DETERMINING PROGNOSIS ASSESSING PERFORMANCE STATUS
CLINICIANS ARE SYSTEMATICALLY OVER-OPTIMISTIC Physicians typically over- estimated prognosis by 3‒5 times; nurses by 2‒3 times. “Would you be surprised if the patient died in the next six or 12 months,” results in a more accurate estimate of prognosis. PERFORMANCE STATUS The ability to function, to independently perform the activities of daily living, is most powerfully associated with prognosis. The ability to function represents the sum total of all biological, cognitive and pathophysiological processes. ECOG / WHO / ZUBROD SCALE
KPS: KARNOFSKY PERFORMANCE SCALE
0 Normal activity 1 Reduced activity 2 < 50 % waking hours in bed, all self -care 3 > 50 % waking hours in bed, limited self -care 4 Bed or chair bound 5 Dead
100 Normal, no symptoms 90 Normal activity, minor symptoms 80 Normal activity, moderate symptoms 70 Unable to continue normal activity 60 Requires occasional assistance 50 Considerable assistance, medical care 40 Disabled, special assistance & care 30 Severely disabled, constant care 20 Very sick, active treatment needed 10 Moribund, fatal processes active 0 Dead
ACTIVITIES OF DAILY LIVING PRIMARY
SECONDARY
Bathing Toileting Continence Dressing Feeding Transferring
Use of telephone Meal preparation Housework, i.e., cleaning, laundry Medication management Money-management Travel by car, public transit
52 NB: These Reference Cards do not replace careful clinical judgment specific to each patient / family situation. PCIC: Palliative Care Interdisciplinary Curriculum is a collaborative effort of OhioHealth, The Ohio State University Wexner Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio, USA, and other contributors. Permission to reproduce any or all of these PCIC Reference Cards is granted for non-commercial educational purposes only, provided that the attribution statement and copyright are displayed. To reproduce for all other purposes, contact Frank D. Ferris at info@pallmed.us. Copyright © Frank D Ferris 2013-2024. All rights reserved. V14.1, 2024
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