Content Validation of Advanced Illness Criteria of a Palliative Care Screening Tool.

Abstract

Early identification of patients appropriate for palliative care continues to be a challenge for healthcare systems. Danbury Hospital embedded a palliative care screening tool (PCST) in the nursing admission assessment of the electronic medical record to screen a patient's appropriateness for a palliative care consult. Although the screening tool was helpful in early identification of patients, feedback from healthcare providers indicated lack of clarity in determining "advanced illness" outside of the oncology population. To (1) validate sections 1 and 2 of the PCST to a broader patient population, using the content validity ratio (CVR) and (2) determine the presence of a correlation between the PCST and an existing validated tool. An online survey was distributed to collect feedback on five categories of basic disease processes as major criterion for determination for a PCST score. Healthcare providers and content experts were within Western Connecticut Health Network. Surveys evaluated basic disease processes as major criteria to determine whether a palliative care consultation was needed. A total of 120 healthcare providers participated: 27 nurses and 93 physicians. Respondents identified poor or limited functional status as essential items upon identifying high-risk patients appropriate for palliative services. Advanced illnesses concurrent with complete activities of daily living dependence yielded the highest positive CVRs. The functional assessments, Eastern Cooperative Oncology Group, and Karnofsky are significantly correlated (p = 9.999*10-05). The Karnofsky scale score was determined to be significantly negatively correlated with the PCST score (p = 4.314*10-45). Cross-sectional feedback of healthcare professionals validated criteria of advanced illness in the PCST.