1
|
Georgiopoulos AM, DiFiglia S, Seng EK, Portenoy R, Chaudhary N, Wei R, Berdella MN, Friedman D, Kier C, Linnemann RW, Middour-Oxler B, Stables-Carney T, Walker P, Wang J, Yonker LM, Dhingra L. Validation of the Integrated Palliative Care Outcome Scale (IPOS) in adults with cystic fibrosis. Pediatr Pulmonol 2024. [PMID: 38934771 DOI: 10.1002/ppul.27143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/22/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND A primary palliative care model for cystic fibrosis (CF) recommends using the Integrated Palliative Care Outcome Scale (IPOS) for screening. Validation of the IPOS is needed. METHODS This secondary analysis utilized baseline data from a multisite trial of the palliative care model, Improving Life with CF. Adults with CF completed the IPOS, the Memorial Symptom Assessment Scale-CF (MSAS-CF), the CF Questionnaire-Revised (CFQ-R), the Patient Health Questionnaire (PHQ-8), the Generalized Anxiety Disorder (GAD-7), and the Perceived Stress Scale (PSS). IPOS structure was assessed using Cronbach α coefficients and a factor analysis. Construct validity was evaluated through bivariate relationships between IPOS scores and other questionnaire scores, and linear regressions assessing the extent to which the IPOS explains variance in quality-of-life domains. RESULTS The sample comprised 256 adults with complete IPOS data. α coefficients were .86 for the IPOS total score, .81 for the Physical Symptoms subscale, .79 for the Emotional Symptoms subscale, and .63 for the Communication/Practical Issues subscale. A two-component factor structure best aligned with the current subscales. IPOS scores were significantly associated with other measures; associations with MSAS-CF and CFQ-R subscales differentiated the IPOS Physical and Emotional subscales. The IPOS total score provided unique information about the variance in the CFQ-R Physical Functioning and Respiratory Symptoms domain scores. CONCLUSIONS In adults with CF, the IPOS has acceptable internal consistency and there is evidence of construct validity. These findings support adoption of the IPOS in the primary palliative care model for CF.
Collapse
Affiliation(s)
- Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
| | - Elizabeth K Seng
- Ferkauf Graduate School of Psychology, New York, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
- Departments of Family and Social Medicine and Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ruobin Wei
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Rachel W Linnemann
- Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Brandi Middour-Oxler
- Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | - Patricia Walker
- Lenox Hill Hospital Northwell Health, New York, New York, USA
| | - Janice Wang
- Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Lael M Yonker
- Pulmonary Division, Massachusetts General for Children, Boston, Massachusetts, USA
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
2
|
Křemenová Z, Vlčková K. Translation, cultural adaptation, and validation of the Integrated Palliative Outcome Scale-renal (IPOS-r) to Czech. Palliat Care 2022; 21:152. [PMID: 36038854 PMCID: PMC9425933 DOI: 10.1186/s12904-022-01044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/23/2022] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Patients with advanced kidney disease suffer from burdensome symptoms, which should be assessed by valid and reliable patient-reported outcome measures. This study aimed to provide a translation, cultural adaptation, and validation of the Czech version of the IPOS-r. METHODS The IPOS-r was translated to Czech and culturally adapted using cognitive interviews. During the validation phase, patients and staff in dialysis centres and outpatient renal clinics completed the IPOS-r. Internal consistency was tested with Cronbach's alpha, its reliability via intraclass correlation coefficient for total IPOS-r score, and weighted Kappa (for test-retest and interrater reliability of individual items). Convergent validity was tested with Spearman correlation to Kidney Disease Quality of Life Survey-Short Form 1.2 (KDQOL-SF 1.2). We assessed sensitivity to change using a distribution-based approach. RESULTS Two sets of translators independently performed forward and backward translations of the IPOS-r. Ten patients and ten health care professionals participated in cognitive pre-testing. The sample size for validation included 88 patients (mean age 66 ± SD13.8; 58% men) who were treated with haemodialysis (70.5%), home haemodialysis (5.5%), peritoneal dialysis (3%), and conservative management (21%). Cronbach's alpha was 0.72, and the intraclass correlation was 0.84 for test-retest reliability and 0.73 for interrater reliability. The IPOS-r correlated with KDQOL-SF 1.2 had a rho between 0.4-0.8 for most of the IPOS-r items, showing good convergent validity. The IPOS-r measure is feasible and takes 9 minutes to complete. Patients who reported a change in health status after 1 month demonstrated a total IPOS-r score change of eight points in both positive and negative directions. CONCLUSIONS The process of translation and cultural adaptation of the IPOS-r was successful, and the Czech IPOS-r measure is a valid and reliable tool. The Czech IPOS-r can be used to assess symptoms in patients with advanced chronic kidney disease. TRIAL REGISTRATION GAUK [82121].
Collapse
Affiliation(s)
- Zuzana Křemenová
- Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic. .,Kralovske Vinohrady University Hospital in Prague, Šrobárova 50, 10034, Prague, Czech Republic.
| | - Karolína Vlčková
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Center for Palliative Care, Prague, Czech Republic
| |
Collapse
|
3
|
Martinsson L, Sahlén KG. Translation and cultural adaptation of the Integrated Palliative care Outcome Scale for Dementia (IPOS-Dem) to Swedish. BMC Nurs 2022; 21:78. [PMID: 35365128 PMCID: PMC8975724 DOI: 10.1186/s12912-022-00859-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Systematic assessment tools are helpful for improving and maintaining quality of care. The Integrated Palliative care Outcome Scale (IPOS) was developed for systematic assessment of persons receiving palliative care in a patient-centred way. A version of this tool, the Integrated Palliative care Outcome Scale for Dementia (IPOS-Dem), has been developed for patients with dementia. The aim of this study was to develop a version of the IPOS-Dem translated into Swedish and culturally adapted to a Swedish care setting. METHODS Forward and backward translations from English into Swedish were performed to develop a first Swedish version. This version was modified for clarity and cultural adaptation based on 13 interviews with nurses and assistant nurses working in geriatrics and dementia care homes. RESULTS The interview process revealed several issues with the first version that emerged from the translation process. This was changed and further tested to work well, resulting in the final version of the Swedish IPOS-Dem. The tool was perceived as clinically useful but somewhat overlapping with already implemented tools for assessing behavioural and psychological symptoms in dementia. CONCLUSION The Swedish version of the IPOS-Dem can now be used as a tool for assessing palliative care related problems and concerns for persons with advanced dementia. Future studies can focus on implementation as well as examining validity and reliability of this tool in a Swedish context.
Collapse
Affiliation(s)
- Lisa Martinsson
- Department of Radiation Sciences, Umeå University, 901 87, Umeå, Sweden.
| | - Klas-Göran Sahlén
- Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| |
Collapse
|
4
|
Kebebew T, Mavhandu-Mudzusi AH, Mosalo A. A cross-sectional assessment of symptom burden among patients with advanced cervical cancer. BMC Palliat Care 2021; 20:190. [PMID: 34920716 PMCID: PMC8684193 DOI: 10.1186/s12904-021-00883-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022] Open
Abstract
Background The increasing burden of chronic non-communicable diseases in developing countries is driving attention to palliative care services. Identification of disease-specific symptoms of concern and their prevalence will guide designing, monitoring, and evaluating palliative care programmes. This study assessed the burden of symptoms and problems among patients with advanced cervical cancer. Methods This research followed a cross-sectional study design to quantitatively review the symptom burden among patients diagnosed with advanced cervical cancer attending treatment at Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia from January to July 2019. Symptoms were assessed using a patient-reported, seven-day recall Integrated Palliative Care Outcome Scale (IPOS) version III. Frequency, median and mean scores with a standard deviation were used in the descriptive analysis whereas t-test and one-way analysis of variance were used for comparisons. Results There were 385 patients with advanced cervical cancer, stage IIB-IVB, successfully interviewed. The median age was 50 years, the majority were illiterate (63.1%) and in marital union (62.3%). Over 50% of the patients experienced pain, weakness, poor appetite, constipation, limited mobility, and dry mouth. The burdens of emotional symptoms such as patient anxiety, family anxiety, and patient depression were also prevalent at 79.7%, 82.3%, and 47.0%, respectively. Patients who are illiterate, at a higher stage of the disease, not currently in marriage, and who received palliative radiotherapy bear a higher symptom burden. Conclusion Patients with advanced cervical cancer bear a high symptom burden. Early initiation of palliative care is recommended to alleviate the concerning symptoms, and to improve patients’ quality of life.
Collapse
Affiliation(s)
- Tolcha Kebebew
- Student at University of South Africa, Ethiopia Learning Centre, Addis Ababa, Ethiopia.
| | | | - Annah Mosalo
- Department of Health Studies, University of South Africa, Pretoria, South Africa
| |
Collapse
|
5
|
Psychometric validation and cross-cultural adaptation of the Integrated Palliative care Outcome Scale in Polish (IPOS-Pol). Palliat Support Care 2021; 20:687-693. [PMID: 34579798 DOI: 10.1017/s1478951521001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The study aimed to assess the reliability and validity of the IPOS-Pol for patient self-reporting. METHOD Patients (>18 years of age) with advanced cancer admitted to three palliative care centers (inpatient units and home-based) were recruited to a multicenter, cross-sectional, observational, prospective study. Participants provided responses to the IPOS-Pol Patient version and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care (EORTC QLQ-C15-PAL) Polish version at baseline (T1) and four to seven days later (T2). We assessed test-retest reliability, internal consistency, and construct validity of the tool. RESULTS One hundred and eighty patients were included. Test-retest reliability demonstrated no statistically significant differences in the average outcomes of the IPOS-Pol between T1 and T2 (27.2 ± 9.2 vs. 26.5 ± 8.7; p > 0.05). The intra-class correlation coefficient between T1 and T2 was r = 0.83 (p < 0.0001), the intra-class correlation coefficient for test-retest reliability of the IPOS-Pol items ranged from 0.63 to 0.84 (p < 0.0001), and the Cronbach's α coefficient for internal consistency was 0.773. The correlation coefficient between the IPOS-Pol and EORTC QLQ-C15-PAL total score was 0.79 (p < 0.001). SIGNIFICANCE OF RESULTS The patient version of the Polish adaptation of IPOS is a valid and reliable outcome measure for assessing symptoms and concerns of individuals receiving palliative care, as well as the quality of care provided.
Collapse
|
6
|
Vlckova K, Polakova K, Tuckova A, Houska A, Loucka M. Views of patients with advanced disease and their relatives on participation in palliative care research. BMC Palliat Care 2021; 20:80. [PMID: 34090400 PMCID: PMC8180046 DOI: 10.1186/s12904-021-00779-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background Patients with advanced disease may not be invited to participate in research based on the assumption that participation would be too burdensome for them. The aim of this study was to explore how patients with advanced disease and their relatives evaluate their experience with research participation. Method This study used data from two parts of a larger project. The first dataset was a cross-sectional questionnaire study focused on priorities at the end of life. The second dataset used a longitudinal design with structured interviews on prognostic awareness. In both studies, participants evaluated their experience on a 5-point Likert scale and specified their motivation in an open-ended question. Data were collected in 6 hospitals in the Czech Republic with patients with advanced disease and life expectancy less than 1 year and their relatives. Data were analysed using non-parametric tests and thematic analysis. Results First dataset consisted of 167 patients and 102 relatives, and second dataset consisted of 135 patients and 92 relatives (in total, 496 respondents). Results were similar in both datasets, with half of the sample (53%, 48%) scoring neutral, and over 30% of the sample identified their experience as interesting. The most significant factors associated with the evaluation were religiosity (p = 0.001) and the type of diagnosis (p = 0.04). Motivation for participation was to improve care, support research, express own opinion, opportunity to talk and trusting relationship. Conclusions Patients with advanced disease and relatives do not mind participating in palliative care research, and it can be even a positive experience for them. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00779-2.
Collapse
Affiliation(s)
- Karolina Vlckova
- Center, for Palliative Care, Dykova 15, Prague, 110 00, Czech Republic. .,First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Kristyna Polakova
- Center, for Palliative Care, Dykova 15, Prague, 110 00, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anna Tuckova
- Center, for Palliative Care, Dykova 15, Prague, 110 00, Czech Republic.,Faculty of Social Science, Charles University, Prague, Czech Republic
| | - Adam Houska
- Center, for Palliative Care, Dykova 15, Prague, 110 00, Czech Republic.,First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Loucka
- Center, for Palliative Care, Dykova 15, Prague, 110 00, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| |
Collapse
|
7
|
Long VJE, Cheung YB, Qu D, Lim K, Lee G, Yee ACP, Guo P, Harding R, Yang GM. Validity and reliability of the English and translated Chinese versions of the Integrated Palliative care Outcome Scale (IPOS) in Singapore. BMC Palliat Care 2021; 20:40. [PMID: 33750367 PMCID: PMC7944591 DOI: 10.1186/s12904-021-00737-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
CONTEXT Measurement of patient-centred outcomes enables clinicians to focus on patient and family priorities and enables quality of palliative care to be assessed. OBJECTIVES This study aimed to evaluate the validity and reliability of the English and translated Chinese versions of the Integrated Palliative care Outcome Scale (IPOS) among advanced cancer patients in Singapore. METHODS IPOS was forward and backward translated from English into Chinese. Structural validity was assessed by confirmatory factor analysis; known-group validity by comparing inpatients and community patients; construct validity by correlating IPOS with Edmonton Symptom Assessment System-revised (ESAS-r) and Functional Assessment of Cancer Therapy-General (FACT-G); internal consistency by Cronbach's alpha; inter-rater reliability between patient and staff responses; test-retest reliability of patient responses between two timepoints. RESULTS One hundred eleven English-responding and 109 Chinese-responding patients participated. The three-factor structure (Physical Symptoms, Emotional Symptoms and Communication and Practical Issues) was confirmed with Comparative Fit Index and Tucker-Lewis-Index > 0.9 and Root Mean Square Error of Approximation < 0.08. Inpatients scored higher than outpatients as hypothesised. Construct validity (Pearson's correlation coefficient, r ≥ |0.608|) was shown between the related subscales of IPOS and FACT-G and ESAS-r. Internal consistency was confirmed for total and subscale scores (Cronbach's alpha≥0.84), except for the Communication and Practical Issues subscale (Cronbach's alpha = 0.29-0.65). Inter-rater reliability (Intra-class correlation coefficient [ICC] ≤ 0.43) between patient and staff responses was insufficient. Test-retest reliability was confirmed with Intra-class correlation coefficient ICC = 0.80 (English) and 0.88 (Chinese) for IPOS Total. CONCLUSION IPOS in English and Chinese showed good validity, good internal consistency, and good test-retest reliability, except for the Communication and Practical Issues subscale. There was poor inter-rater reliability between patients and staff.
Collapse
Affiliation(s)
| | - Yin Bun Cheung
- Duke-NUS Medical School, Singapore, Singapore
- Tampere University, Tampere, Finland
| | - Debra Qu
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Guozhang Lee
- Singapore General Hospital, Singapore, Singapore
| | - Alethea C P Yee
- National Cancer Centre Singapore, Singapore, Singapore
- Assisi Hospice, Singapore, Singapore
| | - Ping Guo
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Grace Meijuan Yang
- Duke-NUS Medical School, Singapore, Singapore.
- National Cancer Centre Singapore, Singapore, Singapore.
| |
Collapse
|