title: Palliative Care Phase: inter-rater reliability and acceptability in a national study.
abstract: BACKGROUND
  The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was developed in Australia about 20 years ago and is used routinely for communicating clinical status, care planning, quality improvement and funding.
  
  
  OBJECTIVE
  To test the reliability and acceptability of revised definitions of Palliative Care Phase.
  
  
  METHODS
  Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase.
  
  
  METHODS
  Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service.
  
  
  RESULTS
  A total of 102 nursing and medical clinicians participated, undertaking 595 paired assessments of 410 patients, of which 90.7% occurred within 2 h. Clinicians rated 54.8% of patients in the stable phase, 15.8% in the unstable phase, 20.8% in the deteriorating phase and 8.7% in the terminal phase. Overall agreement between clinicians' rating of Palliative Care Phase was substantial (kappa = 0.67; 95% confidence interval = 0.61-0.70). A moderate level of inter-rater reliability was apparent across all participating sites. The results indicated that Palliative Care Phase was an acceptable measure, with no significant difficulties assigning patients to a Palliative Care Phase and a good fit between assessment of phase and the definition of that phase. The most difficult phase to distinguish from other phases was the deteriorating phase.
  
  
  CONCLUSIONS
  Policy makers, funders and clinicians can be confident that Palliative Care Phase is a reliable and acceptable measure that can be used for care planning, quality improvement and funding purposes.
authors.affiliation: Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia mmasso@uow.edu.au.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Masso
authors.affiliation: Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia.
authors.forename: Samuel Frederic
authors.initials: SF
authors.lastname: Allingham
authors.affiliation: Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia.
authors.forename: Maree
authors.initials: M
authors.lastname: Banfield
authors.affiliation: Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, University of Western Australia, Perth, WA, Australia.
authors.forename: Claire Elizabeth
authors.initials: CE
authors.lastname: Johnson
authors.affiliation: Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, University of Western Australia, Perth, WA, Australia.
authors.forename: Tanya
authors.initials: T
authors.lastname: Pidgeon
authors.affiliation: School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Patsy
authors.initials: P
authors.lastname: Yates
authors.affiliation: Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia.
authors.forename: Kathy
authors.initials: K
authors.lastname: Eagar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards*; D015397:Program Evaluation; D015203:Reproducibility of Results
keywords: Episode of care; needs assessment; palliative care; patient acuity; reproducibility of results