Wilk-Lelito Katarzyna, Białoń-Janusz Anna, Kowalczyk Magdalena, Wesołek Elżbieta, Grądalski Tomasz
St Lazarus Hospice, Fatimska 17, 31-831, Kraków, Poland.
Chair of Palliative Medicine Andrzej Frycz Modrzewski Krakow University, Kraków, Poland.
BMC Palliat Care. 2024 Dec 27;23(1):301. doi: 10.1186/s12904-024-01616-y.
Measuring palliative care quality requires the application of evaluation methods to compare clinically meaningful groups of patients across different settings. Such protocols are currently lacking in Poland. The Australian Palliative Care Outcome Collaboration (PCOC) concept of Palliative phases precisely defines patients, enables episodes of care extraction for benchmarking and further assessment of service delivery. The present study is aimed at developing cross-cultural adaptation and psychometric validation for a Polish translation of Palliative phases.
Forward and backward translation was performed to obtain a Polish draft version regarding definitions of the PCOC phases. The draft was then subjected to linguistic and graphical transformations in the process of cognitive interviewing. The acceptability of the Polish version was assessed based on staff perceptions of fit, ease of assignment and familiarity with the patient's and family's situation. Finally, cross-sectional analysis was conducted among 313 hospice and home-care palliative patients. The attending doctor and nurse independently evaluated the same patients using the Polish version of the PCOC phases to establish inter-rater reliability values. Then, to determine its construct validity, the PCOC indicators were referred to patients' prognosis, functioning level and PALCOM scale scores.
A Polish draft version of the PCOC phases was prepared. Seven of the 13 interviewees reported problems with comprehending this proposal. This prompted changes being made to linguistic and graphical aspects of the tool. The majority of respondents preferred the final graphical scheme of phases, prepared after round-two of interviews. Scheme application acceptability was confirmed in a practical trial. The respondents' overall conviction regarding degree of fit and assignment ease was high. Seventy percent of PCOC phase assignments was in agreement, and a moderate level or inter-rater reliability was obtained (kappa 0.573). The highest proportion of totally bed-bound patients with the shortest survival prognosis was observed for the terminal phase, while the highest complexity of palliative care needs was noted for the unstable one.
The PCOC phases tool appears to be a valuable resource for specialists in palliative care settings to support audit measures. Practical training is recommended prior to its implementation in routine practice.
衡量姑息治疗质量需要应用评估方法，以比较不同环境下具有临床意义的患者群体。波兰目前缺乏此类方案。澳大利亚姑息治疗结果协作组织（PCOC）的姑息阶段概念精确地定义了患者，能够提取护理事件以进行基准测试和进一步评估服务提供情况。本研究旨在对姑息阶段的波兰语翻译进行跨文化适应和心理测量学验证。
进行了正向和反向翻译，以获得关于PCOC阶段定义的波兰语草稿版本。然后在认知访谈过程中对草稿进行语言和图形转换。根据工作人员对适用性、分配 ease 和对患者及家庭情况的熟悉程度的看法，评估波兰语版本的可接受性。最后，对313名临终关怀和居家姑息治疗患者进行了横断面分析。主治医生和护士使用波兰语版的PCOC阶段对同一患者进行独立评估，以确定评分者间的可靠性值。然后，为了确定其结构效度，将PCOC指标与患者的预后、功能水平和PALCOM量表评分进行对照。
编制了PCOC阶段的波兰语草稿版本。13名受访者中有7人报告在理解该提案方面存在问题。这促使对该工具的语言和图形方面进行了修改。大多数受访者更喜欢第二轮访谈后编制的阶段最终图形方案。在实际试验中确认了方案应用的可接受性。受访者对适用性程度和分配 ease 的总体信心较高。PCOC阶段分配的70%达成一致，获得了中等水平的评分者间可靠性（kappa 0.573）。在终末期观察到完全卧床且生存预后最短的患者比例最高，而在不稳定期注意到姑息治疗需求的复杂性最高。
PCOC阶段工具似乎是姑息治疗环境中的专家支持审核措施的宝贵资源。建议在常规实践中实施之前进行实践培训。
