End-of-Life Issues

Abstract

Older adults with terminal illness face many end-of-life care challenges. Specifically, knowing how much time remains is essential for closure for personal and family matters. The Palliative Performance Scale (PPS) has been widely used for survival prediction among patients with cancer; however, few studies have reviewed PPS scores in heterogeneous hospice populations across multiple care settings. The purpose of this systematic literature review was to determine how the PPS tool has been used to predict survival for older adults at the end-of-life. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and electronic databases (PubMed, Embase, Cochrane Library) were searched for all published literature from 2008 to 2017. We analyzed study characteristics, the PPS score on admission, and primary outcomes, and explored differences in survival estimates by diagnosis. Seventeen studies were included in this review (9 with cancer and 8 with mixed diagnoses). The primary findings from this review were that the PPS predicted length of survival across all studies. In this review, survival estimates ranged from 1 to 3 days for older adults with PPS scores of 10% compared with a range of 5 to 36 days for those with scores of 30%. The findings confirm that the PPS has been used more frequently to estimate survival in patients with cancer and that there are opportunities to apply the tool to patients with different end-of-life diagnoses.