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. These are the exact rungs of each column, in the order they appear in the calculator below:

1. Ambulation: full / reduced / mainly sits or lies / mainly in bed / totally bed-bound
2. Activity and evidence of disease: normal activity and work with no evidence of disease / with some evidence / normal activity with effort / unable to do the normal job / unable to do hobbies or housework / unable to do any work / unable to do most activity / unable to do any activity
3. Self-care: full / occasional assistance necessary / considerable assistance required / mainly assistance / total care
4. Intake: normal / normal or reduced / reduced / minimal to sips / mouth care only
5. Conscious level: full / full or confusion / full or drowsy with or without confusion / drowsy or coma with or without confusion

Scoring is a “best horizontal fit”, and the rule is not what most people assume. You start at the left column, read down until the ambulation level matches, then move right and read down again for activity and evidence of disease, and so on across all five columns. Where the columns disagree, the leftward columns take precedence. Ambulation is the strongest single determinant, consciousness the weakest.

It is not a floor rule, and reading it as one gives the wrong answer. Someone still ambulating fully but taking only mouth care does not drop to the 10-20 band on the strength of the intake column alone. Ambulation and activity have already placed them much higher, and the intake column simply does not fit, which is a signal to look again at the assessment rather than to take the lowest row. In practice the columns rarely conflict by more than a level or two, because these five things decline together. A wide spread usually means either a very unusual clinical picture or a domain that was assessed too hastily.

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 applies the leftward-precedence rule to the five domain answers, names any column that would not fit, and returns the level descriptor and survival context. Determining the actual PPS for a specific patient still requires bedside clinical assessment by a trained team member. Treat this as a reference aid for someone who already knows the scale, not as a substitute for the assessment.