Development and Validation of Integrated Palliative Care Outcome Scale Short Form for Efficient Specialist Palliative Care Screening in Oncology (ScreeningPALL): A Cross-Sectional Study

Abstract

Background:

Widespread implementation of specialist palliative care screening in oncology can be facilitated by efficient screening tools. It has been shown that patient-reported outcome measures are useful as screening tools and might reduce staff effort. Short forms could further improve feasibility.

Objective:

Development and validation of a short form of the Integrated Palliative Care Outcome Scale (IPOS) for use as a screening tool for specialist palliative care need in patients with incurable cancer.

Design:

In a cross-sectional study, patients completed the IPOS. In an independent process, the palliative care consultation service assessed specialist palliative care need in each patient through multiprofessional case review (reference standard). Statistical analysis included bootstrapping and binary logistic regression to select suitable items for an IPOS short form and receiver operating characteristics analyses for validation.

Setting/Subjects:

The analysis included 205 hospital episodes of 194 inpatients and outpatients with incurable cancer (prognosis <2 years) at a German Comprehensive Cancer Center.

Results:

Possible IPOS short forms of two to eight items showed acceptable or excellent accuracy in predicting specialist palliative care need. A six-item IPOS short form that included the most predictive items of each of the three IPOS dimensions identified specialist palliative care need with 87.5% sensitivity (specificity = 56.4%; area under the curve = 0.786).

Conclusions:

IPOS short forms can facilitate efficient screening for specialist palliative care need, and the validation results are comparable to the full version of IPOS. Results also indicate which symptoms and problems might be most relevant as red flags in routine data or staff-based screening approaches.