Palliative care problem severity score: Reliability and acceptability in a national study

Authors

Malcolm R. Masso, University of WollongongFollow
Samuel F. Allingham, University of WollongongFollow
Claire E. Johnson, University of Western Australia
Tanya Pidgeon, University of Western AustraliaFollow
Patsy Yates, Queensland University of Technology
David C. Currow, Flinders UniversityFollow
Kathy Eagar, University of WollongongFollow

RIS ID

103664

Publication Details

M. Masso, S. Frederic. Allingham, C. Elizabeth. Johnson, T. Pidgeon, P. Yates, D. Currow & K. Eagar, "Palliative care problem severity score: Reliability and acceptability in a national study", Palliative Medicine 30 5 (2016) 479-485.

Abstract

Background: The Palliative Care Problem Severity Score is a clinician-rated tool to assess problem severity in four palliative care domains (pain, other symptoms, psychological/spiritual, family/carer problems) using a 4-point categorical scale (absent, mild, moderate, severe). Aim: To test the reliability and acceptability of the Palliative Care Problem Severity Score. Design: Multi-centre, cross-sectional study involving pairs of clinicians independently rating problem severity using the tool. Setting/participants: Clinicians from 10 Australian palliative care services: 9 inpatient units and 1 mixed inpatient/community-based service. Results: A total of 102 clinicians participated, with almost 600 paired assessments completed for each domain, involving 420 patients. A total of 91% of paired assessments were undertaken within 2 h. Strength of agreement for three of the four domains was moderate: pain (Kappa = 0.42, 95% confidence interval = 0.36 to 0.49); psychological/spiritual (Kappa = 0.48, 95% confidence interval = 0.42 to 0.54); family/carer (Kappa = 0.45, 95% confidence interval = 0.40 to 0.52). Strength of agreement for the remaining domain (other symptoms) was fair (Kappa = 0.38, 95% confidence interval = 0.32 to 0.45). Conclusion: The Palliative Care Problem Severity Score is an acceptable measure, with moderate reliability across three domains. Variability in inter-rater reliability across sites and participant feedback indicate that ongoing education is required to ensure that clinicians understand the purpose of the tool and each of its domains. Raters familiar with the patient they were assessing found it easier to assign problem severity, but this did not improve inter-rater reliability.