| ObjectiveThe palliative care referral screening tool can help medical staff quickly,accurately and scientifically identify cancer patients who have a strong need for palliative care,and provide palliative care support in time,thus improving the quality of life of cancer patients.However,there is no mature screening tool for palliative care referral for cancer patients in China.The purpose of this study is to construct a palliative care referral screening tool for cancer patients and conduct clinical validation to test its reliability and validity.MethodsThe study is divided into two parts:1.Construction of cancer patient palliative care referral screening tool(1)A qualitative research method was used to conduct a semi structured interview with cancer patients and their families hospitalized in the oncology department of a Class III comprehensive hospital in Shanghai.The traditional content analysis method was used to understand the palliative care needs of cancer patients and their families in the coping with cancer,providing a basis and reference for the formation of the items pool of the palliative care referral screening tool for cancer patients.cancer patient palliative medical admission screening list.(2)Combining literature review,the results of qualitative research,and referring to relevant items in existing palliative care referral screening tools abroad,an initial entry pool of screening tables was formed.Invite medical and nursing experts from the fields of clinical oncology treatment or nursing,and palliative care to participate in expert group meetings to screen,revise,and assign values to the initial item pool,and form the first draft of the palliative care referral screening tool.(3)Through the Delphi expert consultation method,medical and nursing experts in the fields of oncology clinical treatment or nursing,and palliative medicine were invited to evaluate the items and scores of the cancer patient palliative care referral screening tool.The items were deleted according to the two indicators of the importance average score and the coefficient of variation,and the scores were adjusted also according to the two indicators of the rationality average score and the coefficient of variation.At the same time,the items were supplemented and revised according to the opinions of experts to form a pre-test version of the cancer patient palliative care referral screening tool.2.Clinical validation of cancer patient palliative care referral screening toolNurses who had received unified training used the pre-test version of the cancer patient palliative care referral screening tool to investigate,evaluate and collect data on cancer patients hospitalized in the oncology department of a Class III comprehensive hospital in Shanghai.The items in the screening tool were evaluated by item analysis method(critical ratio method,total-item correlation method and homogeneity test);The non-parametric test was used to compare the total screening scores of cancer patients with different characteristics for evaluating the Discriminant validity of the screening tool;The internal consistency of the screening tool was evaluated by Cronbach’s α coefficient and half-factor,and the stability and equivalence of the screening tool were evaluated by interrater reliability and retest reliability.A formal screening tool was formed based on item analysis and reliability and validity test.Using the evaluation results of palliative care experts as the reference criteria for palliative care referral,the cut-off point for palliative care referral in the palliative care referral screening tool is determined through the ROC curve.The research team invited nurses and palliative care medical experts participating in the clinical evaluation,and experts participating the expert group meeting in the early stage,to further grade the scores of the screening tool based on the evaluation results and clinical practice.Results1.A total of 19 cancer patients and their families were interviewed in this study.The results showed that the patients and their families had significant palliative needs in symptom management,disease-related professional information support,communication support,decision-making support,psychological and spiritual support,and social support.2.Based on the results of qualitative research and literature review,the experts group meeting was organized to discuss,formed the first draft of cancer patient palliative care referral screening tool,and determine the score of second-level indicators.The first draft of the screening tool includes 6 first-level indicators and 26 second-level indicators,including cancer trajectory,comorbidities,serious cancer complications,functional status,physical symptom burden,and issues related to palliative care needs.3.Completed two rounds of Delphi expert consultation and revised the first draft of the screening form.In the first round of expert consultation,18 questionnaires were sent and 16 were recovered,with a recovery rate of 88.89%.In the second round of expert consultation,16 questionnaires were sent and 13 were recovered,with a recovery rate of81.25%.The expert authority coefficient of Delphi experts in both rounds was 0.88,and the Kendall W coefficient had statistical difference(P<0.005).In the first round of expert consultation,1 first-level indicator was modified,2 second-level indicators were deleted,3 second-level indicators were added,2 second-level indicators were merged,7second-level indicators were modified,and the score of 1 second-level indicator was raised.In the second round of expert consultation,3 first-level indicators and 1second-level indicator were revised.Finally,6 first-level indicators and 24 second-level indicators were formed in the pre-test version of the cancer patient palliative care referral screening tool.4.5 nurses evaluated 263 cancer patients using the pre-test version of the cancer patient palliative care referral screening tool.Based on the results of the comprehensive items analysis,after discussion by the research group,the evaluation content,methods and scores of the first-level indicators "comorbidities that affect the treatment or quality of life of patients" and "cancer complications/syndromes that affect the prognosis or quality of life of patients" were adjusted,then 10 items were finally retained.The reliability and validity of the final retained items were tested.The screening tool can distinguish the palliative care needs of cancer patients with different personality,economic burden of treatment,cancer stage,duration of illness,number of comorbidities,nutritional status and self-care ability(P<0.05).The Cronbach’s α coefficient was0.660.The Spearman-Brown coefficient was 0.724 and 0.725,respectively.The Guttman split-half coefficient was 0.654.The r value of interrater reliability was 0.995(P<0.001),the r value of retest reliability was 0.963(P<0.001).So the reliability of the screening tool was acceptable.The formal version of the cancer patient palliative care referral screening tool contained 6 categories and 10 items,with a score range of 0-21 points,including cancer trajectory,comorbidities that affect patient treatment or quality of life,cancer complications/syndromes that affect patient prognosis or quality of life,functional status,severe physical symptoms,and issues related palliative care needs.2 nurses and 2 palliative care specialists evaluated 53 patients separately.The cut-off point for referral to palliative care on the screening tool was 7 points,which means that a screening score of ≥ 7 points can be identified as requiring palliative care support.The score grading of the screening tool was as follows: the total screening score ≤ 3 points without intervention;total score are 4-6 points,observe the patient and re-screen when the condition changes;total score ≥ 7 points,providing palliative care to patients.ConclusionsThis study constructed a cancer patient palliative care referral screening tool through qualitative interviews,expert group meetings,and two rounds of Delphi expert consultation.The results of clinical validation shown that the reliability and validity of the screening tool were acceptable,and it was simple and understandable.It can be used to screen and identify the needs of cancer patients for palliative care,help medical personnel provide the limited palliative care resources to urgently needed cancer patients in a timely manner,help patients and their families cope the cancer better,improve quality of life,and has certain clinical use value. |
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