2004 - 2007 - Cicely Saunders Institute - King's College London

the POS to identify patient's problems and enables staff
to provide individualised care. It is a flexible tool, the
usage of which can be determined by the needs of local
services. A version completed by the family/caregiver
has also been developed.
The POS showed acceptable validity when used in a
variety of settings, such as home care, hospice inpatient
and day care, and hospital inpatient care, as well as
outpatient and community services. It has also been
shown to be a credible, clinical, research and audit tool,
which is acceptable to both patients and staff and quick
(five minutes) to complete (Hearn and Higginson Quality
in Healthcare 1999;8:219-277). The POS can be used
routinely to guide clinical practice and monitor service
interventions. Moreover, the POS is a valuable audit tool
that can help meet the current statutory requirements on
clinical governance. You can download free copies of
the POS questionnaires from the Questionnaires & tools
section of our website (www.kcl.ac.uk/palliative). A
user's guide to the POS with further details on the
origins of the POS, as well as suggestions for its
implementation in clinical practice and analysis of data
is also available. Table 2.2 shows details of current users
of POS, and external validations which independently
confirm the value of POS assessment and
measurement. A next step with the POS is to test: its
utility in identifying patients who would benefit from
referral to palliative care and potential to assess
complexity and costs using a similar approach to
rehabilitation measures (see 2.3.3); culturally appropriate
formats; and additional modules assessing symptoms or
other aspects in more detail.
Comparison of quality of life scales in
palliative care
Using data collected on 140 patients to evaluate
palliative day care we further explored the factors within
the Palliative Outcome Scale (POS) and other measures
of hope and quality of life. Using these different tools, we
were able to identify a relative factorial structure of all
scales combined. Four components appeared to be
reflected in the different measures – self sufficiency,
positivity, symptoms and spiritual needs. The results
suggest ways in which items within the POS might be
further improved, and suggests that the POS could form
the basis of a measure in the future containing 11 (rather
than 10) items which would explain the variability of
needs within patients and might be useful for identifying
individuals for referral to palliative care 16 .
The German translation of POS
The German version of the POS was translated forward
and backward according to EORTC recommendations
for translation procedures and then validated in palliative
care (hospital support team, hospice, home care) and a
pain clinic. The German POS version was well accepted
by patients and staff, and appears to be valid. The study
identified some areas where the scale would benefit
from expansion to more closely capture staff and patient
concerns 132 .
The APCA African POS
This collaboration between the African Palliative Care
Association (APCA), KCL and National Hospice and
Palliative Care Organisation (NHPCO) (USA), along with
partner agencies in 11 sites across South Africa, has
developed and begun the validation of an African
Palliative Outcome Scale (POS) for use across the
region. This important collaboration will enable future
evaluative efforts to be conducted using a valid outcome
tool, something missing to date. Work is currently
underway to develop an African POS for children.
Funded by the BIG Lottery in the UK, The Encompass
Project (Ensuring Core Outcomes and Measuring
Palliation in Sub-Saharan Africa) unites five sites across
ENCOMPASS
Ensuring Core Outcomes and Measuring
Palliation in Sub-Saharan Africa
South Africa and Uganda: The Hospice Association of
the Western Cape, Philanjalo Hospice in Tugela Ferry,
South Coast Hospice, The N’Doro project at Chris Hani
Baragwanath Hospital in SOWETO, and Hospice Africa
Uganda. The project aims to complete validation of the
African APCA POS and to work with the partners above
to act as “model” audit centres, conducting a full audit
cycle during the second year. This project has achieved
a number of successes: the recruitment and training of a
cadre of African palliative care nurses; the generation of
a large original dataset; and has laid the foundation for
audit in these new services. Harding, Selman and
Higginson are now planning the analysis of the data, so
it can be fed back to services, and the utility of this new
version of POS can be tested.
2.3.2 Common Language Outcome Measures
for Rehabilitation in the UK
In the last triennial report we described the tools we
have developed to measure outcomes from rehabilitation
and provide a common language with which to
compare different populations, programmes and
practices. These include the Northwick Park
Dependency and Care needs assessment (NPDS/
NPCNA) and the UK Functional Assessment Measure
(UK FIM+FAM). A recent survey has demonstrated that
these are now widely taken up and used in clinical
practice in rehab units across the UK 248 .
The NPDA/NPCNA provides a generic measure of care
needs in the community and thus the cost of continuing
care provided by health and social services. Work is
ongoing to develop hospital versions of these scales (the
NPDS-H and NPRNA) which could ultimately be used to
determine the nursing staff required for a rehabilitation
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