Adaptación y validación en Chile del instrumento de identificación de pacientes con necesidad de atención paliativa: NECPAL-CCOMS-ICO 3.1©

Abstract

ObjectiveAdapt and validate the NECPAL instrument in Chile. DesignProspective, longitudinal, analytical study for validation of the instrument in 5 stages: cultural adaptation, content validation, pilot test, application, and statistical analysis. PlaceFour primary care centers of the South East Metropolitan Health Service, in Santiago, Chile. ParticipantsPrimary health care physicians and nurses for cultural adaptation and application, and palliative care experts for content validation. Main measurementsCultural adaptation was carried out through cognitive interviews. Content validity was measured using Delphi method and the Lawshe content validity ratio (CVR) was obtained. In the pilot test, we measured stability (test–retest), inter judge harmony and application time in 14 chronic advanced patients (CAP). The test was applied to this same group, calculating the sample according to Nunally's recommendation. ResultsA sample of 118 CAP was obtained. The CVR was 0.75 and the average testing time was 6.7 min (SD = 4.01). The test–retest obtained a Kappa test concordance index between 0.632 and 1.0; and the interjudge harmony agreement between 0.192 and 0.692. The surprise question (PS) was positive in 20.3% of the sample. The main conditions associated with the disease-specific severity item, were fragility (23.7%), chronic heart disease (21.2%) and chronic lung disease (12.7%). The demand group and specific severity indicators obtained a greater predictive capacity of PS+, with an area under the curve of 0.808 (95% CI: 0.697–0.918). ConclusionsNECPAL is feasible to be used in Chile, has adequate psychometric properties and will allow early detection of patients in need of palliative care.