Using the Palliative Performance Scale to Estimate Survival for Patients at the End of Life: A Systematic Review of the Literature

Abstract

Background: The Palliative Performance Scale (PPS) has been widely used for survival prediction among patients with cancer; however, few studies have reviewed PPS scores in heterogeneous palliative care populations across multiple care settings.

Objective: The aim of this systematic review was to determine how the PPS tool has been used to estimate survival at the end of life.

Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and the Cochrane Library were searched for the existing literature published from 2008 to 2017. We synthesized study characteristics, the PPS scores at baseline, and primary outcomes, and explored differences in survival estimates by diagnosis. The quality of the studies was assessed using the Good ReseArch for Comparative Effectiveness (GRACE) checklist.

Results: Seventeen studies were included in this review (nine with cancer and eight with mixed diagnoses). All included studies reported that the PPS exhibited a significant association with survival. Survival estimates ranged from 1 to 3 days for patients with PPS scores of 10% compared with 5 to 36 days for those with scores of 30%. The categorical cut-points for the PPS scores were not consistently reported across studies.

Conclusion: This review provides a broad overview on the prognostic value of the PPS tool for survival among multiple patient populations across care settings. Consistent reporting of PPS scores would facilitate the comparison of survival estimates across end-of-life diagnoses.

Keywords: Palliative Performance Scale; hospices; palliative care; prognosis; review; survival.

Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.

PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

FIG. 2.

Characteristics of included studies. (A) Countries. (B) Study settings. *Mixed palliative care settings included skilled nursing facilities, inpatient palliative care units, home hospice settings, and outpatient palliative care settings.