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


OBJECTIVE
To test the reliability and acceptability of the Palliative Care Problem Severity Score.


METHODS
Multi-centre, cross-sectional study involving pairs of clinicians independently rating problem severity using the tool.


METHODS
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).


CONCLUSIONS
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.
Centre for Health Service Development (CHSD), Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia mmasso@uow.edu.au.
Malcolm
M
Masso
Palliative Care Outcomes Collaboration (PCOC), Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia.
Samuel Frederic
SF
Allingham
Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, University of Western Australia, Perth, WA, Australia.
Claire Elizabeth
CE
Johnson
Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, University of Western Australia, Perth, WA, Australia.
Tanya
T
Pidgeon
School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.
Patsy
P
Yates
Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia.
David
D
Currow
Palliative Care Outcomes Collaboration (PCOC), Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia.
Kathy
K
Eagar
D001315:Australia; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005246:Feedback; D006301:Health Services Needs and Demand; D006801:Humans; D020380:Needs Assessment; D010166:Palliative Care; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
Australia; assessment of health-care needs; palliative care; patient outcome assessment; reproducibility of results