Mini Review

Measuring patient outcomes in palliative care: a reliability and validity study of the Support Team Assessment Schedule

This study reports the process and results of a psychometric evaluation of a clinical audit tool, the Support Team Assessment Schedule (STAS), used to measure outcomes of palliative care. The STAS was developed in London, UK to audit community palliative care services provided by a support team. The purpose of this study was to evaluate the reliability and validity of the STAS when introduced in a different setting and with different populations from those for which it had been designed. Evaluation of the STAS was completed using multidisciplinary team members, patients and families from a palliative care unit and an oncology unit of a large urban Canadian teaching hospital. The results from the reliability tests revealed a lack of consistency in the use of the tool by team members with simulated patients in clinical scenarios. The validity analysis highlighted the differences between patients, families and health care professionals' perceptions of the same clinical situation. This study provided a valuable perspective on using a previously developed clinical audit tool in different patient populations and clinical settings. Recommendations for future use of the tool are offered.

Palliative care in chronic obstructive airways disease: a needs assessment

The view that palliative care should move beyond cancer is widely endorsed, however, there remains a lack of clarity about the level at which this should occur. In order to target the palliative approach effectively, the value of more detailed and localized needs assessment becomes apparent. This paper provides evidence from a study commissioned by a department of public health, where the focus was the palliative care needs of an individual with chronic obstructive airways disease (COAD). Over a six-month period, 63 individuals in the district were interviewed about their experiences of living with COAD and the services utilized, using a combination of qualitative and quantitative research methods. The findings revealed a poor quality of life, relating to a high degree of social isolation and emotional distress, associated with low physical functioning and disability, and physical symptoms. Current service provision focused on acute exacerbations. Consequently, there is a need to manage the health and social care interface more effectively, with a shift in emphasis from reactive ad hoc provision, which is where the palliative approach to care could be best suited to meet the needs identified.