The Palliative Performance Scale (PPS) is a specialized tool used primarily in palliative and hospice care to objectively measure a person’s functional status and progressive decline due to advanced illness. This assessment provides a standardized way for healthcare providers to communicate a patient’s condition using a simple percentage-based system. The score ranges from 100%, representing a fully healthy and functional state, down to 0%, which signifies death.
The Five Assessment Criteria
The calculation of the PPS score is based on five observable and distinct functional domains, which are assessed sequentially to determine the patient’s status.
- Ambulation: Evaluates the patient’s ability to walk, ranging from full mobility to being totally bed-bound.
- Activity and Evidence of Disease: Looks at the patient’s capacity to perform normal activities, such as work or hobbies, and whether the disease is actively progressing.
- Self-Care: Assesses the need for assistance with daily tasks like washing, dressing, and toileting, ranging from requiring no help to needing total care.
- Intake: Measures the patient’s ability to consume food and fluids, looking for a reduction from a normal diet to minimal sips.
- Conscious Level: Assesses the patient’s cognitive state, ranging from full alertness to varying degrees of confusion, drowsiness, or coma.
Assigning the Percentage Score
The PPS is scored in 10-point increments, meaning a patient’s score must be 100%, 90%, 80%, and so on, with no scores in between. The process of assigning the percentage is hierarchical, relying on a principle known as “leftward precedence,” where the domains on the left side of the scale (Ambulation and Activity) are the strongest determinants. An assessor reads across the five domains to find the single row that is the “best fit” for the patient’s current status.
A significant drop in one of the leftward domains immediately sets a maximum possible score, even if the patient is performing well in the other areas. For instance, a patient who can no longer ambulate but is still consuming a normal diet and remains fully conscious cannot score higher than 70%. At 70%, the patient has reduced ambulation and is unable to perform normal work or hobbies, yet still manages full self-care.
If a patient is mostly sitting or lying down due to weakness and requires considerable assistance for walking, their score is likely 50%, regardless of their mental clarity or oral intake. This 50% mark indicates a significant shift, as the patient is no longer able to carry out most daily activities, requiring help with self-care. A score of 30% is assigned to a patient who is totally bed-bound and requires total care, even if they can still swallow small amounts of fluid.
Understanding the Score’s Clinical Application
The final PPS score provides healthcare teams with a snapshot that serves multiple purposes in managing advanced illness. The score is widely used to monitor the trajectory of a patient’s decline over time, with a steady decrease indicating disease progression. This measurement helps guide discussions about the transition from aggressive treatment to comfort-focused care.
A specific score is often used as a benchmark for determining eligibility for hospice services. For patients with cancer, a score of 70% or below frequently suggests a level of functional decline appropriate for hospice admission, while for non-cancer diagnoses like advanced heart failure, a score of 50% or below is often the threshold. The lower the PPS score, the shorter the anticipated survival time, making it an aid for prognosis communication.
Scores between 70% and 100% generally represent a stable or mobile patient with minimal to mild functional restriction. A score in the 40% to 60% range indicates a transitional phase where the patient spends a considerable portion of the day sitting or lying down and requires substantial assistance for care. Scores in the 10% to 30% range represent the end-of-life phase, where the patient is totally bed-bound, requires total care, and survival is often measured in weeks or days.