Malcolm Masso1, Samuel Frederic Allingham2, Maree Banfield2, Claire Elizabeth Johnson3, Tanya Pidgeon3, Patsy Yates4, Kathy Eagar5. 1. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia mmasso@uow.edu.au. 2. Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia. 3. Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, University of Western Australia, Perth, WA, Australia. 4. School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia. 5. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia.
Abstract
BACKGROUND: The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was developed in Australia about 20 years ago and is used routinely for communicating clinical status, care planning, quality improvement and funding. AIM: To test the reliability and acceptability of revised definitions of Palliative Care Phase. DESIGN: Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase. SETTING/PARTICIPANTS: Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service. RESULTS: A total of 102 nursing and medical clinicians participated, undertaking 595 paired assessments of 410 patients, of which 90.7% occurred within 2 h. Clinicians rated 54.8% of patients in the stable phase, 15.8% in the unstable phase, 20.8% in the deteriorating phase and 8.7% in the terminal phase. Overall agreement between clinicians' rating of Palliative Care Phase was substantial (kappa = 0.67; 95% confidence interval = 0.61-0.70). A moderate level of inter-rater reliability was apparent across all participating sites. The results indicated that Palliative Care Phase was an acceptable measure, with no significant difficulties assigning patients to a Palliative Care Phase and a good fit between assessment of phase and the definition of that phase. The most difficult phase to distinguish from other phases was the deteriorating phase. CONCLUSION: Policy makers, funders and clinicians can be confident that Palliative Care Phase is a reliable and acceptable measure that can be used for care planning, quality improvement and funding purposes.
BACKGROUND: The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was developed in Australia about 20 years ago and is used routinely for communicating clinical status, care planning, quality improvement and funding. AIM: To test the reliability and acceptability of revised definitions of Palliative Care Phase. DESIGN: Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase. SETTING/PARTICIPANTS: Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service. RESULTS: A total of 102 nursing and medical clinicians participated, undertaking 595 paired assessments of 410 patients, of which 90.7% occurred within 2 h. Clinicians rated 54.8% of patients in the stable phase, 15.8% in the unstable phase, 20.8% in the deteriorating phase and 8.7% in the terminal phase. Overall agreement between clinicians' rating of Palliative Care Phase was substantial (kappa = 0.67; 95% confidence interval = 0.61-0.70). A moderate level of inter-rater reliability was apparent across all participating sites. The results indicated that Palliative Care Phase was an acceptable measure, with no significant difficulties assigning patients to a Palliative Care Phase and a good fit between assessment of phase and the definition of that phase. The most difficult phase to distinguish from other phases was the deteriorating phase. CONCLUSION: Policy makers, funders and clinicians can be confident that Palliative Care Phase is a reliable and acceptable measure that can be used for care planning, quality improvement and funding purposes.
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