Background: More than 50% of patients worldwide die in hospitals and end-of-life care is costly. We aimed to explore whether support from the palliative team can influence end-of-life costs. Methods: This was a descriptive retrospective case–control study conducted at a Czech tertiary hospital. We explored the difference in daily hospital costs between patients who died with and without the support of the hospital palliative care team from January 2019 to April 2020. Big data from registries of routine visits were used for case–control matching. As secondary outcomes, we compared the groups over the duration of the terminal hospitalization, intensive care unit (ICU) days, intravenous antibiotics, magnetic resonance imaging/computed tomography scans, oncological treatment in the last month of life, and documentation of the dying phase. Standard descriptive statistics were used to describe the data, and differences between the case and control groups were tested using Fisher's exact test for categorical variables and the Mann–Whitney U test for numerical data. Results: In total, 213 dyads were identified. The average daily costs were three times lower in the palliative group (4392.4 CZK per day = 171.3 EUR) than in the nonpalliative group (13992.8 CZK per day = 545.8 EUR), and the difference was probably associated with the shorter time spent in the ICU (16% vs. 33% of hospital days). Conclusions: We showed that the integration of the palliative care team in the dying phase can be cost saving. These data could support the implementation of hospital palliative care in developing countries.

Background Patients with advanced kidney disease suffer from burdensome symptoms, which should be assessed by valid and reliable patient-reported outcome measures. This study aimed to provide a translation, cultural adaptation, and validation of the Czech version of the IPOS-r. Methods The IPOS-r was translated to Czech and culturally adapted using cognitive interviews. During the validation phase, patients and staff in dialysis centres and outpatient renal clinics completed the IPOS-r. Internal consistency was tested with Cronbach’s alpha, its reliability via intraclass correlation coefficient for total IPOS-r score, and weighted Kappa (for test-retest and interrater reliability of individual items). Convergent validity was tested with Spearman correlation to Kidney Disease Quality of Life Survey-Short Form 1.2 (KDQOL-SF 1.2). We assessed sensitivity to change using a distribution-based approach. Results Two sets of translators independently performed forward and backward translations of the IPOS-r. Ten patients and ten health care professionals participated in cognitive pre-testing. The sample size for validation included 88 patients (mean age 66 ± SD13.8; 58% men) who were treated with haemodialysis (70.5%), home haemodialysis (5.5%), peritoneal dialysis (3%), and conservative management (21%). Cronbach’s alpha was 0.72, and the intraclass correlation was 0.84 for test-retest reliability and 0.73 for interrater reliability. The IPOS-r correlated with KDQOL-SF 1.2 had a rho between 0.4–0.8 for most of the IPOS-r items, showing good convergent validity. The IPOS-r measure is feasible and takes 9 minutes to complete. Patients who reported a change in health status after 1 month demonstrated a total IPOS-r score change of eight points in both positive and negative directions. Conclusions The process of translation and cultural adaptation of the IPOS-r was successful, and the Czech IPOS-r measure is a valid and reliable tool. The Czech IPOS-r can be used to assess symptoms in patients with advanced chronic kidney disease. Trial registration GAUK [82121].

Background: Patients with advanced kidney disease suffer from burdensome symptoms, which should be assessed by reliable and valid patient-reported outcome measures. This study aimed to provide translation, cultural adaptation, and validation of the Czech version of IPOS-r.Methods: The IPOS-r was translated and culturally adapted to Czech using cognitive interviews. Patients and staff in dialysis centers and outpatient renal clinics completed the IPOS-r. The reliability of Czech IPOS-r was tested with Cronbach alpha (for internal consistency), the intraclass correlation coefficient for total IPOS-r score, and weighted Kappa (for test-retest and inter-rater reliability of individual items). Convergent validity was tested with Spearman correlation analysis to Kidney Disease Quality of Life Survey-Short Form 1.2 (KDQOL-SF 1.2). We tested responsiveness to change using a distribution-based approach.Results: The sample included 88 patients (mean age 66 ±SD 13.8; 58% men), who were treated with hemodialysis (70.5%), home hemodialysis ( 5.5%), peritoneal dialysis (3%), and conservative management (21%).). The Cronbach alpha was 0.72; intraclass correlation was 0,84 for test-retest reliability and 0.73 for inter-rater reliability. Good convergent validity of IPOS-r correlated to KDQOL-SF 1.2 was proved with Spearman correlations between 0.4-0.8 for most of the IPOS-r items. Using IPOS-r is feasible and meantime to complete the questionnaire was 9 minutes. Patients who reported a change in health status after one month demonstrated a total IPOS-r score change of 8 points in both positive, and negative directions.Conclusions: The process of translation and cultural adaptation of IPOS-r was efficient and the Czech IPOS-r questionnaire is a reliable and valid tool. Our results recommend the use of Czech IPOS-r for the documentation of symptoms in patients with advanced chronic kidney disease.Trial registration GAUK[82121]