Evaluating the Palliative Performance Scale and Palliative Prognostic Index as Objective Tools to Support Eligibility Decisions for End-of-Life Care.

BACKGROUND: In the Netherlands, eligibility for reimbursed end-of-life care is based on an estimated life expectancy of less than three months, despite the well-recognized difficulty of predicting survival. Objective measures such as the Palliative Performance Scale (PPS) and Palliative Prognostic Index (PPI) may better reflect patients' functional status and care needs, but their role in supporting eligibility decisions has not been evaluated. OBJECTIVE: To evaluate the potential value of the PPS and PPI as objective tools to support eligibility decisions for reimbursed end-of-life care in the Dutch health care system. DESIGN: Prospective multicenter cohort study of patients admitted to high-care residential hospices. SETTING: Thirteen high-care residential hospices were asked to include 15 consecutive patients per hospice in this study. RESULTS: A total of 194 patients were included, of whom 179 died during hospice admission. Kaplan-Meier analysis showed significantly longer survival among patients with PPS > 40% than among those with PPS ≤ 40% (median 20 versus 8 days; p < 0.001). Both PPS and PPI were independently associated with survival. Agreement between clinicians' estimated survival and observed survival was poor (weighted Cohen's κ = 0.191). CONCLUSION: Estimated life expectancy alone appears insufficient to support eligibility decisions for end-of-life care. PPS and PPI may provide objective, standardized information to complement clinical judgment by focusing on patients' functional status and care needs. Because the PPS is simpler and applicable across disease groups, it may be the more practical tool for supporting eligibility decisions within the Dutch health care system.