Adaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional data
Abstract Background Palliative care phases (stable, unstable, deteriorating, terminal and bereavement) are routinely used in Australia and the UK to describe the clinical situation of patients and their families and to evaluate the associated care plan. In addition, it serves as a benchmark develope...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12904-021-00825-z |
| _version_ | 1818363298954870784 |
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| author | Eva Lehmann Farina Hodiamont Mirjam Landmesser Carina S. Knobloch Friedemann Nauck Christoph Ostgathe Bettina Grüne Claudia Bausewein |
| author_facet | Eva Lehmann Farina Hodiamont Mirjam Landmesser Carina S. Knobloch Friedemann Nauck Christoph Ostgathe Bettina Grüne Claudia Bausewein |
| author_sort | Eva Lehmann |
| collection | DOAJ |
| description | Abstract Background Palliative care phases (stable, unstable, deteriorating, terminal and bereavement) are routinely used in Australia and the UK to describe the clinical situation of patients and their families and to evaluate the associated care plan. In addition, it serves as a benchmark developed by the Australian Palliative Care Outcome Collaboration (PCOC) and is used nationwide for comparisons between services. In Germany, the concept is not used consistently due to various translations. Furthermore, there is no nationwide systematic approach to routinely assess clinical outcomes in palliative care. The study aims to develop a German version of the palliative care phase definitions by adapting them culturally, and to examine the inter-rater reliability of the adjusted definitions with healthcare professionals. Methods Mixed-methods approach: Cognitive interview study using ‘think aloud’ and verbal probing techniques and a consecutive multi-center cross-sectional study with two clinicians independently assigning the phase definitions. Interviewees/participants were selected through convenience and purposive sampling in specialist palliative care inpatient units, advisory and community services and in three specialist palliative care units with doctors, nursing staff and allied health professionals. Results Fifteen interviews were conducted. Identified difficulties were: Some translated terms were 1) not self-explanatory (e.g. ‘family/carer’ or ‘care plan’) and (2) too limited to the medical dimension neglecting the holistic approach of palliative care. (3) Problems of comprehension regarding the concept in general occurred, e.g. in differentiating between the ‘unstable’ and ‘deteriorating’ phase. Inter-rater reliability was moderate (kappa = 0.44; 95% CI = 0.39–0.52). The assignment of the phase ‘deteriorating’ has caused the most difficulties. Conclusion Overall, the adapted palliative care phases are suitable to use in the German specialist palliative care setting. However, the concept of the phases is not self-explanatory. To implement it nationwide for outcome measurement/benchmarking, it requires further education, on-the-job training and experience as well as the involvement of healthcare professionals in implementation process. For the use of international concepts in different healthcare systems, a deeper discussion and cultural adaptation is necessary besides the formal translation. |
| first_indexed | 2024-12-13T21:46:16Z |
| format | Article |
| id | doaj.art-3522998f4fea4a14becb6793fdc9472f |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-12-13T21:46:16Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-3522998f4fea4a14becb6793fdc9472f2022-12-21T23:30:24ZengBMCBMC Palliative Care1472-684X2021-08-0120111110.1186/s12904-021-00825-zAdaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional dataEva Lehmann0Farina Hodiamont1Mirjam Landmesser2Carina S. Knobloch3Friedemann Nauck4Christoph Ostgathe5Bettina Grüne6Claudia Bausewein7Department, of Palliative Medicine, University Hospital, LMU MunichDepartment, of Palliative Medicine, University Hospital, LMU MunichDepartment of Palliative Medicine, University Medical Center GoettingenDepartment of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen–EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)Department of Palliative Medicine, University Medical Center GoettingenDepartment of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen–EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)Department, of Palliative Medicine, University Hospital, LMU MunichDepartment, of Palliative Medicine, University Hospital, LMU MunichAbstract Background Palliative care phases (stable, unstable, deteriorating, terminal and bereavement) are routinely used in Australia and the UK to describe the clinical situation of patients and their families and to evaluate the associated care plan. In addition, it serves as a benchmark developed by the Australian Palliative Care Outcome Collaboration (PCOC) and is used nationwide for comparisons between services. In Germany, the concept is not used consistently due to various translations. Furthermore, there is no nationwide systematic approach to routinely assess clinical outcomes in palliative care. The study aims to develop a German version of the palliative care phase definitions by adapting them culturally, and to examine the inter-rater reliability of the adjusted definitions with healthcare professionals. Methods Mixed-methods approach: Cognitive interview study using ‘think aloud’ and verbal probing techniques and a consecutive multi-center cross-sectional study with two clinicians independently assigning the phase definitions. Interviewees/participants were selected through convenience and purposive sampling in specialist palliative care inpatient units, advisory and community services and in three specialist palliative care units with doctors, nursing staff and allied health professionals. Results Fifteen interviews were conducted. Identified difficulties were: Some translated terms were 1) not self-explanatory (e.g. ‘family/carer’ or ‘care plan’) and (2) too limited to the medical dimension neglecting the holistic approach of palliative care. (3) Problems of comprehension regarding the concept in general occurred, e.g. in differentiating between the ‘unstable’ and ‘deteriorating’ phase. Inter-rater reliability was moderate (kappa = 0.44; 95% CI = 0.39–0.52). The assignment of the phase ‘deteriorating’ has caused the most difficulties. Conclusion Overall, the adapted palliative care phases are suitable to use in the German specialist palliative care setting. However, the concept of the phases is not self-explanatory. To implement it nationwide for outcome measurement/benchmarking, it requires further education, on-the-job training and experience as well as the involvement of healthcare professionals in implementation process. For the use of international concepts in different healthcare systems, a deeper discussion and cultural adaptation is necessary besides the formal translation.https://doi.org/10.1186/s12904-021-00825-zPalliative care phasesPalliative careCognitive interviewingInter-rater reliabilityReproducibility of resultsOutcome measurement |
| spellingShingle | Eva Lehmann Farina Hodiamont Mirjam Landmesser Carina S. Knobloch Friedemann Nauck Christoph Ostgathe Bettina Grüne Claudia Bausewein Adaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional data BMC Palliative Care Palliative care phases Palliative care Cognitive interviewing Inter-rater reliability Reproducibility of results Outcome measurement |
| title | Adaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional data |
| title_full | Adaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional data |
| title_fullStr | Adaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional data |
| title_full_unstemmed | Adaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional data |
| title_short | Adaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional data |
| title_sort | adaptation of the australian palliative care phase concept to the german palliative care context a mixed methods approach using cognitive interviews and cross sectional data |
| topic | Palliative care phases Palliative care Cognitive interviewing Inter-rater reliability Reproducibility of results Outcome measurement |
| url | https://doi.org/10.1186/s12904-021-00825-z |
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