Palliative care problem severity score: Reliability and acceptability in a national study

Masso, Malcolm, Allingham, Samuel Frederic, Johnson, Claire Elizabeth, Pidgeon, Tanya, Yates, Patsy, Currow, David, & Eagar, Kathy (2016) Palliative care problem severity score: Reliability and acceptability in a national study. Palliative Medicine, 30(5), pp. 479-485.

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The Palliative Care Problem Severity Score is a clinician-rated tool to assess problem severity in four palliative care domains (pain, other symptoms, psychological/spiritual, family/carer problems) using a 4-point categorical scale (absent, mild, moderate, severe).


To test the reliability and acceptability of the Palliative Care Problem Severity Score. Design: Multi-centre, cross-sectional study involving pairs of clinicians independently rating problem severity using the tool.


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


A total of 102 clinicians participated, with almost 600 paired assessments completed for each domain, involving 420 patients. A total of 91% of paired assessments were undertaken within 2 h. Strength of agreement for three of the four domains was moderate: pain (Kappa = 0.42, 95% confidence interval = 0.36 to 0.49); psychological/spiritual (Kappa = 0.48, 95% confidence interval = 0.42 to 0.54); family/carer (Kappa = 0.45, 95% confidence interval = 0.40 to 0.52). Strength of agreement for the remaining domain (other symptoms) was fair (Kappa = 0.38, 95% confidence interval = 0.32 to 0.45).


The Palliative Care Problem Severity Score is an acceptable measure, with moderate reliability across three domains. Variability in inter-rater reliability across sites and participant feedback indicate that ongoing education is required to ensure that clinicians understand the purpose of the tool and each of its domains. Raters familiar with the patient they were assessing found it easier to assign problem severity, but this did not improve inter-rater reliability.

Impact and interest:

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1 citations in Web of Science®
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ID Code: 89663
Item Type: Journal Article
Refereed: Yes
Keywords: Australia, reproducibility of results, patient outcome assessment, palliative care, assessment of health-care needs
DOI: 10.1177/0269216315613904
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 2015 Sage Publications
Deposited On: 29 Oct 2015 22:44
Last Modified: 09 May 2016 01:50

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