Translation, Adaptation And Validation Of The Palliative Care Screening Tool And Its Application Among The Elderly With Chronic Diseases

Objectives(1)To translate and cross-culturally adapt the English version of the Palliative Care Screening Tool(PCST)into Mandarin and test the reliability and validity of the Chinese version of PCST among the elderly with chronic diseases.(2)To assess the rates of unmet palliative care needs and its influencing factors using the Chinese version of PCST among the elderly with chronic diseases in the community settings.Methods(1)After the original author’s authorization,The English version of PCST was translated and cross-culturally adapted into Chinese on the basis of the Beaton guidelines.A total of 266 participants who met the eligibility criteria were recruited using the convenience sampling method of Changsha communities in August to October 2021.Participants were asked to complete the general information questionnaire,the tentative Chinese version of PCST,12-Item Short-Form Health Survey(SF-12),and Edmonton Symptom Assessment System(ESAS).The content validity(content validity index),construct validity(exploratory factor analysis)and concurrent validity(Pearson correlation coefficient)were tested to evaluate the validity.The internal consistency reliability(Cronbach’s α)and test-retest reliability(Pearson correlation coefficient)were tested to evaluate the reliability.(2)A total of 302 participants who met the eligibility criteria were recruited using the convenience sampling method of Changsha communities in February to March 2022.Participants were asked to complete the general information questionnaire and the Chinese version of PCST.The rates of unmet palliative care needs and its influencing factors among the elderly with chronic diseases in the community settings were investigated.Data analysis was performed with SPSS Statistics Version 26.0.Descriptive statistical analysis was performed on general data.The measurement data were described using mean and standard deviation and the enumeration data were described using number and percentage.A chi-square test was used to test the differences in the general data.Multivariate analyses were performed using logistic regression analysis.p<0.05 indicated a statistical significance.Results(1)The Chinese version of PCST includes three subscales with 20 items.For the results of validity,the scale-level content validity index/universal agreement of The Chinese version of PCST was 0.950,and the item-level content validity index was between 0.857 and 1.000.The exploratory factor analysis on each subscale of the Chinese version of PCST showed the structure is consistent with the original scale.The physical symptoms of the Chinese version of PCST showed a negative correlation with physical component summary of SF-12(r=-0.706,p<0.001),and the score on emotional concerns of The Chinese version of PCST showed a negative correlation with mental component summary of SF-12(r=-0.714,p<0.001).Moreover,the Chinese version of PCST showed a positive correlation with ESAS(r = 0.885,p<0.001).For the results of reliability,the Cronbach’s α coefficient for the overall scale was0.824,and each subscale was 0.662,0.831 and 0.584,respectively.The test-retest reliability coefficient for the overall scale was 0.948,and each subscale was 0.890,0.921 and 0.907,respectively.(2)The results showed that 17.9% of participants screened positive for unmet palliative care needs.The logistic regression results showed that the longer of illness duration(OR=1.461,95%CI: 1.017～2.099,P=0.040),The lower of the self-care ability(OR=3.265,95%CI:1.189～8.964,P=0.022),and the poorer of the self-rated health(OR=3.622,95%CI: 1.871～7.009,P=0.000)were associated with the higher of unmet palliative care needs.Conclusions(1)The Chinese version of PCST demonstrated moderate internal consistency reliability,excellent test-retest reliability and good content,construct and concurrent validity and could be used to identify chronically ill elders who has the palliative care need in community settings.(2)The unmet palliative care needs for the elderly with chronic diseases in the community is lower than the middle level,and the important influencing factors are illness duration,self-care ability and self-rated health.Primary health workers can screen the unmet palliative care needs for the elderly with chronic diseases in the community and provide timely services,thus improving the quality of life of the elderly with chronic diseases.