Development of an Abstraction Tool to Assess Palliative Care Components.

Little is known regarding the fidelity of delivery of guideline-recommended components of palliative care in "real world" encounters. To develop a qualitative coding framework to identify components of clinical palliative care in clinical documentation across care settings. Retrospective review of palliative care clinical documentation from medical providers, with directed qualitative content analysis to identify components of clinical care documented. Purposively sampled deceased patients seen by palliative care at a US academic medical center between 7/1/2011-7/1/2018. The outcome of this work is a coding framework for use in future research. We assessed the robustness of the framework using Cohen's kappa. We reviewed sixty-two encounters from twenty-six patients. We identified 7 major themes in documentation: (1) addressing physical symptoms, (2) addressing psychological symptoms, (3) establishing illness understanding, (4) supporting decision making, (5) end-of-life planning, (6) understanding psychosocial context, and (7) care coordination. Interrater reliability varied widely between components, with Cohen's kappa ranging from -.51 to 1. This pilot study provides a coding framework to measure documentation of clinical palliative care components. Several components could not be reliably identified using this framework, suggesting the need for additional measurement strategies.