Masso Malcolm, Allingham Samuel Frederic, Banfield Maree, Johnson Claire Elizabeth, Pidgeon Tanya, Yates Patsy, Eagar Kathy
Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia.
Palliat Med. 2015 Jan;29(1):22-30. doi: 10.1177/0269216314551814. Epub 2014 Sep 23.
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.
To test the reliability and acceptability of revised definitions of Palliative Care Phase.
Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase.
SETTING/PARTICIPANTS: Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service.
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.
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.
大约20年前，澳大利亚提出了姑息治疗由五个不同的、具有临床意义的阶段（稳定期、不稳定期、恶化期、终末期和丧亲期）组成的概念，并将其常规用于沟通临床状况、护理计划、质量改进和资金筹集。
测试姑息治疗阶段修订定义的可靠性和可接受性。
多中心横断面研究，由成对的临床医生根据姑息治疗阶段的修订定义对患者进行独立评分。
地点/参与者：来自澳大利亚10家姑息治疗服务机构的临床医生，包括9个住院单元和1个住院/社区混合服务机构。
共有102名护理和医疗临床医生参与，对410名患者进行了595次配对评估，其中90.7%在2小时内完成。临床医生将54.8%的患者评定为稳定期，15.8%为不稳定期，20.8%为恶化期，8.7%为终末期。临床医生对姑息治疗阶段评定的总体一致性较高（kappa = 0.67；95%置信区间 = 0.61 - 0.70）。所有参与地点的评分者间信度均处于中等水平。结果表明，姑息治疗阶段是一项可接受的指标，在将患者分配到某个姑息治疗阶段时没有显著困难，且阶段评估与该阶段定义之间匹配良好。最难与其他阶段区分的是恶化期。
政策制定者、资助者和临床医生可以确信，姑息治疗阶段是一项可靠且可接受的指标，可用于护理计划、质量改进和资金筹集目的。
