Palliative Performance Scale

Learn about the Palliative Performance Scale and its application in hospice care. Download a free PDF template and follow our guide to using the PPS effectively.

By Audrey Liz Perez on Jun 20, 2024.


Fact Checked by RJ Gumban.

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Palliative Performance Scale PDF Example
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What is a Palliative Performance Scale (PPS)?

The Palliative Performance Scale (PPS) is a reliable and valid tool based on and derived from the Karnofsky Performance Scale (KPS). Healthcare professionals use it to assess the functional status of palliative care patients, commonly advanced cancer patients or those with a significant disease (Anderson et al., 1996).

The PPS comprehensively evaluates a patient's ability to perform daily activities and addresses physical decline, level of consciousness, and the need for assistance. This is an 11-point scale ranging from 0% to 100%, with 10% increments. Each score represents a specific level of functional ability and describes the extent of assistance required for self-care activities, such as ambulation, activity level, evidence of disease, intake, and consciousness level (Ho et al., 2008).

At the higher end of the scale, a score of 100% indicates a fully ambulatory patient with normal activity levels and self-care abilities with minimal or no help. As the score decreases, the patient's functional status declines, indicating a greater need for assistance and a higher level of palliative care interventions.

The PPS scale is widely used in palliative care settings, including hospice care and a palliative care unit, to assess a patient's eligibility for services and to guide care planning. Patients with a PPS score of 70% or lower are generally considered appropriate candidates for hospice care, as they typically require considerable assistance with self-care activities and have limited life expectancy.

Printable Palliative Performance Scale

Download this Palliative Performance Scale to evaluate the functional status of patients receiving palliative or hospice care

How does this PPS Scale work?

The Palliative Performance Scale (PPS) assesses a patient's functional status, particularly in palliative and hospice care. By systematically evaluating key aspects of a patient's condition, such as ambulation, activity level, self-care, intake of fooWhat does this assess among palliative care patients?

The PPS uses a 100-point scale, with 100% representing a patient's normal activity level and 0% indicating death. By evaluating five critical areas of a patient's daily life, the PPS offers a snapshot of their functional ability (Ho et al., 2008):

  • Ambulation: Ranging from fully ambulatory to completely bed-bound.
  • Activity and evidence of disease: Considering normal activity, reduced ambulation, and extensive disease.
  • Self-care: Assessing the assistance required for self-care activities, such as bathing, dressing, and eating.
  • Intake: Evaluating the person's usual eating habits or oral intake and need for nutritional sustenance.
  • Conscious level: Ranging from full alertness to coma or minimal responsiveness to verbal or physical stimuli.

The PPS score provides valuable information for health care professionals in palliative care settings, hospice care, and end-of-life care situations.

How does this Palliative Performance Scale work?

The PPS is a reliable tool used in palliative care to assess a patient’s physical abilities, level of consciousness, and overall care needs. Below is a step-by-step guide on how the PPS works, making it a comprehensive resource for healthcare practitioners.

Step 1: Determining the level of ambulation and activity

Begin by assessing the patient’s physical ability to perform daily activities and their level of ambulation. On the PPS, being fully ambulatory and able to carry on with normal job duties or hobbies like enjoying walking or backyard putting corresponds to higher scores, indicating minimal impact on the patient's lifestyle.

Step 2: Evaluating the ability to carry out self-care

The self-care column of the PPS measures a patient's ability to fulfill personal care tasks, ranging from fully independent to completely unable, showcasing degrees of physical decline.  The goal is to pinpoint where patients require minor assistance for certain activities, significant help, or are totally bed-bound, guiding healthcare providers in adjusting care strategies accordingly.

Step 3: Assessing oral intake and response to physical stimuli

A normal intake reflects a diet unaltered by disease, while new or challenging symptoms due to illnesses like cancer or extensive disease may affect this. Additionally, evaluating how the patient responds to external stimuli helps in understanding their conscious level and the presence of good cognitive abilities. This is crucial in planning active treatments or palliative measures.

Step 4: Refer to the PPS

The PPS's prognostic value lies in its ability to predict median survival time based on the patient’s condition. This function is instrumental for clinicians in making informed clinical judgments regarding disease progression and potential significant complications.

Step 5: Calculating the PPS score and implementing care plans

After evaluating the patient across different dimensions—activity, self-care, oral intake, and consciousness—the PPS score is determined. This score ranges from 100% (full alertness and normal activity) to 0% (death). Using this score, healthcare professionals can communicate effectively about the patient’s status and tailor care plans that address physical decline, provide appropriate support for maintaining quality of life, and help in decision-making for advanced care planning.

Scoring the PPS

Scoring the PPS assessment is straightforward. After completing the five steps outlined above, assign the PPS score corresponding to the most accurate description of the patient's condition, ranging from 0% to 100% in 10% increments:

  • A score of 100% indicates a fully ambulatory patient with normal activity levels and self-care abilities.
  • A score of 0% represents a patient who is entirely bed-bound, unable to provide self-care, and minimally responsive to stimuli.

Note that the PPS should be used as a part of a comprehensive palliative care assessment and in conjunction with other clinical observations and prognostic tools.

Palliative Performance Scale example (sample)

We have provided a sample template of the PPS for your reference. This example illustrates how the PPS is structured, with each category of functional status broken down into specific criteria.

By familiarizing yourself with the template, you can better understand how to use the PPS in clinical practice.

Download this Palliative Performance Scale example (sample) here:

Palliative Performance Scale example (sample)

When to use the PPS?

The PPS Scale is essential when caring for patients with advanced illnesses, particularly those receiving palliative or hospice care. Its primary purpose is objectively assessing a patient's functional status, which can inform various aspects of their care. 

Here are several instances when using the PPS Scale in hospice care is most appropriate:

Initial assessment

The PPS Scale can be used during the initial assessment of a patient entering palliative or hospice care. This baseline measurement helps the care team understand the patient's functional status and develop a tailored care plan.

Ongoing monitoring

Regular use of the PPS Scale enables the care team to track changes in a patient's functional status over time. This ongoing monitoring is crucial for identifying trends, adjusting care plans, and ensuring appropriate interventions are in place to support the patient's needs.

Treatment decisions

The PPS Scale can guide healthcare professionals in making informed treatment decisions. For example, a decline in the PPS score may prompt the care team to reevaluate the current treatment plan, consider alternative interventions, or discuss care goals with the patient and their family.

Care transitions

The PPS Scale can be a valuable tool when determining appropriate care transitions, such as moving a patient from the hospital to hospice care or from one level of hospice care to another. A change in PPS score can signal the need for a different care setting or additional support.

In summary, the PPS Scale, hospice eligibility assessments, and other measures can provide healthcare professionals valuable insights into a patient's functional status. 

Benefits of free PPS template

The free Hospice PPS Scale template offers several advantages to healthcare professionals in palliative and hospice care settings. This is a standardized and accessible way to assess a patient's functional status. The PPS can improve patient outcomes, facilitate communication among the care team, and streamline the decision-making process. 

This section will explore the key benefits of using a free Hospice PPS Scale template in greater detail.

Standardized assessment

The PPS provides a standardized method for assessing a patient's functional status, promoting consistency and clarity among healthcare professionals. This common language helps ensure that all care team members have a shared understanding of the patient's condition, which can lead to more informed decision-making and better patient outcomes.

Improved communication

Using the PPS can facilitate communication among the care team by concisely summarizing the patient's functional status. This can help prevent misunderstandings and promote more effective collaboration, ultimately improving the quality of care provided to the patient.

Guides clinical decision-making

The PPS can help inform decisions about treatment plans, resource allocation, and care transitions, leading to more personalized and appropriate care. By offering a snapshot of the patient's current functional status, the PPS can assist healthcare professionals in identifying areas where additional support or intervention may be needed.

Healthcare professionals can use our free Hospice PPS Scale template to take advantage of these benefits and improve the quality of care provided to patients in palliative and hospice settings.

Why use Carepatron as your PPS app?

Carepatron is the ideal practice management software for using the Palliative Performance Scale and other assessment tools. Here's why:

  • Accessibility: Carepatron is accessible from any device with an internet connection, making it easy to complete assessments on the go.
  • Collaboration: The platform allows seamless collaboration among healthcare professionals, promoting effective communication and decision-making.
  • Customizable templates: Our clinical documentation software offers templates for various assessments, including the PPS, enabling clinicians to tailor tools to their specific needs and preferences.
  • Secure data storage: Patient information is securely stored on the Carepatron platform, ensuring compliance with privacy regulations.

Choose Carepatron as your practice management partner and transform how you deliver care. Get started today!

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Anderson, F., Downing, G. M., Hill, J., Casorso, L., & Lerch, N. (1996). Palliative performance scale (PPS): a new tool. Journal of Palliative Care, 12(1), 5–11.

Ho, F., Lau, F., Downing, M. G., & Lesperance, M. (2008). A reliability and validity study of the palliative performance scale. BMC Palliative Care, 7, 10.

What is a Palliative Performance Scale?
What is a Palliative Performance Scale?

Commonly asked questions

What is a Palliative Performance Scale?

Healthcare professionals use the Palliative Performance Scale (PPS) to assess the functional status and decline of palliative care patients, primarily those with advanced cancer or other significant illnesses. The PPS evaluates five key areas: ambulation, activity, evidence of disease, self-care, oral intake, and level of consciousness.

What does a PPS score of 30 mean?

A PPS score of 30% indicates that the patient is entirely bed-bound, requiring extensive assistance for all self-care activities, and has a minimal intake, often only able to take sips of fluid. At this stage, the patient is likely experiencing profound weakness or paralysis, with a significantly reduced level of consciousness, potentially ranging from drowsiness to coma.

What is the difference between the PPS and the Karnofsky scale?

While both scales assess a patient's functional status and ability to perform daily activities, the PPS is specifically designed for palliative care settings and focuses on five key areas. In contrast, the KPS is a broader measure of general performance status. Additionally, the PPS scale is presented in 10% increments, while the KPS uses a 100-point scale with 10-point increments.

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