Construction Of A Screening Checklist For Palliative Care Patients With Advanced Cancer

[Objective]This study intends to construct a scientific and localized screening checklist for for palliative care patients with advanced cancer to identify the characteristics of advanced cancer patients in need of palliative care in a timely manner and to provide a basis for the palliative care service of clinical health care workers.[Methods]1.Through literature search,clinical guidelines,systematic evaluations,and original studies on the indications for palliative care patients with advanced cancer were systematically searched using a combination of mesh terms and text words,and relevant entries were extracted by reading and evaluating the literature to form a pool of entries for the screening checklist for palliative care patients with advanced cancer2.Focus group interviews were used to discuss and analyze the obtained entries in depth,add or delete entries based on the actual clinical situation of palliative care for patients with advanced cancer in China,and develop the content of the entries of the screening checklist for palliative care patients with advanced cancer3.Using the Delphi method,15 experts from different provinces in China were selected for consultation,and the results were statistically analyzed to form a screening checklist for palliative care patients with advanced cancer.[Results]1.Based on the evidence-based search and literature analysis,we completed the background research of the project,and used the concept of end-of-life trajectory proposed by Glaser and Strauss as the theoretical basis,combined with the guidelines of palliative care for oncology patients and related literature,extracted and organized the indications for identifying palliative care services for patients with advanced cancer,and formed a pool of entries for the screening checklist for palliative care for patients with advanced cancer.Based on the results of the literature search and the actual clinical situation in China,the extracted items of the palliative care screening checklist for advanced cancer patients were discussed in depth,and the specific contents of the palliative care screening checklist for advanced cancer patients were developed based on the focus group interview method to form the Delphi expert correspondence questionnaire.2.After two rounds of expert consultation,the items and content of the Palliative care Screening Checklist for Advanced Cancer Patients were clarified to include"disease diagnosis","patient/family needs","physical indications" and "psychological indications"."Among them,"disease diagnosis" includes the addition of distant metastatic lesions or local progression and advanced cancer,and the diminished or ineffective treatment of the cause of the disease.The "patient/family needs" included patient/family request for hospice services;"physical indications" included the presence of cancer anorexia-cachexia syndrome(CACS),poor activity status with ECOG ≥ 3 or KPS ≤ 50,the presence of uncontrollable symptoms,and the presence of a number of other symptoms in the past 6 months.The physical indications included the presence of anorexia-cachexia syndrome(CACS),poor activity status,ECOG ≥3 or KPS ≤50,difficult-to-control symptoms,weight loss >10% in the past 6months,serum protein <25g/l,and the presence of 2 or more chronic comorbidities;the psychological indications included psychological distress of moderate to severe symptom intensity in patients/families.(1)A total of 15 experts were included,and the questionnaire return rate of both rounds of correspondence was 100%,which showed high motivation of experts.(2)The authority coefficients Cr were 0.88 and0.89,respectively,both >0.7,and the results of the correspondence inquiries were reliable.(3)In this study,the coefficients of variation of the importance evaluations of each index fluctuated between 0.05 and 0.42 after the first round of consultation,and the coefficients of variation of the importance evaluations of each index fluctuated between 0.1 and 0.22 after the second round of consultation,indicating that the experts’ coordination was good.The coefficients of coordination for the importance evaluation of items and content indicators in the first round of expert consultation were 0.152 and 0.165,respectively,and the coefficients of coordination for the importance evaluation of items and content indicators in the second round of expert consultation were 0.162 and 0.199,respectively,and the tests of coordination coefficients in both rounds of expert consultation were statistically significant(P <0.05).[Conclusions]The positive,authoritative,and importance-assigned opinion of experts on the entries and content of the screening checklist for palliative care patients with advanced cancer is well focused to provide a basis for hospice practice by clinical providers.