3. Self-Care: ‘Occasional assistance’ means that most of the clinical situation, the patient may or may not be able to chew time patients are able to transfer out of bed, walk, wash, and swallow food once prepared and fed to him or her. toilet and eat by their own means, but that on occasion (per- 4. Intake: Changes in intake are quite obvious with ‘normal haps once daily or a few times weekly) they require minor Palliative Performance Scale (PPS) intake’ referring to the person’s usual eating habits while assistance. healthy. ‘Reduced’ means any reduction from that and is ‘Considerable assistance’ means that regularly every highly variable according to the unique individual circum- day the patient needs help, usually by one person, to do stances. ‘Minimal’ refers to very small amounts, usually pu- some of the activities noted above. For example, the per- reed or liquid, which are well below nutritional sustenance. son needs help to get to the bathroom but is then able to 5. Conscious Level: ‘Full consciousness’ implies full alert- brush his or her teeth or wash at least hands and face. Food The Palliative Performance Scale (PPS) is a validated and reliable tool used ness and orientation with good cognitive abilities in will often need to be cut into edible sizes but the patient is various domains of thinking, memory, etc. ‘Confusion’ is to assess a patient’s functional performance and to determine progression then able to eat of his or her own accord. used to denote presence of either delirium or dementia toward end of life. However, it does not take the place of a physician’s ‘Mainly assistance’ is a further extension of ‘considerable.’ and is a reduced level of consciousness. It may be mild, Using the above example, the patient now needs help get- moderate or severe with multiple possible etiologies. professional judgment. ting up but also needs assistance washing his face and shav- ‘Drowsiness’ implies either fatigue, drug side effects, de-

ing, but can usually eat with minimal or no help. This may lirium or closeness to death and is sometimes included VNSNY-HOS-1251A fluctuate according to fatigue during the day. in the term stupor. ‘Coma’ in this context is the absence This reference card can be helpful for clinicians in timing the goals-of-care of response to verbal or physical stimuli; some reflexes ‘Total care’ means that the patient is completely unable to conversation with patients and their families. may or may not remain. The depth of coma may fluctuate eat without help, toilet or do any self-care. Depending on the throughout a 24 hour period.

1 Harrold, Joan, Rickerson, Elizabeth, Carroll, Janet T., McGrath, Jennifer, Morales, Knashawn, Kapo, Jennifer, Casarett, David. Is the Palliative Scale a Useful Predictor of Mortality in a Heterogeneous Hospice Program? Journal of Palliative Medicine. 2005, 43 (3): 503-509. Patients with a PPS score of < 70% may be appropriate for hospice care. Research 2 Palliative Performance Scale (PPSv2) version 2. Medical Care of the Dying, 4th ed.; 120-121. ©Victoria Hospice Society, 2006. substantiates, for these patients, survival for greater than six months is unlikely.1

To make a referral, call 212-609-1900. Or fax a referral to 212-290-1825. For more information, visit us online at vnsny.org/professionals/hospice. Would you be surprised if this patient lived longer than one year? Hospice Appropriate Stable Palliative Performance Scale (PPSv2) version 2 PPS Level PPS 100% 40% 90% 60% 80% 50% 20% 30% 70% 10% 0% Totally bed bound Totally bed bound Totally bed bound Totally bed Mainly in bed Mainly sit/lie Ambulation Reduced Reduced Death Full Full Full Unable to do normal job/work job/work normal todo Unable Activity & Evidence of Disease of &Evidence Activity Unable to do hobby/housework todo Unable Normal activity withNormal effort activity Unable to do most activity most todo Unable Some evidence of disease Some evidence of disease Unable to do any activity to do Unable any activity todo Unable any activity todo Unable Normal activity &work activity Normal &work activity Normal No evidence of disease of evidence No Unable to do any work todo Unable Significant disease Significant disease Significant Extensive disease Extensive disease Extensive disease Extensive disease Extensive disease Extensive -

Considerable assistance assistance Considerable Occasional assistance assistance Occasional Mainly assistance necessary Total care Total care Total care Self-Care required Full Full Full Full - 2 Normal or reduced or Normal reduced or Normal reduced or Normal reduced or Normal reduced or Normal reduced or Normal Mouth care only care Mouth Minimal tosips Minimal Normal Normal Intake - Full or confusion Full or confusion Drowsy or coma or Drowsy Conscious Level Conscious Full or drowsy drowsy or Full drowsy or Full drowsy or Full +/- confusion +/- confusion +/- confusion +/- confusion Full Full Full Full -

As notedAs below, some of the terms have similar meanings with the differencesbeing more all five five all columns. Definition of Terms for PPS readily apparent as one reads horizontally across each row to find an overall ‘bestusing fit’ 1. ‘ 2. 2. ‘bed’ is proportionate to the amount of time the patient patient the time of amount to the is proportionate ‘bed’ Ambulation: either profound weakness or paralysis such that the the that such paralysis or weakness profound either differences are related to items in the self-care column. column. self-care the in items to related are differences and ‘ and patient not only can’t get out of bed but is also unable unable isalso but bed of out get can’t only not patient to do any self-care. The difference between ‘sit/lie’ and and ‘sit/lie’ between difference The anyto do self-care. is able to sit up vs need to lie down. to lie need vs up to sit is able For example, ‘totally bed bound’ at PPS 30% is due to isdue at PPS 30% bound’ bed ‘totally example, For duction of ambulation is tied to inability to carry out out to carry to inability istied ambulation of duction assistance. Activity & Extent of Disease: of &Extent Activity transfer on their own but at PPS 60% needs occasional occasional needs at PPS 60% but own their on transfer their normal job, work occupation or some hobbies or PPS 60% level. By using the adjacent column, the re the column, adjacent the using By level. PPS 60% housework activities. The person is still able to walk and and to walk able isstill person The activities. housework gative evidence which shows degrees of progression. progression. of degrees shows which evidence gative and ‘ and For example in breast cancer, a local recurrence would would recurrence cancer, a local breast in example For Reduced ambulation totally bed bound extensive

The items ‘ items The ’ disease refer to physical and investi and to physical refer ’ disease ’ is located at the PPS 70% at the and ’ islocated mainly sit/lie ’ are clearly similar. The subtle similar. subtle The clearly ’ are ‘ Some ,’ ‘ ,’ mainly in bed ,’ ‘ ,’ significant ,’ ,’ ,’ ,’ - -

‘Extensive’ refers to‘Extensive’ one or more serious complications ‘significant’ to AIDS, HIV from shift the may mean ‘some’ The above extent of disease is also judged in context context in judged isalso disease of extent above The close to death (eg. trying to walk the halls). the to walk (eg. trying to death close enjoy who People putting. to backyard 3, or a par just or although they may continue trying, sometimes even even sometimes trying, may continue they although still person the may mean activity in Decline activities. plays golf but reduces from playing 18 holes to 9 holes, 18 to playing 9 holes, from holes reduces but golf plays walking will gradually reduce the distance covered, covered, distance the reduce gradually will walking or hobbies and one’s work to maintain ability the with symptoms and laboratory findings with low counts. low counts. with findings laboratory and symptoms or bone would imply ‘significant’ disease, whereas mul whereas disease, ‘significant’ imply would bone or disease despite active treatments. Using PPS in AIDS, PPS Using AIDS, in treatments. active despite disease of to progression refer may also extent The disease. antibiotics, etc. etc. antibiotics, mia or other major complications would be ‘extensive’ ‘extensive’ be would complications major other or mia with or without continuation of active antiretrovirals, antiretrovirals, continuation active of without or with liver, hypercalce bone, brain, lung, in metastases tiple imply ‘some’ disease, one or two metastases in the lung lung the in metastases two or one disease, ‘some’ imply implies progression in physical decline, new or difficult difficult or new decline, physical in progression implies - -