title: Survival implications of sudden functional decline as a sentinel event using the palliative performance scale.
abstract: BACKGROUND
  This retrospective study analyzed sudden functional decline using the Palliative Performance Scale (PPSv2) for patients recently admitted to a palliative care unit (PCU) to determine if this adversely affects survival. There were 3328 patients in the cohort over a 13-year period admitted to a tertiary palliative care bed (71.1%) or a residential hospice bed (28.9%). Patient age ranged from 17-102 years old with 51.9% female and 48.1% male; the majority (88.3%) had a cancer diagnosis.
  
  
  RESULTS
  Given several limitations noted in the study, six preliminary findings emerged: (1) The lower the initial PPS at PCU admission, the higher the likelihood of an abrupt drop occurring shortly after admission; (2) An abrupt decline in function appears to be associated with smaller survival probabilities; (3) A greater increment change in PPS may be associated with shorter survival probabilities; (4) The lower the PPS on admission, the shorter the survival; (5) When dropping a specific increment amount, the new survival projection appears similar to the PPS level dropped to; and (6) Sudden or abrupt functional decline may be a sentinel event.
  
  
  CONCLUSIONS
  The data provide evidence that abrupt functional decline implies the likelihood of shorter survival in palliative care patients and may act as a sentinel marker. It is unclear whether these findings would be generalizable outside of a PCU. These results should be interpreted with caution as a prospective evaluation is needed to confirm the results. If substantiated, it may be that incorporating sudden functional decline into palliative prognostic models may increase their predictive accuracy.
authors.affiliation: Department of Palliative Medicine, Victoria Hospice Society, Victoria, British Columbia, Canada. michael.downing@viha.ca
authors.forename: G Michael
authors.initials: GM
authors.lastname: Downing
authors.forename: Mary
authors.initials: M
authors.lastname: Lesperance
authors.forename: Francis
authors.initials: F
authors.lastname: Lau
authors.forename: Ju
authors.initials: J
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D015996:Survival Rate