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The Paediatric Palliative Screening Scale: Further validity testing
Eva Bergstraesser1, Michaela Paul2, Kaspar Rufibach2
11 Department of Palliative Care and Oncology, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
Pediatric palliative care screening identifies life expectancy and child/family preferences as key indicators for timely intervention. This helps ensure children with life-limiting illnesses receive necessary support earlier in their disease trajectory.
Area of Science:
- Pediatric Palliative Care
- Clinical Screening Tools
- Health Outcomes Research
Background:
- Paediatric palliative care is often initiated late for children with life-limiting diseases.
- Challenges persist in effectively translating palliative care principles into practice for pediatric populations.
Purpose of the Study:
- To further validate the Paediatric Palliative Screening Scale.
- To identify specific attributes that predict the need for palliative care in children aged 1-18 years.
Main Methods:
- Proportional-odds logistic regression analysis was used to assess attribute relationships.
- Online questionnaires with case vignettes were distributed to 33 pediatric palliative care experts globally.
- Regression estimates were converted into empirical weightings for the screening scale attributes.
Main Results:
- Estimated life expectancy <12 months received the highest weighting (40%).
- Child/parent preferences were also significant predictors (24%).
- Disease trajectory, treatment outcomes, and symptom burden had lower weightings.
Conclusions:
- Life expectancy and child/family preferences are the strongest indicators for initiating paediatric palliative care.
- Findings from this validation step show some divergence from previous research and instrument validation.
- These results emphasize the critical role of prognostic information and family-centered decision-making in pediatric palliative care.
Background:
Paediatric palliative care is still often introduced late in the illness trajectory of children with life-limiting diseases. Translating palliative care into practice continues to be a challenge.
Aim:
To validate the Paediatric Palliative Screening Scale further by defining attributes that predict the need for palliative care in children between 1 and 18 years.
Design:
Proportional-odds logistic regression analysis was performed to investigate the relationship between the attributes of the Paediatric Palliative Screening Scale and the experts' assessment of case vignettes with various combinations of different attribute characteristics. Estimates from regression analysis were transformed to empirical weightings of the Paediatric Palliative Screening Scale attribute characteristics.
Setting/Participants:
Online questionnaires with case vignettes were sent to 33 paediatric palliative care experts from Europe, the United States, Canada, Australia and New Zealand.
Results:
The highest weightings among the five previously defined attributes were estimated life expectancy <12 months (40% of maximum score) and preferences of the child/parents received (24%). Trajectory of disease and impact on daily activities of the child, expected outcome of treatment directed at the disease and burden of treatment, and symptom or problem burden were weighted less.
Conclusions:
According to this second step of psychometric testing of the Paediatric Palliative Screening Scale, the strongest and most urgent necessity indicators for a palliative care approach are life expectancy and child/family preferences. These results are somewhat discrepant with results from the previous validation of the instrument as well as previous research findings.
