Palliative Care

Prognostication in palliative care guides goals-of-care discussions, hospice eligibility, and treatment intensity decisions. The Palliative Performance Scale (PPSv2) measures functional status in 10% increments from 100% (fully active) to 0% (death), with scores of ≤40% suggesting a prognosis of weeks to months. The Palliative Prognostic Index (PPI) combines PPS with oral intake, edema, dyspnea, and delirium to predict 3-week and 6-week survival.

Symptom assessment using the Edmonton Symptom Assessment System (ESAS) provides a validated, patient-rated 0-10 scale for nine common symptoms: pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath. Serial ESAS scores track symptom trajectories and guide interventions.

Delirium assessment in palliative care using the Confusion Assessment Method (CAM) and the Memorial Delirium Assessment Scale (MDAS) identifies reversible causes of acute confusion, differentiating terminal delirium from treatable conditions such as opioid neurotoxicity, hypercalcemia, or infection.