The German Hospice and Palliative Care Evaluation (HOPE) is a national, long-term quality assurance project. Every year, German hospice and palliative care institutions document a core data set for their patients for a period of three months.
To validate the multidimensional symptom and problem checklist (HOPE-SP-CL) of the core data set and report details on reliability and validity.
Data from yearly evaluation periods between 2002 and 2009 were used to calculate construct and convergent validity, internal consistency, test-retest reliability, and documentation discipline and acceptance of the core documentation system.
The HOPE-SP-CL includes items on physical, nursing, psychological, and social symptoms and problems. Factor analysis extracted four low to moderately intercorrelating factors with eigenvalues greater than 1.0 explaining 56% of the total variance. Discriminant validity of the HOPE-SP-CL showed good properties in detecting patient groups with different symptom intensities and overall symptom burden using the Eastern Cooperative Oncology Group performance status and primary cancer diagnosis as external validation criteria. The global sum score of the HOPE-SP-CL correlated most closely with the Palliative Outcome Scale staff version (r=0.750). Internal consistencies ranged between α=0.768-0.801 at three different times of assessment. Test-retest coefficients showed moderate to high correlations at one-week intervals.
Analyses of reliability and validity of the HOPE-SP-CL showed satisfactory to good psychometric properties; therefore, the HOPE-SP-CL can be recommended for standard implementation in German hospice and palliative care institutions.
"[11,25,28,40], 17 (54.8%) [10,12-15,18,20,24,26,27,30-32],[34,36-38], and 10 (32.2%) [16,17,19,21-23,29,33,35,39] articles classified as good, fair, and poor, respectively, with regards to the overall quality criteria. No article was classified as excellent according to the aforementioned criteria. "
[Show abstract][Hide abstract] ABSTRACT: Patient-reported outcome validation needs to achieve validity and reliability standards. Among reliability analysis parameters, test-retest reliability is an important psychometric property. Retested patients must be in a clinically stable condition. This is particularly problematic in palliative care (PC) settings because advanced cancer patients are prone to a faster rate of clinical deterioration. The aim of this study was to evaluate the methods by which multi-symptom and health-related qualities of life (HRQoL) based on patient-reported outcomes (PROs) have been validated in oncological PC settings with regards to test-retest reliability.
A systematic search of PubMed (1966 to June 2013), EMBASE (1980 to June 2013), PsychInfo (1806 to June 2013), CINAHL (1980 to June 2013), and SCIELO (1998 to June 2013), and specific PRO databases was performed. Studies were included if they described a set of validation studies. Studies were included if they described a set of validation studies for an instrument developed to measure multi-symptom or multidimensional HRQoL in advanced cancer patients under PC. The COSMIN checklist was used to rate the methodological quality of the study designs.
We identified 89 validation studies from 746 potentially relevant articles. From those 89 articles, 31 measured test-retest reliability and were included in this review. Upon critical analysis of the overall quality of the criteria used to determine the test-retest reliability, 6 (19.4%), 17 (54.8%), and 8 (25.8%) of these articles were rated as good, fair, or poor, respectively, and no article was classified as excellent. Multi-symptom instruments were retested over a shortened interval when compared to the HRQoL instruments (median values 24 hours and 168 hours, respectively; p = 0.001). Validation studies that included objective confirmation of clinical stability in their design yielded better results for the test-retest analysis with regard to both pain and global HRQoL scores (p < 0.05). The quality of the statistical analysis and its description were of great concern.
Test-retest reliability has been infrequently and poorly evaluated. The confirmation of clinical stability was an important factor in our analysis, and we suggest that special attention be focused on clinical stability when designing a PRO validation study that includes advanced cancer patients under PC.
BMC Medical Research Methodology 01/2014; 14(1):8. DOI:10.1186/1471-2288-14-8 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hintergrund
Die Einführung der Palliativmedizin in Pflegeeinrichtungen wurde in den letzten Jahren zunehmend gefordert. Für die Implementierung der Palliativversorgung in stationären Pflegeheimen und anderen Einrichtungen stellt die Evaluation der Implementierungsmaßnahmen eine große Herausforderung dar. Eine quantitative Messung sollte aufgrund der hohen Komplexität des Gegenstands v. a. auf das Wissen in Bezug auf Palliativversorgung abzielen. Zusätzlich kann die spezifische Selbstwirksamkeit Auskunft über die Umsetzung des Wissens geben. Für beide Bereiche gibt es bislang noch keinen Test in deutscher Sprache.
Material und Methoden
Unter Berücksichtigung der bereits in anderen Sprachen vorhandenen Instrumente wurde eine Inhaltsvalidierung von Items durch 5 Experten für Palliativversorgung durchgeführt. Zusätzlich wurde der Fragebogen mithilfe der Think-aloud-Methode durch 5 Experten inhaltlich validiert. Im weiteren Konstruktionsprozess diente eine Gruppe von Ausbildern für Palliativversorgung (n=23) als Kriteriumsstichprobe. Außerdem wurde eine Prä-post-Messung an Altenpflegern (n=36) durchgeführt, die an einem Kurs zur Palliativversorgung teilnahmen, um die Änderungssensitivität der Items zu prüfen.
Für den Wissenstest wurden 23 Items und für den Selbstwirksamkeitstest 15 Items ausgewählt. Die Schwierigkeit der Items war adäquat und die Änderungssensitivität hervorragend. Der Cronbach-α-Wert lag für den Wissenssteil bei 0,71 und für den Selbstwirksamkeitsteil bei 0,84.
Mit dem Bonner Palliativwissenstest (BPW) liegt das erste validierte Messinstrument für die Evaluation von Wissen über die Palliativversorgung vor. Beim Einsatz sollte jedoch die Komplexität des gemessenen Gegenstands nicht außer Acht gelassen werden, weshalb der zusätzliche Einsatz von qualitativen Methoden empfohlen wird.
Der Schmerz 12/2011; 25(6). DOI:10.1007/s00482-011-1111-7 · 1.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Palliative care (PC) infrastructure has developed differently around the globe. Whereas some institutions consider the palliative care unit (PCU) a valuable component, others report that the sole provision of a state-of-the art palliative care consultation service (PCCS) suffices to adequately care for the severely ill and dying.
To aid institutional planning, this study aimed at gathering patient data to distinguish assignments of a concomitantly run PCU and PCCS at a large hospital and academic medical center.
Demographics, Eastern Cooperative Oncology Group performance status, symptom/problem burden, discharge modality, and team satisfaction with care for all 601 PCU and 851 PCCS patients treated in 2009 and 2010 were retrospectively analyzed.
Patients admitted to the PCU versus those consulted by the PCCS: (a) had a significantly worse performance status (odds ratio [OR], 1.48); (b) were significantly more likely to suffer from severe symptoms and psychosocial problems (OR, 2.05), in particular concerning physical suffering and complexity of care; and (c) were significantly much more likely to die during hospital stay (OR, 11.03). For patients who were dying or in other challenging clinical situations (suffering from various severe symptoms), self-rated team satisfaction was significantly higher for the PCU than the PCCS.
This study presents a direct comparison between patients in a PCU and a PCCS. Results strongly support the hypothesis that the coexistence of both institutions in one hospital contributes to the goal of ensuring optimal high-quality PC for patients in complex and challenging clinical situations.
The Oncologist 02/2012; 17(3):428-35. DOI:10.1634/theoncologist.2011-0326 · 4.87 Impact Factor
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