Validity and Reliability of the Integrated Palliative Care Outcome Scale in Asian Heart Failure Patients

Abstract

Background: The Integrated Palliative Care Outcome Scale (IPOS) was developed in the United Kingdom for health assessment in advanced illness. Objectives: To evaluate the validity and reliability of a culturally adapted IPOS (both patient and staff versions) for heart failure (HF). Design/Setting: We recruited HF patients and staff from a tertiary hospital in Singapore. We collected patient IPOS, New York Heart Association (NYHA) status, Edmonton Symptom Assessment System (ESAS) and Minnesota Living with Heart Failure (MLHF) scores at baseline, and patient IPOS at follow-up. Each baseline patient IPOS was matched with a staff IPOS. Measurements: Pearson correlation coefficient ( r ) between ESAS, MLHF, and patient IPOS was calculated to assess construct validity. The two-sample T -test assessed difference in patient and staff IPOS scores across NYHA status and care settings for known-group validity. Internal consistency of patient and staff IPOS was assessed using Cronbach's alpha ( α ). Intraclass correlation coefficient (ICC) was used to assess test-retest reliability of patient IPOS and inter-rater reliability between patient and staff IPOS. Results: Ninety-one patients and 12 staff participated. There was strong convergent validity of total patient IPOS with MLHF ( r = 0.78) and ESAS ( r = 0.81). There were statistically significant differences in total IPOS across care settings (patient-IPOS: 8.05, staff-IPOS 13.61) and NYHA (patient-IPOS: 7.52, staff-IPOS 12.71). There was high internal consistency of total patient ( α = 0.83) and staff IPOS ( α = 0.88) and high test-retest reliability of patient IPOS (ICC 0.81). Inter-rater reliability (ICC) ranged between 0.82 and 0.91. Conclusion: The IPOS was valid and reliable for HF patients in Singapore.

Facilitators and barriers to implementation of a patient and staff reported measure for screening of palliative concerns of patients with heart failure: a qualitative analysis using the Consolidated Framework for Implementation Research

“…While there was a suggestion by a patient that there should be an ‘inpatient’ version of the IPOS versus an ‘outpatient’ version of the IPOS, we believe that this perceived ‘difference’ is more related to the severity of the palliative care issues rather than a qualitative difference in the type of palliative care concerns detected by IPOS screening. This is corroborated by our own results from the validity phase 18 where the patient and staff IPOS scores were higher in the inpatient setting (indicating more severe concerns). Therefore, rather than delineating specific surveys for different settings, we believe that more attention could be paid to planning out the relevant palliative care responses to match the severity of issues that are detected in different care settings.…”

“…Lastly, process factors such as ‘stage of change’ related well with our prior study on the staff validity of IPOS. 18 We noted that a significant number of staff assessments were incomplete or marked by staff as ‘unable to assess’. These were mainly related to psychosocial issues, such as screening for patient’s anxiety, or screening for practical problems.…”

“…21 In the first phase of the project, we validated the IPOS scale (full details are described in the prior published paper). 18 English-speaking patients with heart failure, aged 21 years and above, and who were aware of their diagnosis participated in the study. Patients were given a physical hard copy of the patient IPOS to fill in.…”

“…15 It is also unknown whether a tool that was developed in a specialist palliative care setting would be readily usable in a setting where most of the care are provided by cardiac specialists who are non-palliative care specialists (generalists) 16 and specialist palliative care services are only available on a consult basis. Therefore, our team sought to evaluate the validity and reliability of the IPOS locally 17,18 as well as seek factors that would influence subsequent IPOS implementation for routine screening of patients with advanced heart failure in Singapore, in the clinical, non-research setting. In a prior study, 18 we described our results that the IPOS was valid and reliable for screening patients with advanced heart failure in Singapore.…”

“…Therefore, our team sought to evaluate the validity and reliability of the IPOS locally 17 , 18 as well as seek factors that would influence subsequent IPOS implementation for routine screening of patients with advanced heart failure in Singapore, in the clinical, non-research setting. In a prior study, 18 we described our results that the IPOS was valid and reliable for screening patients with advanced heart failure in Singapore. In this article, we will describe the factors that could affect implementation of the IPOS for screening for needs of patients with advanced heart failure, who are cared for in a non-palliative care setting.…”