Use of Tools
Victoria Hospice is a Not-for-Profit organization committed to providing high quality compassionate care for those facing End-of-Life. As part of our mission, we believe in protecting the integrity of the material we create, while also making it widely available. We offer numerous resources, including our validated Palliative Performance Scale version 2 (PPSv2). All material other than the PPSv2 is not validated and should be considered a working form. We provide our resources free of charge for Not-for-Profit Purposes.*
*Not-for-Profit Purposes refers to healthcare services or not-for-profit organizations. The user may not incur monetary profits from use of the tool in any way.
Palliative Performance Scale version 2 (PPSv2)
The Victoria Hospice Palliative Performance Scale (PPSv2) is an 11-point scale designed to measure patients’ performance status in 10% decrements from 100% (healthy) to 0% (death) based on five observable parameters: ambulation, ability to do activities, self-care, food/fluid intake, and consciousness level.
To use the PPSv2 in English for Not-for-Profit purposes please fill out the Request for PPSv2 Permission (Not for Profit). Victoria Hospice will contact you within 2 weeks for a permission letter.
If you wish to use the tool, in an electronic medical record, or for a non-clinical purpose such as publication or website display, use the button at the bottom of this page “Other Requests”. If you wish to use the tool For Profit, you must also fill out the “Other Requests” form.
To learn more about the tool, register for the learning module, “Putting the Palliative Performance Scale into Practice,” or click here to download the manual.
EX. healthcare provider, a patient or a not-for-profit organization
- Palliative Performance Scale Translations
See below for sample versions of different translations. To use the tool in another language please fill out the “All Other Requests”
To use resources other than the PPSv2 for Not-for-Profit purposes, use the download links below. On behalf of Victoria Hospice, this message confirms you have permission to download and use the materials for Not-for-Profit services based on the following conditions:
- The complete tool(s) will appear with complete instructions for its usage.
- A credit line will appear on the bottom of the tool and will include: Copyright Victoria Hospice Society, BC, Canada www.victoriahospice.org
- The tools cannot be altered or used in any way other than as intended and described.
- Permission granted is for non-exclusive English rights only.
- The tool(s) may not be displayed on a public facing website without express written permission from Victoria Hospice to do so
- The tool(s) may not be published without express written permission from Victoria Hospice
Bowel Performance Scale
Psychosocial Assessment Tool
Respiratory Congestion Scale
10 Steps to Better Prognostication
“Forget Me Not”: Palliative Care for Patients with Dementia
Bereavement Risk Assessment Tool (BRAT)*
If you wish to use our tools for another purpose, such as research, publications, electronic medical records, or websites, please submit the request form below.
Contact us to learn more about the use of our tools at Victoria Hospice.