title: Revisiting the Palliative Performance Scale: change in scores during disease trajectory predicts survival.
abstract: BACKGROUND
  The Palliative Performance Scale (PPS) on admission is a predictor of survival. However, it is not highly discriminating for mid-range scores. 'PPS Change' between two time points considers the disease trajectory, and may improve the scale's utility.
  
  
  OBJECTIVE
  The aim of this study is to determine if a change in PPS scores between two significant time points predicts survival.
  
  
  METHODS
  This prospective cohort study examined 'Change on Admission', 'Change at Week 1', and 'Change at Week 2'. We followed patients until death or 6 months, whichever was earlier. Cox regressions were used to determine if the Change scores were predictors of survival, adjusting for age, sex, diagnosis category, Charlson Index, and Do-Not-Resuscitate order.
  
  
  METHODS
  The sample consisted of patients referred to the palliative care service.
  
  
  RESULTS
  All three Change scores were independent predictors of survival. The greater the change, the poorer the prognosis. At week 1, when compared to 'PPS Change ≤ 10%', 'Change 11% -30%' and 'Change > 30%' increased the hazard ratios by 1.70 (95% CI 1.10-2.63) and 3.14 (95% CI 1.77-5.59), respectively. At week 2, when compared to 'PPS Change ≤ 10%', 'Change 11% -30%' and 'Change > 30%' increased the hazard ratios by almost 3- and 8-fold, respectively. The same magnitude of Change scores also has higher hazard ratios as patients' hospitalization progressed.
  
  
  CONCLUSIONS
  The magnitude of change in PPS score during the disease trajectory is associated with one's survival and is a potentially useful prognostication tool. Further research is needed to extend on our work.
authors: Nursing Service, Tan Tock Seng Hospital, Singapore. eeyuee@gmail.com
authors: Ee-Yuee
authors: EY
authors: Chan
authors: Huei-Yaw
authors: HY
authors: Wu
authors: Yiong-Huak
authors: YH
authors: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012846:Singapore; D016019:Survival Analysis