Parker Deborah, Hodgkinson Brent
1. University of Queensland/Blue Care Research and Practice Development Centre, The Joanna Briggs Australian Centre for Evidence-Based Community Care (ACEBCC).
JBI Libr Syst Rev. 2010;8(3):90-120. doi: 10.11124/01938924-201008030-00001.
Provision of palliative care in residential aged care facilities (RACFs) is important but limited research has been undertaken to investigate the most appropriate outcome measures for use in this setting.
This systematic review aimed tomeasure the psychometric properties (reliability/validity) and feasibility of palliative outcome measures used to assess the quality of palliative care provided in residential aged care facilities.
This review considered studies reporting on the psychometric properties of palliative care outcome measures that have been used in assessing the quality of palliative care provided in residential aged care facilities, including support to family. Measures may be those completed by a health professional, the person receiving care or their family.
The search strategy aimed to identify both English language published and unpublished studies. A three-step strategy was followed, in which the initial phase consisted of searches of the CINAHL, MEDLINE and PsycINFO databases using keywords or terms. Second, a more extensive search was performed using the appropriate Subject Headings and/or keywords/phrase/strategy for several major databases. Finally, the reference lists or bibliographies of identified reports and articles were hand searched for additional relevant studies.
Included studies were assessed by two independent reviewers for methodological quality prior to inclusion in the review using an appraisal checklist developed for the review based on the review methods of Zwakhalen et al to evaluate validity, reliability and feasibility.
The database and hand searches yielded 441 articles for review of which 17 were duplicates leaving 422 abstracts which were critically appraised for relevance to the review based on the title and abstract. After applying the inclusion and exclusion criteria, twenty three abstracts were retained and full articles were retrieved for screening by the two authors. Of these twenty three articles, ten were included in the final review. The ten articles provide specific information on the psychometric properties of ten outcome measures. Of the ten included articles, four report on the psychometric properties of the outcome measure used exclusively within the residential aged care setting while the remaining six measures report the use in a sub-population. The Family Perceptions of Care Scale (FPCS) is considered by the authors as the most suitable outcome measure for use in RACFs. The FPCS has a number of properties that has led to its preferred selection, in particular the development and testing of the scale which occurred exclusively in the RACF population. This scale has excellent content validity, covering all essential domains of palliative care. It has a robust factor structure and is simple to administer and score. Of the remaining nine measures, a further two were also considered suitable for measuring quality of palliative care in RACFs. These are the Quality of Dying in Long Term Care (QOD-LTC) scale and the Toolkit Interview.
Based on psychometric qualities, the outcome measure of choice from this review is the Family Perceptions of Care Scale although further psychometric and clinical research needs to be conducted. Limitations regarding the use of outcome measures for assessing quality in this setting include reliance on proxy ratings and limited psychometric testing for some of the measures specifically in the RACF population.
在老年护理机构（RACFs）中提供姑息治疗很重要，但针对该环境下最适宜的结局指标进行的研究有限。
本系统评价旨在衡量用于评估老年护理机构中姑息治疗质量的姑息治疗结局指标的心理测量特性（信度/效度）及可行性。
本评价纳入了报告姑息治疗结局指标心理测量特性的研究，这些指标用于评估老年护理机构中提供的姑息治疗质量，包括对家属的支持。这些指标可以由健康专业人员、接受护理者或其家属完成。
检索策略旨在识别已发表和未发表的英文研究。采用了三步策略，第一步包括使用关键词在CINAHL、MEDLINE和PsycINFO数据库中进行检索。第二步，使用几个主要数据库的适当主题词和/或关键词/短语/策略进行更广泛的检索。最后，人工检索已识别报告和文章的参考文献列表或书目，以查找其他相关研究。
在纳入评价之前，由两名独立的评价者使用根据Zwakhalen等人的评价方法为本次评价制定的评价清单，对纳入的研究进行方法学质量评估，以评估效度、信度和可行性。
数据库检索和人工检索共获得441篇文章以供评价，其中17篇为重复文章，剩余422篇摘要根据标题和摘要进行了与评价相关性的严格评估。应用纳入和排除标准后，保留了23篇摘要，并检索了全文供两位作者筛选。在这23篇文章中，10篇被纳入最终评价。这10篇文章提供了关于10个结局指标心理测量特性的具体信息。在纳入的10篇文章中，4篇报告了仅在老年护理机构环境中使用的结局指标的心理测量特性，其余6个指标报告了在亚人群中的使用情况。作者认为家庭护理感知量表（FPCS）是老年护理机构中最适宜使用的结局指标。FPCS具有多项特性，使其成为首选指标，特别是该量表专门针对老年护理机构人群进行了开发和测试。该量表具有出色的内容效度，涵盖了姑息治疗的所有重要领域。它具有稳健的因子结构，易于实施和评分。在其余9个指标中，另有2个也被认为适用于测量老年护理机构中姑息治疗的质量。这两个指标分别是长期护理中的死亡质量（QOD-LTC）量表和工具包访谈。
基于心理测量特性，本次评价选择的结局指标是家庭护理感知量表，不过还需要进行进一步的心理测量和临床研究。在该环境下使用结局指标评估质量的局限性包括依赖代理评级，以及一些指标特别是在老年护理机构人群中的心理测量测试有限。
