Evaluating correlation and interrater reliability for four performance scales in the palliative care setting
Validation Studies as Topic; Validation Studies
Performance scales are used by clinicians to objectively represent a patient's level of function and have been shown to be important predictors of response to therapy and survival. Four different scales are commonly used in the palliative care setting, two of which were specifically developed to more accurately represent this population. It remains unclear which scale is best suited for this setting. The objectives of this study were to determine the correlations among the four scales and concurrently compare interrater reliability for each. Patients were each assessed at the same point in time by three different health care professionals, and all four scales were used to rate each patient. Spearman correlation coefficient values and both weighted and unweighted kappa values were calculated to determine correlation and interrater reliability. The results confirmed highly significant linear correlation among and between all four scales. Whether using a reliability measure that incorporates the concept of "partial credit" for "near misses" or a measure reflecting exact rater agreement, no one scale emerged as having a significantly higher likelihood of agreement among raters. We propose that what may be more important than clinical experience or rater profession is the level of training an individual health care professional rater receives on the administration of any particular performance scale. In addition, given that low levels of exact rater agreement could have substantial clinical implications for patients, we suggest that this parameter be considered in the design of future comparative studies.
2010
Myers J; Gardiner K; Harris K; Lilien T; Bennett M; Chow E; Selby D; Zhang L
Journal Of Pain And Symptom Management
2010
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.jpainsymman.2009.06.013" target="_blank" rel="noreferrer">10.1016/j.jpainsymman.2009.06.013</a>
Managing children's pain
Child; Humans; Adolescent Psychology; Age Factors; Nurse's Role; Child Psychology; Cognition; Child Development; Nursing Assessment; Acute Disease; Primary Health Care; adolescent; Preschool; PedPal Lit; infant; Parents/education/psychology; Cognitive Therapy; Patient Education; Pediatric Nursing/methods; Analgesia/methods/nursing; Communication Disorders/complications; Pain Measurement/methods/nursing; Pain/diagnosis/psychology/therapy
2006
Savory J; Bennett M
Nursing Times
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Using bisphosphonates to control the pain of bone metastases: evidence-based guidelines for palliative care
Female; Humans; Male; Evidence-Based Medicine; Practice Guidelines; Palliative Care/standards; Clodronate; Diphosphonates/therapeutic use; Pain/prevention & control; Prostatic Neoplasms; Bone Neoplasms/secondary; Breast Neoplasms; Multiple Myeloma
This work was undertaken by the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland (APM) as a demonstration project in developing clinical guidelines relevant to palliative care from a pragmatic approach to literature review and grading of clinical evidence. CANCERLIT and Embase were searched for relevant papers written in English, published since 1980. Each study identified was rated against agreed criteria for levels of evidence. Most studies were not specifically designed to define speed of response, and were not undertaken in palliative care patients. Thus, careful reading and grading of each study was necessary. Sufficient evidence was identified to make recommendations for clinical practice in a palliative care population of patients, and areas for future research have been identified. Bisphosphonates appear to have a role in managing pain from metastases which has been refractory to conventional analgesic management and where oncological or orthopaedic intervention is delayed or inappropriate.
2000
Mannix K; Ahmedzai SH; Anderson H; Bennett M; Lloyd-Williams M; Wilcock A
Palliative Medicine
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1191/026921600701536372" target="_blank" rel="noreferrer">10.1191/026921600701536372</a>
Survival duration among patients with a noncancer diagnosis admitted to a palliative care unit: a retrospective study
Female; Humans; Male; retrospective studies; Palliative Care; Terminally Ill; Adult; Prognosis; Medical Audit; Aged; Middle Aged; Length of Stay; Ontario; Survival Analysis; Regression Analysis; 80 and over
BACKGROUND: Palliative care unit (PCU) beds are a limited resource in Canada, so PCU admission is restricted to patients with a short prognosis. Anecdotally, PCUs further restrict admission of patients with noncancer diagnoses out of fear that they will "oversurvive" and reduce bed availability. This raises concerns that noncancer patients have unequal access to PCU resources. PURPOSE/METHODS: To clarify survival duration of patients with a noncancer diagnosis, we conducted a retrospective review of all admissions to four PCUs in Toronto, Canada, over a 1-year period. We measured associations between demographic data, prognosis, Palliative Performance Score (PPS), length of stay (LOS), and waiting time. RESULTS: We collected data for 1000 patients, of whom 21% had noncancer diagnoses. Noncancer patients were older, with shorter prognoses and lower PPS scores on admission. Noncancer patients had shorter LOS (14 versus 24, p<0.001) than cancer patients and a similar likelihood of being discharged alive to cancer patients. Noncancer patients had a trend to lower LOS across a broad range of demographic, diagnostic, prognostic, and PPS categories. Multivariable analysis showed that LOS was not associated with the diagnosis of cancer (p=0.36). DISCUSSION/CONCLUSION: Noncancer patients have a shorter LOS than cancer patients and a similar likelihood of being discharged alive from a PCU than cancer patients, and the diagnosis of cancer did not correlate with survival in our study population. Our findings demonstrate that noncancer patients are not "oversurviving," and that referring physicians and PCUs should not reject or restrict noncancer referrals out of concern that these patients are having a detrimental impact on PCU bed availability.
Downar J; Chou Yang-Chieh; Ouellet D; La Delfa Ignazio; Blacker S; Bennett M; Petch C; Cheng SM
Journal Of Palliative Medicine
2012
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1089/jpm.2011.0401" target="_blank" rel="noreferrer">10.1089/jpm.2011.0401</a>