Abstract
BackgroundDifficulties in identifying patients at risk of clinical deterioration or death represent one of the main barriers to Palliative Care (PC) development in the community. Currently, no specific Italian tools aimed at identifying patients with PC needs are available. Of the different European tools available, the SPICT™ can be used easily in any kind of setting and does not include the Surprise Question. The purpose of the study was to translate, cross-culturally adapt and pre-test the Italian version of the SPICT™.MethodsThe Beaton recommendations for the cross-cultural adaptation of instruments were followed. Content validity was assessed using the Lynn method. A sample of Italian General Practitioners (GPs) assessed the SPICT-IT™ for feasibility and tested it.ResultsDuring the cross-cultural adaptation, some issues regarding semantic, experiential, idiomatic and conceptual equivalences were raised and resolved. The Scale-Content Validity Index/Ave was 0.86. Of the 907 GPs included in the sample, 71 (7.8%) agreed to test the SPICT-IT™ and to assess its feasibility. The participants provided care for 73,526 people in the community. Of these people, 1.7% (N = 1303) were identified as being in need of PC according to the SPICT-IT™. Sixty-six (93.0%) GPs stated they would use the SPICT-IT™ in their daily clinical practice.ConclusionsThe SPICT-IT™ demonstrated acceptable content validity. The percentage of patients identified through the SPICT-IT™ was comparable to findings from literature. The next phase of this project will investigate the impact of a proactive training programme aimed at supporting GPs in identifying patients with PC needs and delivering appropriate Primary Palliative Care (PPC).
Highlights
Difficulties in identifying patients at risk of clinical deterioration or death represent one of the main barriers to Palliative Care (PC) development in the community
Translation and cross-cultural adaptation The Italian translation and cross-cultural adaptation of the SPICTTM was carried out according to the Beaton protocol [13] and the World Health Organization (WHO) recommendations for translation and adaptation of instruments [14]
During the cross-cultural adaptation of the SPICTTM, researchers identified the following main discrepancies with respect to the four types of equivalences: Semantic equivalence – The experts agreed to add “mechanical, invasive or non-invasive ventilation” to the item known as “has needed ventilation”, to specify that non-invasive ventilation had to be considered. – The expression “plan care” was not literally translated because the experts believed that it may result in healthcare professionals (HCPs) considering only “medical care”
Summary
Difficulties in identifying patients at risk of clinical deterioration or death represent one of the main barriers to Palliative Care (PC) development in the community. Difficulties in identifying patients at risk of clinical deterioration or death have been recognised as one of the main barriers for palliative care (PC) development and integration in the community [1]. Patients identified as at risk of deteriorating or of dying, will still require assessment of symptoms and needs across all domains to determine whether they would benefit from PC, or if they have unmet PC needs. The available diagnostic or screening tools (used by clinicians) for the identification of patients at risk of deterioration or death, very useful for helping general practitioners (GPs), are rarely used in clinical practice [7]
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