The Australia-modified Karnofsky Performance Status (AKPS) scale: a revised scale for contemporary palliative care clinical practice [ISRCTN81117481]

BackgroundThe Karnofsky Performance Status (KPS) is a gold standard scale. The Thorne-modified KPS (TKPS) focuses on community-based care and has been shown to be more relevant to palliative care settings than the original KPS. The Australia-modified KPS (AKPS) blends KPS and TKPS to accommodate any setting of care.MethodsPerformance status was measured using all three scales for palliative care patients enrolled in a randomized controlled trial in South Australia. Care occurred in a range of settings. Survival was defined from enrollment to death.ResultsRatings were collected at 1600 timepoints for 306 participants. The median score on all scales was 60. KPS and AKPS agreed in 87% of ratings; 79% of disagreements occurred within 1 level on the 11-level scales. KPS and TKPS agreed in 76% of ratings; 85% of disagreements occurred within one level. AKPS and TKPS agreed in 85% of ratings; 87% of disagreements were within one level. Strongest agreement occurred at the highest levels (70–90), with greatest disagreement at lower levels (≤40). Kappa coefficients for agreement were KPS-TKPS 0.71, KPS-AKPS 0.84, and AKPS-TKPS 0.82 (all p < 0.001). Spearman correlations with survival were KPS 0.26, TKPS 0.27 and AKPS 0.26 (all p < 0.001). AKPS was most predictive of survival at the lower range of the scale. All had longitudinal test-retest validity. Face validity was greatest for the AKPS.ConclusionThe AKPS is a useful modification of the KPS that is more appropriate for clinical settings that include multiple venues of care such as palliative care.

[1]  D. Karnofsky,et al.  The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma , 1948 .

[2]  T. Morita,et al.  Improved accuracy of physicians' survival prediction for terminally ill cancer patients using the Palliative Prognostic Index , 2001, Palliative medicine.

[3]  A. Abernethy,et al.  A pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial of educational outreach visiting and case conferencing in palliative care-methodology of the Palliative Care Trial [ISRCTN 81117481]. , 2006, Contemporary clinical trials.

[4]  P. Glare,et al.  Validation of the palliative performance scale for inpatients admitted to a palliative care unit in Sydney, Australia. , 2002, Journal of pain and symptom management.

[5]  Hospice.  National Consensus Project for Quality Palliative Care: Clinical Practice Guidelines for quality palliative care, executive summary. , 2004, Journal of palliative medicine.

[6]  M. Pike,et al.  Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. , 1977, British Journal of Cancer.

[7]  Malcolm R Masso,et al.  Ethical Research in Palliative Care: a guide through the Human Research Ethics Committee process , 2004 .

[8]  K. Eagar,et al.  The Australian National Sub-Acute and Non-Acute Patient casemix classification. , 1999, Australian health review : a publication of the Australian Hospital Association.

[9]  G. Downing,et al.  Palliative Performance Scale (PPS): A New Tool , 1996, Journal of palliative care.

[10]  M. Mccarthy,et al.  PROGNOSTIC UNCERTAINTY IN TERMINAL CARE: CAN THE KARNOFSKY INDEX HELP? , 1985, The Lancet.

[11]  M. Maltoni,et al.  Successful validation of the palliative prognostic score in terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care. , 1999, Journal of pain and symptom management.

[12]  M. Tamburini,et al.  Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. , 1996, European journal of cancer.

[13]  J. Wessel,et al.  The Edmonton Functional Assessment Tool: Further Development and Validation for Use in Palliative Care , 2001, Journal of palliative care.

[14]  M. Bennett,et al.  Using the modified Barthel index to estimate survival in cancer patients in hospice: observational study , 2000, BMJ : British Medical Journal.

[15]  Janette P Green,et al.  An Australian casemix classification for palliative care: technical development and results , 2004, Palliative medicine.

[16]  P. Ms,et al.  HYPOPITUITARISM AFTER CHILDBIRTH. , 1965 .

[17]  S. Nikoletti,et al.  Performance status assessment in home hospice patients using a modified form of the Karnofsky Performance Status Scale. , 2000, Journal of palliative medicine.

[18]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[19]  I. Tannock,et al.  Measuring health-related quality of life in clinical trials that evaluate the role of chemotherapy in cancer treatment. , 1998, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[20]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[21]  D. Altman,et al.  Comparing methods of measurement: why plotting difference against standard method is misleading , 1995, The Lancet.

[22]  J. Guralnik,et al.  Patterns of functional decline at the end of life. , 2003, JAMA.

[23]  L. Laliberte,et al.  The Karnofsky performance status scale: An examination of its reliability and validity in a research setting , 1984, Cancer.

[24]  Jacob Cohen.  A Coefficient of Agreement for Nominal Scales , 1960 .

[25]  J. Yates,et al.  Evaluation of patients with advanced cancer using the karnofsky performance status , 1980, Cancer.