Palliative care phase : inter-rater reliability and acceptability in a national study

Masso, Malcolm, Allingham, Samuel Frederic, Banfield, Maree, Johnson, Claire Elizabeth, Pidgeon, Tanya, Yates, Patsy, & Eagar, Kathy (2015) Palliative care phase : inter-rater reliability and acceptability in a national study. Palliative Medicine, 29(1), pp. 22-30.

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The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was developed in Australia about 20 years ago and is used routinely for communicating clinical status, care planning, quality improvement and funding.


To test the reliability and acceptability of revised definitions of Palliative Care Phase.


Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase.


Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service.


A total of 102 nursing and medical clinicians participated, undertaking 595 paired assessments of 410 patients, of which 90.7% occurred within 2 h. Clinicians rated 54.8% of patients in the stable phase, 15.8% in the unstable phase, 20.8% in the deteriorating phase and 8.7% in the terminal phase. Overall agreement between clinicians’ rating of Palliative Care Phase was substantial (kappa = 0.67; 95% confidence interval = 0.61–0.70). A moderate level of inter-rater reliability was apparent across all participating sites. The results indicated that Palliative Care Phase was an acceptable measure, with no significant difficulties assigning patients to a Palliative Care Phase and a good fit between assessment of phase and the definition of that phase. The most difficult phase to distinguish from other phases was the deteriorating phase.


Policy makers, funders and clinicians can be confident that Palliative Care Phase is a reliable and acceptable measure that can be used for care planning, quality improvement and funding purposes.

Impact and interest:

3 citations in Scopus
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5 citations in Web of Science®

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ID Code: 77713
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: episode of care, needs assessment, palliative care, reproducibility of results, patient acuity
DOI: 10.1177/0269216314551814
ISSN: 1477-030X
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Nursing not elsewhere classified (111099)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Copyright Owner: Copyright 2014 The Authors
Deposited On: 15 Oct 2014 23:46
Last Modified: 19 Feb 2015 01:04

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