The Palliative Prognostic Score (PaP) was originally developed for use in cases of solid tumors and has been validated in large prospective studies in such patients.
The PaP uses the Karnofsky Performance Score and 5 other criteria to generate a numerical score from 0 to 17.5 with specific cutoff values to assign patients to three risk groups according to a 30-day survival probability.
It has been validated in large prospective studies in adult and pediatric oncology settings, as well as patients in inpatient hospices, inpatient palliative care units, and patients seen by palliative care consult teams. It has been shown to be reliable in various noncancer diagnoses, but large-scale validation studies have not been published.
Since delirium has been shown to be a significant prognostic contributor, the D-PaP was developed to incorporate the clinical presence of delirium. Patients receive 2 extra points if a clinician determines that delirium is present utilizing the CAM algorithm. Therefore, the maximum score is 19.5 instead of 17.5. In a retrospective analysis of terminally ill cancer patients, the D-PaP performed slightly better than the PaP.