Performance Scales

Question 1

PPS

Palliative Performance Scale

Answer 1

Reliable and Valid tool developed by Victoria Hospice Society, British Columbia, divided into 3 categories:

1. Stable 2. Transitional 3. End of life

Purpose: Measures progressive decline and communication of, workload measurement tool, projects length of survival.

Five observable parameters:

1. Ambulation (Degree of)
2. Activity (Ability to do)
3. Self-care (Ability to do)
4. Intake
5. Level of Consciousness

Ambulation
Reduced 70%, 60% - Look to Activity column. 70% unable to do work but can do hobbies or housework. 60% cannot do work, hobbies, or housework, 60% also comes with occasional self-care.

50%, 40%, 30% - Look to Self-care column. 30% (Totally Bed Bound) needs Total Self Care. 50% and 40% needs assessment of the time spent sitting vs in bed.

Activity
Some - local recurrence.
Significant - one or two metastasis to lung or bone.
Extensive - multiple metastasis, hypercalcemia.

Self-care
Occasional - sometimes needs help.
Considerable - regularly, everyday, needs help but can use toilet and feed once given the opportunity.
Mainly Assistance - regularly, everyday, needs others to help use toilet and feed.
Total Care - Unable to do any Self-care without help.

Intake
Normal - usual while healthy.
Reduced - a reduction of normal.
Minimal - pureed food or liquids.

Conscious Level
Full - full.
Confusion - presence of delirium or dementia and reduced LOC.
Drowsiness - fatigue, drug side effects, delirium, close to death.
Coma - no response.

Question 2

ESAS

Edmonton Symptoms Assesment System

Answer 2

Reliable and Valid to assist in the assessment of 9 common symptoms:

1. Pain
2. Tiredness
3. Nausea
4. Depression
5. Anxiety
6. Drowsiness
7. Appetite
8. Well being
9. Shortness of breath

Can be given by patient, his/her family can self-administer. It is the patients opinion that his the gold standard.

Depression - sad or blue.
Anxiety - nervousness or restlessness.
Tiredness - decreased energy level but not necessarily sleepy.
Drowsiness - sleepiness.
Well-being - overall comfort, answering the question “How are you?”

When a caregiver or professional does the ESAS alone the subjective symptoms scales are not done - tiredness, depression, anxiety, and well being. Pain is assessed on the knowledge of pain behaviour, appetite interpreted as the absence or presence of eating, nausea as the absence or presence of retching/vomiting, and SOB as laboured or accelerated respirations that appear to cause distress.

Question 3

PPI

Palliative Prognosis Index

Answer 3

ONLY used when deteriming expected lenght of stay for cancer patients, with solid tumour.

1. PPS
2. Oral Intake
3. Edema
4. Dyspnea at rest
5. Delerium