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Palliative Care Problem Severity Score: Reliability and acceptability in a national study.

Malcolm Masso1, Samuel Frederic Allingham2, Claire Elizabeth Johnson3

  • 1Centre for Health Service Development (CHSD), Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia mmasso@uow.edu.au.

Palliative Medicine
|October 28, 2015
PubMed
Summary

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The Palliative Care Problem Severity Score shows moderate reliability in assessing pain, psychological/spiritual, and family/carer issues in palliative care. Further education is recommended to improve consistency across all domains.

Area of Science:

  • Palliative Care
  • Clinical Assessment Tools
  • Healthcare Quality Improvement

Background:

  • The Palliative Care Problem Severity Score (PCPSS) is a clinician-rated tool designed to evaluate problem severity across four key palliative care domains.
  • These domains include pain, other symptoms, psychological/spiritual concerns, and family/carer issues, each assessed on a 4-point scale.

Purpose of the Study:

  • To rigorously evaluate the reliability and acceptability of the Palliative Care Problem Severity Score.
  • To determine the consistency of clinician ratings across different palliative care settings.

Main Methods:

  • A multi-centre, cross-sectional study was conducted involving pairs of clinicians rating problem severity independently.
  • Assessments were performed by clinicians across 10 Australian palliative care services, including inpatient and community-based settings.
Keywords:
Australiaassessment of health-care needspalliative carepatient outcome assessmentreproducibility of results

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  • Data involved nearly 600 paired assessments for each domain across 420 patients.

    • Main Results:

    • Moderate inter-rater reliability was observed for pain (Kappa=0.42), psychological/spiritual (Kappa=0.48), and family/carer domains (Kappa=0.45).
    • Fair reliability was found for the 'other symptoms' domain (Kappa=0.38).
    • The majority (91%) of paired assessments were completed within a 2-hour timeframe.

    Conclusions:

    • The Palliative Care Problem Severity Score is an acceptable tool for assessing palliative care needs.
    • While reliability is moderate for most domains, variability across sites suggests a need for enhanced clinician education.
    • Familiarity with patients improved ease of rating but did not significantly enhance inter-rater reliability.