in human palliative medicine

Posted: January 2, 2009 at 7:26 am

we have a tool that helps us to measure in percentage numbers the fluctuating levels of ” daily quality of life” it is called the PPS… it is a personal performance scale. 100% would be no sign of active disease, able to fully work and participate in leisure and personal care daily activities independently….0% would be comatose/death, with percentages assigned between the two as the disease progresses.

it has never been my favorite tool because i detest assigning measurement numbers to people. but it is helpful in a quick glance in helping to determine the progression of “quality of life” especially if the client is unknown to you. the beauty of the tool tho is a way to measure improvements/deterioration trends based on disease progression and medication alterations.

the other thing i do not like about the tool is that it ignores the fact that each human has an “ultimate” but unique level of 100% functioning. folks like me who virtually work 16 hours a day and other folks who even when normally healthy, lay on the couch watching tv for an equal amount of time. you cannot measure quality of life in terms of daily activity…some folks naturally enjoy more activity than others.

it might be a useful tool to revise and bring over into animal palliative care. the part i would change tho is instead of pre-determining optimal quality of life across the board by activity level…we fill in the blanks on each animal individually.

so someone like murphy (he is not palliative, but he is kind of lazy) would look like this…

100%…able to go for leisurely, time limited walks, able to climb up on the couch/bed and roll around. able to play with toys and tear them apart while laying around. highly interested in any kind of food or treat and may even get up to get one.

maude’s (she is not palliative either) would be…

100% able to scale the gate to steal the cats food. able to run and run and run around the pond and the fields, able to continue to be in roxy’s face snarking and barking to keep her in her place.

for a dog like bridgette (who is palliative but is also previously and unrelated paralysized ) might look like this..

100%…able to mobilize in a wheelchair or with a hip walking harnass for brief periods each day, able to scoot herself around on her bed and change her position, able to participate in play by whacking humans with her feet, full enjoyment in cuddles and friendly company, highly interested in catching a cat and having a treat.

at 50% functioning, bridgette might look like this…too easily fatiqued for more than a brief walk across the room. short of breath with activity, not moving herself around very much and needing more frequent turning. interested in food but needs softer foods that require less energy to eat. still plays initially and half heartedly but prefers to cuddle and sleep. raises her head and body and notices cats as they walk by but shows no need or makes any effort to actually catch.

a senior arthritic animal’s 100% or 50% may well be different than a 2 year old without any health issues…but individually it still may be higher functioning at 100% or even at 50% than a young 100% couch potato.

once you have determined their unique 100% functioning and quality of life, then you start subtracting independence and enjoyment by 10% increments until you reach the bottom of the scale at zero. this allows you the opportunity to decide at what point has enjoyment for life been replaced by feeling the burden of continued living.
it could theorectally assist those of us providing palliative care in quantitive measurement of changes in individual quality of life.

so i think i am going to start working on developing this tool…i already do it in my head but it would be easier to track each animal individually, disease progression and evaluate symptom control success as it impacts them individually in “quality of life.”

maybe it would make the decision process easier and less painful too.

i will let you know when i have got it fine tuned.

1 Comment on "in human palliative medicine"

  • Emma says

    I’m not good with %’s or anything else number related (unless it’s counting chocolate). If quality of life for each animal I deal with (that is senior or palliative ) has to be determined by me I seem to base it (not solely though) on the individual animals personality and age and what they could tolerate. What would they consider quality of life for themselves? Knowing the animal helps a lot.

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