Article Text

Clinical frailty and performance scale translation in palliative care: scoping review
  1. Felicity Dewhurst1,2,
  2. Daniel Stow1,
  3. Paul Paes3,4,
  4. Katherine Frew3 and
  5. Barbara Hanratty1
  1. 1 Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
  2. 2 Palliative Medicine, St Oswald's Hospice, Newcastle upon Tyne, UK
  3. 3 Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
  4. 4 School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr Felicity Dewhurst, Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK; drfelicitywerrett{at}


Background Frailty is associated with advancing age and increases the risk of adverse outcomes and death. Routine assessment of frailty is becoming more common in a number of healthcare settings, but not in palliative care, where performance scales (eg, the Australia-modified Karnofsky Performance Status Scale (AKPS)) are more commonly employed. A shared understanding of performance and frailty measures could aid interspecialty collaboration in both end-of-life care research and clinical practice.

Aims To identify and synthesise evidence comparing measures of performance routinely collected in palliative care with the Clinical Frailty Scale (CFS), and create a conversion chart to support interspecialty communication.

Methods A scoping literature review with comprehensive searches of PubMed, Web of Science, Ovid SP, the Cochrane Library and reference lists. Eligible articles compared the CFS with the AKPS, Palliative Performance Scale (PPS), Karnofsky Performance Scale or Eastern Cooperative Oncology Group Performance Status or compared these performance scales, in patients aged >18 in any setting.

Results Searches retrieved 3124 articles. Two articles directly compared CFS to the PPS. Thirteen studies translated between different performance scores, facilitating subsequent conversion to CFS, specifically: AKPS/PPS 10/20=very severe frailty, AKPS/PPS 30=severe frailty, AKPS/PPS 40/50=moderate frailty, AKPS/PPS60=mild frailty.

Conclusion We present a tool for converting between the CFS and performance measures commonly used in palliative care. A small number of studies provided evidence for the direct translation between CFS and the PPS. Therefore, more primary evidence is needed from a wider range of population settings, and performance measures to support this conversion.

  • Clinical decisions
  • Communication
  • Prognosis
  • Supportive care
  • Clinical assessment

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  • Contributors All authors: FD, DS, BH, PP and KF met the following conditions (1) Made a substantial contribution to the concept or design of the work, or acquisition, analysis, or interpretation of data, (2) Drafted the article or revised it critically for important intellectual content, (3) Approved the version to be published and (4) Have participated sufficiently in the work to take public responsibility for appropriate portions of the content. FD, DS, BH, PP and KF were responsible for the designing and conducting the review. FD produced the initial draft of the manuscript. All authors critically reviewed the manuscript and contributed to redrafting. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions relating to the accuracy or the integrity of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.