.