Palliative Performance Scale (PPS) Calculator

The Palliative Performance Scale (PPS), developed by Anderson and colleagues at the Victoria Hospice Society in 1996, scores a patient’s overall functional status on an 11-point scale from 0 (deceased) to 100 (fully functional). It is widely used in hospice and palliative care for tracking change over time, communicating status between team members, and supporting prognostic discussions.

The PPS evaluates five domains simultaneously:

1. Ambulation: full / reduced / mainly sits or lies / mainly in bed / totally bed-bound
2. Activity and evidence of disease: normal with no disease / normal with some disease / unable to work, extensive disease / unable any activity
3. Self-care: full / occasional assistance / considerable assistance / mainly assistance / total care
4. Intake: normal / reduced / minimal / mouth care only
5. Conscious level: full / drowsy / drowsy with periods of confusion / coma

The score is determined by the LOWEST functional level across all five domains — the floor principle. A patient ambulating fully but eating only mouth care would still score in the 10-20 range because intake limits the overall level.

Level summaries (the scale is in 10-point increments):

• 100-90: independent, functioning normally with possible mild disease signs
• 80-70: reduced activity, often still ambulant, normal or slightly reduced intake
• 60-50: significant ambulation reduction, needs assistance, intake may be reduced
• 40-30: mostly bed-bound, total care, intake reduced or normal
• 20-10: bed-bound, minimal to no intake, drowsy or comatose

Survival estimates from the literature vary by patient population, but as rough averages in cancer hospice care:

• PPS 70-100: median survival weeks to months
• PPS 50-60: median survival weeks
• PPS 30-40: median survival days to a few weeks
• PPS 10-20: median survival days

These are population averages, not individual predictions. Many factors beyond PPS (specific diagnosis, comorbidities, response to symptom management, patient and family preferences) modify the trajectory significantly.

Use of the PPS:

• Eligibility for hospice services in many jurisdictions requires a PPS at or below 70.
• Care team handoffs reference PPS as a quick functional summary.
• Tracking PPS weekly (or daily near the end) shows the rate of decline, which often matters more than any single score.

This calculator provides the level descriptor and survival context. Determining the actual PPS for a specific patient requires bedside clinical assessment by a trained team member.