Palliative Care Phase: Inter-rater reliability and acceptability in a national study

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...

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Veröffentlicht in:Palliative medicine Jg. 29; H. 1; S. 22 - 30
Hauptverfasser: Masso, Malcolm, Allingham, Samuel Frederic, Banfield, Maree, Johnson, Claire Elizabeth, Pidgeon, Tanya, Yates, Patsy, Eagar, Kathy
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London, England SAGE Publications 01.01.2015
Sage Publications Ltd
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ISSN:0269-2163, 1477-030X, 1477-030X
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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.
AbstractList 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.BACKGROUNDThe 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.To test the reliability and acceptability of revised definitions of Palliative Care Phase.AIMTo test the reliability and acceptability of revised definitions of Palliative Care Phase.Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase.DESIGNMulti-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase.Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service.SETTING/PARTICIPANTSClinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service.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.RESULTSA 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.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.CONCLUSIONPolicy 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. 15 references
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. To test the reliability and acceptability of revised definitions of Palliative Care Phase. Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase. Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service. 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. 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.
Author Yates, Patsy
Allingham, Samuel Frederic
Eagar, Kathy
Pidgeon, Tanya
Johnson, Claire Elizabeth
Masso, Malcolm
Banfield, Maree
Author_xml – sequence: 1
  givenname: Malcolm
  surname: Masso
  fullname: Masso, Malcolm
  email: mmasso@uow.edu.au
– sequence: 2
  givenname: Samuel Frederic
  surname: Allingham
  fullname: Allingham, Samuel Frederic
– sequence: 3
  givenname: Maree
  surname: Banfield
  fullname: Banfield, Maree
– sequence: 4
  givenname: Claire Elizabeth
  surname: Johnson
  fullname: Johnson, Claire Elizabeth
– sequence: 5
  givenname: Tanya
  surname: Pidgeon
  fullname: Pidgeon, Tanya
– sequence: 6
  givenname: Patsy
  surname: Yates
  fullname: Yates, Patsy
– sequence: 7
  givenname: Kathy
  surname: Eagar
  fullname: Eagar, Kathy
BackLink https://www.ncbi.nlm.nih.gov/pubmed/25249239$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
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The Author(s) 2014.
SAGE Publications © Jan 2015
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Keywords reproducibility of results
needs assessment
Episode of care
patient acuity
palliative care
Language English
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PublicationTitle Palliative medicine
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References Eagar, Green, Gordon 2004; 18
Waller, Girgis, Currow 2008; 22
Myers, Gardiner, Harris 2010; 39
Abernethy, Shelby-James, Fazekas 2005; 4
Eagar 1995; 20
Landis, Koch 1977; 33
Eagar, Watters, Currow 2010; 34
Petersen, Larsen, Pedersen 2006; 42
Smith M (bibr2-0269216314551814)
bibr8-0269216314551814
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Smith M (bibr3-0269216314551814)
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Eagar K (bibr5-0269216314551814) 1997
Palliative Care Outcomes Collaboration (bibr9-0269216314551814) 2013
bibr13-0269216314551814
Australian Institute of Health and Welfare (bibr15-0269216314551814) 2013
Victorian Government Department of Human Services (bibr10-0269216314551814) 2006
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  article-title: Evaluating correlation and interrater reliability for four performance scales in the palliative care setting
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  publication-title: Palliat Med
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  article-title: Development of the Palliative Care Needs Assessment Tool (PC-NAT) for use by multi-disciplinary health professionals
  publication-title: Palliat Med
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  article-title: The Australian Palliative Care Outcomes Collaboration (PCOC) – measuring the quality and outcomes of palliative care on a routine basis
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  doi: 10.2307/2529310
– volume-title: The Australian National Sub-Acute and Non-Acute Patient Classification (AN-SNAP): report of the National Sub-Acute and Non-Acute Casemix Classification Study
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– volume-title: Palliative care workforce: a supply and demand study
  year: 2006
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  doi: 10.1186/1472-684X-4-7
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– volume-title: 8th national casemix conference
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– ident: bibr12-0269216314551814
  doi: 10.1177/0269216308098797
– volume-title: National report on patient outcomes in palliative care in Australia, January–June 2013
  year: 2013
  ident: bibr9-0269216314551814
– ident: bibr13-0269216314551814
  doi: 10.1016/j.jpainsymman.2009.06.013
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  year: 2013
  ident: bibr15-0269216314551814
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Snippet Background: The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and...
The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was...
Background: The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and...
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SubjectTerms Adult
Aged
Aged, 80 and over
Australia
Caregivers
Classification
Collaboration
Cross-Sectional Studies
Female
Funding
Health services
Humans
Male
Middle Aged
Palliative care
Palliative Care - standards
Patients
Program Evaluation
Quality improvement
Reproducibility of Results
Variables
Title Palliative Care Phase: Inter-rater reliability and acceptability in a national study
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