Background    Accurate prognostic information is important for patients, families, and clinicians.   This Fast Fact reviews the Palliative Performance Scale (PPS). Fast Fact #124 The Palliative Prognostic Score and Fast Fact #444 Palliative Prognostic Index describe additional prognostic tools used in palliative care patients.

The PPS uses five observer-rated domains correlated to the Karnofsky Performance Scale (KPS) (see Fast Fact #416 for additional information on the 100-0 graded KPS). The PPS was designed to facilitate a shared language to communicate patient care needs and prognostication among cancer patients receiving hospice care. Research suggests it is a reliable and valid tool and correlates well with actual survival and median survival time for patients with untreatable cancer in hospice care settings (e.g., home hospice or admitted to a hospice or palliative care unit).  Subsequent small studies have shown mixed results in its prognostic value in adults with non-cancer illnesses.  Large validation studies are still needed, as is analysis of how the PPS does, or does not, correlate with other available prognostic tools. 

(a) Survival post-admission to an inpatient palliative unit, all diagnoses. 
(b) Days until inpatient death following admission to an acute hospice unit, diagnoses not specified. 
(c) Survival post admission to an inpatient palliative unit, cancer patients only. 

References

1. Anderson F, Downing GM, Hill J. Palliative Performance Scale (PPS):  a new tool. J Palliat Care. 1996; 12(1): 5-11.
2. Morita T, Tsunoda J, Inoue S, et al. Validity of the Palliative Performance Scale from a survival perspective. J Pain Symp Manage. 1999; 18(1):2-3.
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. 2002; 23(6):455-7.
4. Myers J, Kim A, Flanagan J. Palliative performance scale and survival among outpatients with advanced cancer. Supportive Care in Cancer 2015; 23.4: 913-918.
5. Downing M, Lau F, Lesperance M, et al. Meta-analysis of survival predication with Palliative Performance Scale. J Palliat Care 2007; 23(4):245-252.
6. Aras G, Arkin FS, Dogu. Can survival in cancer patients be accurately predicted with the Palliative Performance Scale? Family Practice and Palliative Care.
7. Te Paske JR, DeWitt S, Vaughan L. Palliative care and rapid emergency screening tool and the Palliative Performance Scale to predict survival of older adults admitted to the hospital from the emergency department. American Journal of Hospice and Palliative Mediciine 2020; 38(7):800-6.
8. Nasr A. Palliative Performance Scale as a prognostic tool for patients with dementia in hospice. 2021.
9. Masterson Creber RM, Russell D, Dooley F, et al.  Use of the Palliative Performance Scale to estimate survival among home hospice heart failure patients. Journal of Cardiac Failure 2018; 24(8):S76-77.

Version History:  This Fast Fact was originally edited by David E Weissman MD and published in November 2004; 2nd Edition in April 2009; 3rd Edition in July 2015; 4th Edition in March 2025. 
Conflicts of Interest: None to report.