Reliability and validity of the Japanese version of the palliative care phase in palliative care facilities

Palliative care phase is a tool to assess five phases that reflect a patient's care needs: stable, unstable, deteriorating, terminal, and bereavement. The palliative care phase is routinely used to describe the clinical status of patients and their families. Australia has established nationwide benchmarks for comparing care services. However, the reliability of palliative care in Japan has not yet been verified. This study aimed to develop a Japanese version of the palliative care phase and examine its inter-rater reliability.

This was a multicenter, cross-sectional study. Based on previous studies, two healthcare providers evaluated the single-patient phase and calculated kappa coefficients. The reliability was assessed between March 2024 and November 2024 in a palliative care facility in Japan.

A total of 419 phase evaluations were conducted. The inter-rater reliability was a kappa of 0.47 (95% confidence interval 0.40-0.54). Assessment disagreements were most common during the unstable and deteriorating phases (11.7%). There were no statistically significant differences in the matches or mismatches in the assessment of the adequacy of the phases (P = 0.338).

The Japanese version of the palliative care phase was well-adapted for use in clinical palliative care. However, the concepts underlying these phases are not clearly distinguishable. In the future, we need to further educate healthcare providers and accumulate experience through on-the-job training to improve the quality of care through palliative care outcome measurements and benchmarking during the palliative care phase.