Introducing the Palliative Performance Scale to clinicians: the Grampian experience
- 1Department of Palliative Medicine, NHS Grampian, Aberdeen, UK
- 2Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- 3Institute of Health Research, University of Bedfordshire, Luton, UK
- Correspondence to Gordon Linklater, Palliative Medicine, NHS Grampian, Roxburghe House, Ashgrove Road, Aberdeen AB25 2ZH, UK;
Contributors GL, SL and DC devised the study. SL liaised with the regional ethics committee. SL, GL and LM extracted and analysed the data with SF and DP providing statistician input. GL, SL and SF wrote the paper. LM and DC commented on drafts of the paper.
Objectives The Palliative Performance Scale (PPS) was introduced across NHS Grampian. Our aim was to determine how practical and useful the PPS was for clinicians looking after palliative patients in a variety of settings.
Methods A prospective audit approach was used in primary, secondary and nursing home care settings who. Demographic and assessment data were gathered for 3 months; feedback was gathered at the end of the data collection phase. Patient follow-up status was determined at 12 months.
Results Fifteen clinical sites participated and feedback was obtained from all clinical areas (n=30). Most respondents found the PPS easy to use and that it helped recognise disease progression in cancer patients, but not in patients with dementia/frailty. Assessment data were gathered on 666 patients. Sixty per cent had a malignant diagnosis and 62.5% of the sample died within 12 months. Lower PPS scores at initial assessment indicated poorer prognosis. Median survival figures differed from previously published data. Falling PPS scores increased the risk of death compared with patients whose PPS scores remained static or improved.
Conclusion Clinicians found the PPS to be a quick, useful way of assessing and reviewing functional changes in palliative patients. However, it may not identify the subtle changes in individuals with advanced dementia. The survival figures confirm that caution is needed in generalising survival data across different settings and populations. Further work is needed to examine changing functional status in patients with non-malignant diseases or dementia/frailty.
Funding Friends of Roxburghe House charity.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
- Received 27 September 2011.
- Accepted 9 February 2012.
- Published Online First 31 March 2012
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions