Palliative Performance Scale
The Palliative Performance Scale

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) [3] 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[4], 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


“Stronger” performance indicators are located on the left, and “softer” ones on the right.  In determining the patient’s PPS then, we would first find the level that fits with the patient’s ambulation level.  From that we would work across the  scale keeping in mind that the leftward indicators have more value than those on the right.  We can not choose between levels (e.g. 45%).  Simply make your best assessment to determine the PPS.



Evaluate Mr. Jones using the 5 spheres of the PPS: ambulation, activity and evidence of disease, self-care, intake and level of consciousness. What is his PPS score?


Mr Jones is a 58 yr old man with metastatic prostate cancer. He is retired and leads an active life driving to his doctor’s appointments, playing golf three times a week with this buddies, and gardening with his wife of 30 years. He has noticed over the last year that he now needs to use a golf cart to complete his 18 holes. In the past, he was able to carry his own clubs and walk the course without effort. He is able to complete all of his activities of daily living without assistance. He has noticed he doesn’t quite have the appetite he once did, requiring smaller more frequent meals due to early satiety, but has not lost any weight in the past 6 months so he is unconcerned about his appetite. He is fully alert and oriented to person, place and time.


PPS Stages

The PPS can also be broken into three stages: 

  • Stable

  • Transitional

  • End-of-Life.




Special Concerns



 - 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



 - 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 [5]



 - 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[5]


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 centred 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.  [1] 


What are some of the specialized skills people within your own professional group bring to patients in transition?


Think about some of the other healthcare professionals you would need to collaborate with while providing care to a patient in transition. What are some of the specialized skills each of these professionals brings to the care team?





1. Kralik, D., Visentin, K., & van Loon, A. (2006). Transition: a literature review. Journal of Advanced Nursing, 55(3), 320-329.

3. For more information about the KPS:

4. Palliative Performance Scale (PPSv2). Medical Care of the Dying, 4th ed.;p.120. copyright Victoria Hospice Society, 2006. accessed January 8, 2008

5. Anderson, F., Downing, G.M., Hill, J., Casorso, L., & Lerch, N. (1996). Palliative Performance Scale (PPS): A new tool. Journal of Palliative Care, 12(1), 5-11.

All references for this section