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Yang GM, Lee Y, Ke Y, Neo PSH, Cheung YB. Feasibility of Weekly Integrated Palliative Care Outcome Scale (IPOS) Within a Stepped Care Model. J Pain Symptom Manage 2024; 68:e174-e182. [PMID: 38878909 DOI: 10.1016/j.jpainsymman.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/31/2024] [Accepted: 06/09/2024] [Indexed: 07/01/2024]
Abstract
CONTEXT Patients with advanced cancer may experience symptoms and concerns that are inadequately identified by the healthcare team, leading to calls for patient-reported symptom monitoring. OBJECTIVES Assess the feasibility of administering weekly patient-reported online Integrated Palliative care Outcome Scale (IPOS) questionnaires within the context of a stepped care model in the outpatient care setting. METHODS Analysis of intervention group data in a randomized controlled trial to assess the effectiveness of a stepped care model of palliative care for patients with advanced cancer. Patients in the intervention group were invited to complete the IPOS weekly for 16 weeks through a remotely-administered online questionnaire. At the end of the 16-week period, patients were invited to complete a feedback survey. Multivariable logistic regression was used to assess factors associated with more versus less than 70% completion of weekly questionnaires. RESULTS Among 111 patients who survived more than 16 weeks, the mean number of questionnaires completed was 9.2/16 (58%). A total of 53 out of the 111 patients (48%) completed more than 70% of the questionnaires. Higher education level was found to be associated with higher completion of the questionnaires. A total of 79 out of 111 (71%) patients responded to the feedback survey, of which 67 (85%) felt comfortable with completing the online questionnaire and 11 (14%) felt it was troublesome to complete it on a weekly basis. CONCLUSION In our study, there was suboptimal completion of patient-reported IPOS questionnaire. Further research is needed to improve the uptake of patient-reported outcomes in real-world clinical settings.
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Affiliation(s)
- Grace Meijuan Yang
- Division of Supportive and Palliative Care (G.M.Y., Y.K., P.S.H.N., Y.B.), National Cancer Centre Singapore, Singapore; Lien Centre for Palliative Care (G.M.Y., Y.K., P.S.H.N., Y.B.), Duke-NUS Medical School, Singapore, Singapore; Programme in Health Services and Systems Research (G.M.Y., Y.K., P.S.H.N., Y.B.), Duke-NUS Medical School, Singapore, Singapore.
| | - Yixuan Lee
- Duke-NUS Medical School (Y.L.), Singapore, Singapore
| | - Yu Ke
- Division of Supportive and Palliative Care (G.M.Y., Y.K., P.S.H.N., Y.B.), National Cancer Centre Singapore, Singapore
| | - Patricia Soek Hui Neo
- Division of Supportive and Palliative Care (G.M.Y., Y.K., P.S.H.N., Y.B.), National Cancer Centre Singapore, Singapore
| | - Yin Bun Cheung
- Programme in Health Services and Systems Research (G.M.Y., Y.K., P.S.H.N., Y.B.), Duke-NUS Medical School, Singapore, Singapore; Centre for Quantitative Medicine (Y.B.C.), Duke-NUS Medical School, Singapore, Singapore; Tampere Center for Child (Y.B.C.), Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
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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.
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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
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Ke Y, Cheung YB, Bakitas M, Odom JN, Lum E, Tan DSW, Tan TJ, Finkelstein E, Oh HC, Zhou S, Yang GM. ENABLE-SG (Educate, Nurture, Advise, Before Life Ends for Singapore) as a proactive palliative care model: protocol for a hybrid type 1 effectiveness-implementation randomized wait-list controlled trial. BMC Palliat Care 2024; 23:29. [PMID: 38287335 PMCID: PMC10826230 DOI: 10.1186/s12904-024-01353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Specialist palliative care is often provided late in the patient's disease trajectory in response to uncontrolled symptoms. Shifting from this reactionary illness-stress paradigm to a proactive health-wellness approach, the ENABLE (Educate, Nurture, Advise, Before Life Ends) telehealth model aims to enhance the coping, stress and symptom management, self-care, and advance care planning skills of patients with advanced cancers and their caregivers. The ENABLE model has been culturally adapted to Singapore (ENABLE-SG) and pilot-tested. A hybrid type 1 effectiveness-implementation design will be used to evaluate the effectiveness of ENABLE-SG while collecting real-world implementation data. METHODS This single-centre, assessor-blind, wait-list (immediately vs. 6 months) randomized controlled trial will recruit 300 adult patients within 60 days of an advanced cancer diagnosis and their family caregivers from the National Cancer Centre of Singapore. ENABLE-SG comprises structured psychoeducational sessions with a telehealth coach, covering essential topics of early palliative care. Participants will be assessed at baseline and every 3 months until patient's death, 12 months (caregivers), or end of study (patients). The primary outcome is patient quality of life 6 months after baseline. Secondary patient-reported outcomes include mood, coping, palliative care concerns, and health status. Secondary caregiver-reported outcomes include caregiver quality of life, mood, coping, and care satisfaction. Mixed-effects regression modelling for repeated measurements will be used. To assess the effectiveness of ENABLE-SG versus usual care, patient and caregiver outcomes at 6 months will be compared. To compare earlier versus delayed ENABLE-SG, patient and caregiver outcomes at 12 months will be compared. Within the hybrid type 1 effectiveness-implementation design, implementation outcomes will be evaluated in both the early and delayed groups. Acceptability, adoption, appropriateness, and feasibility will be assessed using a feedback survey and semi-structured interviews with a purposive sample of patients, caregivers, and healthcare providers. Transcribed interviews will be analysed thematically. Other implementation outcomes of penetration, fidelity, and cost will be assessed using records of study-related processes and summarized using descriptive statistics. A cost-effectiveness analysis will also be conducted. DISCUSSION This study will assess both effectiveness and implementation of ENABLE-SG. Insights into implementation processes can facilitate model expansion and upscaling. TRIAL REGISTRATION Registered prospectively on ClinicalTrials.gov, NCT06044441. Registered on 21/09/2023.
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Affiliation(s)
- Yu Ke
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Yin Bun Cheung
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
- Duke-NUS Medical School, Program in Health Services & Systems Research, Singapore, Singapore
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Centre for Palliative and Supportive Care, Birmingham, AL, USA
| | - J Nicholas Odom
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UAB Centre for Palliative and Supportive Care, Birmingham, AL, USA
| | - Elaine Lum
- Duke-NUS Medical School, Program in Health Services & Systems Research, Singapore, Singapore
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Population Health Research & Implementation, SingHealth, Singapore, Singapore
| | - Daniel Shao Weng Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Cancer Therapeutics Research Laboratory, National Cancer Centre Singapore, Singapore, Singapore
- Genome Institute of Singapore, A*Star, Singapore, Singapore
| | - Tira J Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Program, Singapore, Singapore
| | - Eric Finkelstein
- Duke-NUS Medical School, Program in Health Services & Systems Research, Singapore, Singapore
- Duke-NUS Medical School, Lien Centre for Palliative Care, Singapore, Singapore
| | - Hong Choon Oh
- Duke-NUS Medical School, Program in Health Services & Systems Research, Singapore, Singapore
- Centre for Population Health Research & Implementation, SingHealth, Singapore, Singapore
- Health Services Research, Changi General Hospital, Singapore, Singapore
| | - Siqin Zhou
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore, Singapore
| | - Grace Meijuan Yang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Duke-NUS Medical School, Lien Centre for Palliative Care, Singapore, Singapore.
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Neo SHS, Tan JYT, Ng ESL, Yoon S. Facilitators and barriers to implementation of a patient and staff reported measure for screening of palliative concerns of patients with heart failure: a qualitative analysis using the Consolidated Framework for Implementation Research. Palliat Care Soc Pract 2023; 17:26323524231214814. [PMID: 38044934 PMCID: PMC10693212 DOI: 10.1177/26323524231214814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
Background Screening patients with patient-reported outcome measures allows identification of palliative care concerns. The Integrated Palliative Care Outcome Scale (IPOS) was developed in the United Kingdom for this purpose. Tools developed in another setting might not be readily usable locally. We previously evaluated the validity and reliability of the IPOS in our cardiology setting. However, it remains uncertain what factors would influence the subsequent implementation of IPOS for routine screening of patients with advanced heart failure in future practice. Objectives This study aimed to identify the factors that could affect the IPOS implementation for patients with advanced heart failure. Design This was a qualitative study conducted at the National Heart Centre Singapore. Methods Patients with advanced heart failure who participated in our previous IPOS validation study were purposively recruited for semi-structured interviews. Healthcare workers caring for these patients and involved in the testing of the IPOS tool were also invited for interviews. The interviews were analyzed thematically and mapped to the Consolidated Framework for Implementation Research (CFIR). Results Our analysis identified six potential facilitators and six potential barriers to implementation across five major domains of the CFIR (intervention characteristics, inner setting, outer setting, individual characteristics, and process). Facilitators include: (i) perception of utility, (ii) perception of minimal complexity, (iii) perception of relatability, (iv) conducive culture, (v) dedicated resources, and (vi) advocates for implementation. Barriers include: (i) need for adaptation, (ii) mindsets/role strains, (iii) resource constraints, (iv) cultural concerns, (v) individual needs, and (vi) change process. Conclusion Institutions could focus on cultivating appropriate perceptions and conducive cultures, providing dedicated resources for implementation and introducing facilitators to advocate for implementation. Adaptation of IPOS to suit workflows and individual needs, consideration of change processes, and systemic changes to alleviate cultural, resource, and staff role strains would improve IPOS uptake during actual implementation in clinical services. Trial registration Not applicable.
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Affiliation(s)
- Shirlyn Hui-Shan Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Level 4, 11 Hospital Crescent, Singapore 169610, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Jasmine Yun-Ting Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Elaine Swee-Ling Ng
- Nursing Specialty Care Unit, National Heart Centre Singapore, Singapore, Singapore
| | - Sungwon Yoon
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Chow AYM, Zhang AY, Chan IKN, Fordjour GA, Lui JNM, Lou VWQ, Chan CLW. Caregiving Strain Mediates the Relationship Between Terminally Ill Patient's Physical Symptoms and Their Family Caregivers' Wellbeing: A Multicentered Longitudinal Study. J Palliat Care 2023:8258597231215137. [PMID: 38018131 DOI: 10.1177/08258597231215137] [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: 11/30/2023]
Abstract
Objectives: Research considered patient outcomes primarily over caregivers in end-of-life care settings. The importance of family caregivers (FCs) in end-of-life care draws growing awareness, evidenced by an increasing number of evaluations of caregiver-targeted interventions. Little is known of FCs' collateral benefits in patient-oriented home-based end-of-life care. The study aims to investigate FC outcomes and change mechanisms in patient-oriented care. Methods: A pre-post-test study. We recruited FCs whose patients with a life expectancy ≤ 6 months enrolled in home-based end-of-life care provided by service organizations in Hong Kong. Patients' symptoms, dimensions of caregiving strain (ie, perception of caregiving, empathetic strain, adjustment demands), and aspects of FCs' wellbeing (ie, perceived health, positive mood, life satisfaction, spiritual well-being) were measured at baseline (T0) and 3 months later (T1). Results: Of the 345 FCs at T0, 113 provided T1 measures. Three months after the service commenced, FCs' caregiving strain significantly reduced, and their positive mood improved. Alleviation of the patient's physical symptoms predicted FC better outcomes, including the perception of caregiving, empathetic strain, and wellbeing. Changes in perception of caregiving mediated the effects of changes in patients' physical symptoms on FCs' changes in life satisfaction and spiritual wellbeing. Changes in empathetic strain mediated the changes between patient's physical symptoms and FCs' positive mood. Conclusions: Collateral benefits of patient-oriented home-based end-of-life care were encouraging for FCs. Patient's physical symptom management matters to FCs' caregiving strain and wellbeing. The active ingredients modifying FCs' perception of caregiving and addressing empathetic strain may amplify their benefits in wellbeing.
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Affiliation(s)
- Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Y Zhang
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Iris K N Chan
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Genevieve A Fordjour
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Julianna N M Lui
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong SAR, China
| | - Cecilia L W Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
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Ishii Y, Ito N, Matsumura Y, Aoyama M, Kohara I, Murai K, Takeuchi K, Yokoyama T, Miyashita M, Miyashita M. Validity and reliability of the Integrated Palliative Care Outcome Scale for non-cancer patients. Geriatr Gerontol Int 2023. [PMID: 37246235 DOI: 10.1111/ggi.14603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
AIM This study assessed the validity and reliability of the Integrated Palliative Care Outcome Scale for non-cancer patients. METHODS We recruited 223 non-cancer patients receiving palliative care and their healthcare providers (222) across two home care facilities and two hospitals for a cross-sectional study. We assessed the construct validity and known-group validity of the Integrated Palliative Care Outcome Scale. The weighted kappa and interclass correlation coefficients were assessed to ascertain reliability. RESULTS The scale scores were significantly higher for the 'non-stable' group (worsening condition group) measured in the palliative care phase than for the 'stable' group (P < 0.001). Regarding validity, Spearman's correlations between similar items on the Integrated Palliative Care Outcome Scale and Edmonton Symptom Assessment System ranged from 0.61 to 0.94. Regarding reliability, the weighted kappa coefficients ranged from 0.53 to 0.81 for patients and from 0.58 to 0.90 for healthcare providers. For inter-rater reliability between patients and healthcare providers, the weighted kappa coefficients for each item ranged from 0.03 to 0.42. CONCLUSION This study confirmed the validity and reliability of the Integrated Palliative Care Outcome Scale for non-cancer patients requiring palliative care. However, the inter-rater reliability indicates poor agreement between the assessments of patients and healthcare providers. This highlights the discrepancies between both their assessments and the importance of the patient's assessment. Geriatr Gerontol Int 2023; ••: ••-••.
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Affiliation(s)
- Yoko Ishii
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
- Jichi Medical University School of Nursing, Tochigi, Japan
| | - Nao Ito
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
- Iwate Medical University School of Nursing, Iwate, Japan
| | - Yuko Matsumura
- Department of Nursing, Kyoto City Hospital, Kyoto, Japan
| | - Maho Aoyama
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Izumi Kohara
- Jichi Medical University School of Nursing, Tochigi, Japan
| | | | | | - Takako Yokoyama
- Multifunctional Small Nursing Care Home "Aisanchi", Tochigi, Japan
| | - Masako Miyashita
- Tohoku Bunka Gakuen University, Faculty of Health and Welfare Department of Nursing, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Health Sciences, Palliative Care Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
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Neo SHS, Tan JYT, Sim DKL, Ng ESL, Loh JKX, Yang GM, Murtagh FE, Cheung YB. Validity and Reliability of the Integrated Palliative Care Outcome Scale in Asian Heart Failure Patients. Palliat Med Rep 2022; 3:287-295. [DOI: 10.1089/pmr.2022.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Shirlyn Hui-Shan Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Jasmine Yun-Ting Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Elaine Swee-Ling Ng
- Nursing Specialty Care Unit, National Heart Centre Singapore, Singapore, Singapore
| | | | - Grace Meijuan Yang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Fliss E.M. Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Yin Bun Cheung
- Program in Health Services & Systems Research and Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Centre for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
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Busquet-Duran X, Esteban-Perez M, Manresa-Domínguez JM, Moreno SM, Leston-Lado L, Torán-Monserrat P. Intra-rater reliability and feasibility of the HexCom advanced disease complexity assessment model. Aten Primaria 2022; 54:102343. [PMID: 35550948 PMCID: PMC9108442 DOI: 10.1016/j.aprim.2022.102343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/11/2022] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
Abstract
Aim To study the intra-rater reliability and feasibility of the HexCom complexity assessment model by analyzing internal consistency, intra-rater reliability and response time. Design Test–retest study with a selection of 11 clinical situations that cover the full scope of situations assessed by the HexCom model and which are responded to individually. Location Home care, primary care, hospital and sociosanitary care. Two specialized palliative home care teams (PADES). Participants A total of 20 professionals comprising 10 experts in palliative home care (PADES) and 10 professionals from general palliative care (primary care, hospital and sociosanitary care). These professionals came from the fields of family medicine (5), internal medicine (2), geriatrics (2), nursing (9), psychology (1) and social work (1). Main measurements Cronbach's alpha, weighted kappa, response time. Results Cronbach's alpha of 0.91 for HexCom-Red and 0.87 for HexCom-Clin. Intra-rater reliability ranging from good to very good for HexCom-Red (kappa: 0.78–1) and from moderate to very good for HexCom-Clin (kappa: 0.58–0.91). Average response time of 0:57 for HexCom-Red and 3:80 min for HexComClin. Conclusions HexCom-Red and HexCom-Clin are reliable tools and feasible for use by all professionals involved in both general and specialized palliative care at different levels.
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Affiliation(s)
- Xavier Busquet-Duran
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Granollers, Barcelona, Spain; Sant Miquel Primary Care Center (CAP), Carrer de Francesc Macià i Llussà, 154, 08401 Granollers, Barcelona, Catalonia, Spain; Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain.
| | - Manel Esteban-Perez
- Home Care Program, Reus Support Team (PADES), Sant Joan de Reus University Hospital, Avinguda del Doctor Josep Laporte, 2, 43204 Reus, Tarragona, Spain
| | - Josep Maria Manresa-Domínguez
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; Metropolitan Nord Unit of Research Support, Jordi Gol University Institute of Research in Primary Care (IDIAP), Mataró, Barcelona, Gran Via de les Corts Catalanes, 587, 08007 àtic, Catalonia, Spain
| | - Susana Martin Moreno
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Granollers, Barcelona, Spain; Sant Miquel Primary Care Center (CAP), Carrer de Francesc Macià i Llussà, 154, 08401 Granollers, Barcelona, Catalonia, Spain
| | - Lola Leston-Lado
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Granollers, Barcelona, Spain; Sant Miquel Primary Care Center (CAP), Carrer de Francesc Macià i Llussà, 154, 08401 Granollers, Barcelona, Catalonia, Spain
| | - Pere Torán-Monserrat
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; Metropolitan Nord Unit of Research Support, Jordi Gol University Institute of Research in Primary Care (IDIAP), Mataró, Barcelona, Gran Via de les Corts Catalanes, 587, 08007 àtic, Catalonia, Spain
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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.
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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
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Hamatani Y, Iguchi M, Ikeyama Y, Kunugida A, Ogawa M, Yasuda N, Fujimoto K, Ichihara H, Sakai M, Kinoshita T, Nakashima Y, Akao M. Comprehensive symptom assessment using Integrated Palliative care Outcome Scale in hospitalized heart failure patients. ESC Heart Fail 2022; 9:1963-1975. [PMID: 35307988 PMCID: PMC9065822 DOI: 10.1002/ehf2.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/06/2022] Open
Abstract
Aims Patients with heart failure (HF) may have variable unrecognized symptom burdens. We sought to investigate the details, determinants, and prognostic significance of symptom burden in hospitalized patients with HF. Methods and results We prospectively evaluated consecutive hospitalized patients with HF as primary diagnosis at our institution using the Integrated Palliative care Outcome Scale (IPOS) both on admission and at discharge. The IPOS, which is a well‐validated multi‐dimensional symptom assessment scale among advanced illness, consists of 17 questions for enquiring about physical symptoms (10 items), emotional symptoms (4 items) and communication and practical issues (3 items) using a 5‐point Likert scale (0 [best]–4 [worst] points). Clinically relevant symptoms were defined as ≥2 points for each IPOS item. Worsening symptom burden was defined as the total IPOS score at discharge being poorer than that on admission. Of 294 patients (mean age: 77.5 ± 12.0 years, male: 168 patients, New York Heart Association class IV: 96 patients, mean left ventricular ejection fraction [LVEF]: 44%, and median N‐terminal pro B‐type natriuretic peptide [NT‐proBNP] level: 4418 ng/L), the median (IQR) total IPOS score on admission was 19 (12, 27) and they were widely distributed (minimum: 0 – maximum: 52). The total IPOS score on admission was not correlated with the HF severity, including LVEF (Spearman's ρ = −0.05, P = 0.43), NT‐proBNP levels (Spearman's ρ = 0.08, P = 0.20) or in‐hospital mortality prediction model (GWTG‐HF risk score) (Spearman's ρ = 0.01, P = 0.90). Total IPOS scores significantly decreased during hospitalization as a whole (median [IQR]: 13 [6, 21] at discharge; P < 0.001 vs. those on admission). All of the four emotional symptoms (patient anxiety, depression, family anxiety and feeling at peace) remained in the top 5 of clinically relevant symptoms at discharge, whereas none of 10 physical symptoms were nominated. Worsening symptom burden was noted in 28% of the patients during hospitalization, and was independently associated with higher all‐cause mortality after discharge (hazard ratio: 2.28, 95% confidence interval: 1.02–5.09; P = 0.044) even after adjustment by age and HF mortality prediction model (MAGGIC risk score). Conclusions We revealed that hospitalized patients with HF had multi‐dimensional symptom burdens which varied among individuals and were not correlated with the disease severity. Emotional symptoms, such as anxiety and depression, were the main clinically relevant symptoms at discharge. A worsening IPOS score was noted in a quarter of patients with HF and was associated with a poor prognosis, suggesting the importance of holistic symptom assessment during the course of hospitalization for HF.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of Cardiology National Hospital Organization Kyoto Medical Center 1‐1, Mukaihata‐cho, Fukakusa, Fushimi‐ku Kyoto 612‐8555 Japan
| | - Moritake Iguchi
- Department of Cardiology National Hospital Organization Kyoto Medical Center 1‐1, Mukaihata‐cho, Fukakusa, Fushimi‐ku Kyoto 612‐8555 Japan
| | - Yurika Ikeyama
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Atsuko Kunugida
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Megumi Ogawa
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Natsushige Yasuda
- Department of Rehabilitation National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kana Fujimoto
- Department of Pharmacy National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Hidenori Ichihara
- Department of Pharmacy National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Misaki Sakai
- Department of Nursing National Hospital Organization Kyoto Medical Center Kyoto Japan
- Department of Palliative Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Tae Kinoshita
- Department of Palliative Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Yasuyo Nakashima
- Department of Rehabilitation National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Masaharu Akao
- Department of Cardiology National Hospital Organization Kyoto Medical Center 1‐1, Mukaihata‐cho, Fukakusa, Fushimi‐ku Kyoto 612‐8555 Japan
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