Question 1

Can PPI be used in non-cancer palliative patients?

Accepted Answer

The original validation was in cancer patients. More recent studies suggest it may have some utility in advanced organ failure (heart failure, COPD) but with lower accuracy. For non-cancer populations, tools like the GSF (Gold Standards Framework) prognostic indicators or the SPICT tool may be more appropriate.

Question 2

How does PPI compare to PaP (Palliative Prognostic Score)?

Accepted Answer

PPI and PaP have similar prognostic accuracy (AUC 0.75–0.85). PPI does not require lab values (making it practical in home/hospice), while PaP includes WBC, lymphocyte count, and performance status. Both tools outperform clinician intuition alone. Using both tools in parallel may improve confidence.

Question 3

What if the patient has reversible causes of poor PPI features (e.g., delirium from infection)?

Accepted Answer

The PPI should be reassessed after treating reversible causes. A PPI score calculated during a reversible acute event may overestimate terminality. However, even with treatment, persistent poor PPI scores should prompt goals of care review.

Question 4

How often should PPI be reassessed?

Accepted Answer

Weekly reassessment is appropriate for stable palliative patients. For patients with declining performance status or new symptoms, reassess at each clinical contact. A decline of ≥2 points in one week is clinically significant and warrants prognostic updating with the patient and family.