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Pg101 PAP EndofLifeBPG2011

The document outlines the Palliative Prognostic Score (PaP), which utilizes various performance status and symptom criteria to predict 30-day survival in terminally ill patients. It includes specific scoring for dyspnea, anorexia, Karnofsky Performance Score, clinical prediction of survival, white blood cell count, and lymphocyte percentage. Additionally, it discusses clinical indicators of decline in diseases with unpredictable death timelines, emphasizing the challenges in predicting outcomes for patients with fluctuating conditions.

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Belén Catagña
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58 views2 pages

Pg101 PAP EndofLifeBPG2011

The document outlines the Palliative Prognostic Score (PaP), which utilizes various performance status and symptom criteria to predict 30-day survival in terminally ill patients. It includes specific scoring for dyspnea, anorexia, Karnofsky Performance Score, clinical prediction of survival, white blood cell count, and lymphocyte percentage. Additionally, it discusses clinical indicators of decline in diseases with unpredictable death timelines, emphasizing the challenges in predicting outcomes for patients with fluctuating conditions.

Uploaded by

Belén Catagña
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd

End-of-life Care During the Last Days and Hours

Palliative Prognostic Score (PaP)


The PaP uses the Karnofsky Performance Score (KPS) and five other criteria to generate a numerical score from 0 to 17.5
to predict 30 day survival (higher scores predict shorter survival).

Performance status/Symptoms Partial score

Dyspnea
No 0

Yes 1

Anorexia
No 0

Yes 1

KPS

>50 0

30–40 0

10–20 2.5

Clinical Prediction of Survival


(weeks)
>12 0

11–12 2.0

9–10 2.5

7–8 2.5

5–6 4.5
APPENDICIES

3–4 6.0

1–2 8.5

102 REGISTERED NURSES’ ASSOCIATION OF ONTARIO


End-of-life Care During the Last Days and Hours

Performance status/Symptoms Partial score

Total WBC
Normal (4,800–8,500 cell/mm3) 0

High (8,501–11,000 cell/mm3) 0.5

Very high(>11,000 cell/mm3) 1.5

Lymphocyte percentage
Normal (20.0–40.0%) 0

Low (12.0–19.9%) 1.0

Very low (0–11.9%) 2.5

Risk groups Total score

A. 30-day survival probability >70% 0–5.5

B. 30-day survival probability 30–70% 5.6–11.0

C. 30-day survival probability <30% 11.1–17.5

PaP score = Dyspnea score + Anorexia score + KPS score + CPS score + Total WBC score + Lymphocyte percentage score.

Reprinted from Journal of Pain and Symptom Management, Vol. 17, No. 4, Maltoni, M, Nanni, O., Pirovano, M., Scarpi, E., Indelli, M.,
Martini, C., et al., Successful Validation of the Palliative Prognostic Score in Terminally Ill Cancer Patient, 240–247., Copyright (1999),
with permission from Elsevier.

Appendix E: Clinical Indicators of Decline


Diseases such as chronic obstructive pulmonary disease or congestive heart failure run a more fluctuating course and
result in death in a less predictable timeframe than diseases such as renal disease or dementia. Each exacerbation can lead to
remission (and future exacerbation) or death; knowing which will occur on any given admission is extremely challenging.

APPENDICIES
General indicators of poorer prognosis (life expectancy of only weeks to many weeks) include poor performance status,
impaired nutritional status and a low albumin level.

BEST PRACTICE GUIDELINES • [Link] 103

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