Question

e. 4. Describe a person's level of functioning when they have a PPS of 2001 onc con

Answer 1

The Palliative Performance Scale

The Palliative Performance Scale (PPS) is a valid, reliable functional assessment tool developed by Victoria Hospice that is based on the Karnofsky Performance Scale (KPS) and is incorporated into the collaborative care plans in the Palliative Care Integration Project that began in Kingston. This tool provides a framework for measuring progressive decline in palliative patients.

In the PPS, physical performance is measured in 10% decremental levels from fully ambulatory and healthy (100%) to death (0%). These levels are further differentiated by five observable parameters:

1. the degree of ambulation

2. ability to do activities/extent of disease

3. ability to do self care

4. food/fluid intake

5. level of consciousness

PPS Stages

The PPS can also be broken into three stages:

· Stable

· Transitional

· End-of-Life.

	PPS	Special Concerns
Stable	100-70%	- patient/family need for hope/understanding of disease - patient/family education re: disease management, medications, personal care, nutrition, symptom crisis/distress management plan - Referrals to optimized functioning - CCAC, physio/OT, dietitian, etc. - psychosocial assessment - spiritual assessment - cultural/religious resources
Transitional	60-40%	- most difficult for patients - impacts on all spheres of life (need for holisitic, patient and family-centred care) - requires greatest amount of nursing care - increasing care and educational needs
End-of-Life	<30%	- review medications/routes of administration, need for further investigations/lab tests/ clinic visits - determine main contact in the community - family physician, homecare, palliative care physician - pain/symptom management - prepare family for death - what do they expect, what are their past experiences with death - ensure affairs are in order - e.g. POA, wills, custody arrangements for children, etc.

Transitional stage needs:

· coordination of care and services

· establishment and maintenance of support systems

· education of care givers

· symptom management

· end of life planning

During the Transitional stage, we must consider the psychological, social and economic as well as the physical changes a patient experiences in order to provide holistic, patient and family centered care. Transition is said to be a challenge to a patients’ self-identity. It is therefore, imperative that healthcare professionals have an understanding of the transition process in order to assist patients and their families to move through it.

Palliative Care Conference:

If resident is at a 30% or below, a palliative care conference should be called. Registered staff will recognize that 30% or below is to trigger a care conference and this should be brought to the attention of the rest of the healthcare team. A care conference is planned after team discusses resident situation and appropriateness of care conference. A palliative care conference is used to inform family members, staff and the resident (if able to attend), the state the resident is at and to further discuss care planning for resident.