[END-OF-LIFE PROGNOSTICATION IN ACUTE HOSPITAL PALLIATIVE PATIENTS: IS THE PALLIATIVE PERFORMANCE SCALE USEFUL?].

AIMS

This study examined PPS (Palliative Performance Scale) use as a tool estimating life expectancy in patients with various life-threatening diseases who required palliative consultation during hospitalization in an acute regional hospital in northern Israel.

BACKGROUND

Prognostication is the ability to evaluate outcome and expected course of a medical condition based on knowledge and experience. Special emphasis is given to the prediction of life expectancy in end-of-life situations, as prognosis directs the treatment approach, the policy regarding tests and procedures, and discharge planning. Research mentions two main methods for assessing life expectancy: one is CPS - Clinician's Prediction of Survival and the other is AES - Actuarial Estimation of Survival based on test results, statistics and clinical tools. Since physical status correlates well with survival, it is included in most prognostication tools.

METHODS

A retrospective study for the period January 2015-September 2018 examined the records of patients assessed by the Palliative Consult Team (PCT), using PPS. Variables were initial PPS score, age, gender, ethnic origin, diagnosis and survival time. Patients were monitored six months from initial assessment.

RESULTS

A total of 588 patients' records assessed by PCT using PPS, were included in the study. Findings showed PPS to be a significant predictor of survival for all research groups, with no ethnic differences. In the current study population, differences were found between varied diagnoses in life expectancy and functional status. It also became clear that life expectancy of most subjects with a functional status of PPS-40 and below did not exceed six months.

DISCUSSION

This research strengthens the link between functional status and life expectancy and is the first in Israel to support the use of the PPS tool as part of the prognostication process in patients with a variety of incurable diseases. The presentation of findings in survival ranges according to the value of PPS is unique to this study and its ability to assist medical staff both in making clinical decisions and in choosing the appropriate terminology for the sensitive and complex procedure of delivering a prognosis to a patient and loved ones.