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Fast Fact and Concept #125: The Palliative Performance Scale (PPS)

L. Scott Wilner, MD and Robert Arnold, MD

The Palliative Performance Scale (PPS) uses five observer-rated domains correlated to the Karnofsky Performance Scale (100-0). The PPS is a reliable and valid tool and correlates well with actual survival and median survival time for cancer patients. It has been found useful for purposes of identifying and tracking potential care needs of palliative care patients, particularly as these needs change with disease progression. Large validation studies are still needed, as is analysis of how the PPS does, or does not, correlate with other available prognostic tools and commonly used symptom scales.

PALLIATIVE PERFORMANCE SCALE (PPS)
%	Ambulation	Activity Level Evidence of Disease	Self-Care	Intake	Level of Consciousness	Estimated Median Survival in Days (a) (b) (c)
100	Full	Normal No Disease	Full	Normal	Full	N/A	N/A	108
90	Full	Normal Some Disease	Full	Normal	Full
80	Full	Normal with Effort Some Disease	Full	Normal or Reduced	Full
70	Reduced	Can’t do normal job or work Some Disease	Full	as above	Full	145
60	Reduced	Can’t do hobbies or housework Significant Disease	Occasional Assistance Needed	as above	Full or Confusion	29	4
50	Mainly sit/lie	Can’t do any work Extensive Disease	Considerable Assistance Needed	as above	Full or Confusion	30	11	41
40	Mainly in Bed	as above	Mainly Assistance	as above	Full or Drowsy or Confusion	18	8
30	Bed Bound	as above	Total Care	Reduced	as above	8	5
20	Bed Bound	as above	as above	Minimal	as above	4	2	6
10	Bed Bound	as above	as above	Mouth Care Only	Drowsy or coma	1	1	6
0	Death	-	-	-	--

(a) See Virik and Glare, reference below. Survival post admission to inpatient palliative unit.

(b) See Anderson, reference below. Days until inpatient death following admission to an acute hospice unit, diagnoses not specified.

REFERENCES:

Anderson F, Downing GM, Hill J. Palliative Performance Scale (PPS): A New Tool. Journal of Palliative Care. 1996; 12(1); 5-11.
Morita T, Tsunoda J, Inoue S, et al. Validity of the Palliative Performance Scale from a Survival Perspective. J Pain Symp Manage. July, 1999; 18(1): 2-3.
Virik K, Glare P. Validation of the Palliative Performance Scale for Inpatients Admitted to a Palliative Care Unit in Sydney, Australia. J Pain Symp Manage. June, 2002; 23(6): 455-7.

Copyright/Referencing Information : Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Wilner FS and Arnold R. The Palliative Performance Scale. Fast Facts and Concepts #125, November 2004 . End-of-Life/Palliative Education Resource Center www.eperc.mcw.edu.

Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007. For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is use

Creation Date: 10/2004

Format: Handouts

Purpose: Instructional Aid, Self-Study Guide, Teaching

Audience(s)

	Training: Fellows, PGY1 (Interns), PGY2-6, Physicians in Practice
	Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
	Non-Physician: Nurses

ACGME Competencies: prognosis