Feasibility and acceptability of a patient-reported outcome intervention in chronic heart failure

Kane, Pauline; Daveson, Barbara A; Ryan, Karen; Ellis‐Smith, Clare; Mahon, Niall; McAdam, Brendan; McQuilllan, Regina; Tracey, Cecelia; Howley, Christine; O’Gara, Geraldine; Raleigh, C. B.; Higginson, Irene J; Koffman, Jonathan; Murtagh, Fliss E.M.

doi:10.1136/bmjspcare-2017-001355

Cited by 50 publications

(87 citation statements)

References 54 publications

(61 reference statements)

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“…Both reviews aimed to appraise the general use of POS in the context and nature of its use and identify strengths and weaknesses of this patient reported outcome measure (23,26). The third study about the use of IPOS in advanced CHF (14), was identified by consulting the CHF group working at the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London.…”

Section: Methodsmentioning

confidence: 99%

“…A variety of changes in emotional, social and spiritual wellbeing are described by this group of patients (13). However, these symptoms and other concerns are poorly recognised and addressed (14), both because of the reluctance to face deterioration and the lack of specialist knowledge in this final illness trajectory (15).…”

Section: Introductionmentioning

confidence: 99%

“…There are different questionnaires for CHF with good evidence of reliability, validity, responsiveness, and feasibility in the CHF population (18). But although the Minnesota Living with Heart Failure Questionnaire and the Kansas City Cardiomyopathy Questionnaire meet these criteria best (11,19,20), no measures have been fully validated for the use in far advanced disease (14).…”

Section: Introductionmentioning

confidence: 99%

“…Both questionnaires can be used across different settings: home, nursing home, hospital, and hospice (21) and are freely available on a web platform www.pos-pal.org for clinical and research use. POS and IPOS have been used for patients affected by CHF 21, although few studies have been performed to evaluate them in advanced CHF (14,25).…”

Section: Introductionmentioning

confidence: 99%

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What are the main symptoms and concerns reported by patients with advanced chronic heart failure?—a secondary analysis of the Palliative care Outcome Scale (POS) and Integrated Palliative care Outcome Scale (IPOS)

Oriani¹,

Guo²,

Gadoud³

et al. 2019

Ann. Palliat. Med.

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There is a lack of valid disease-specific patient-reported outcome measures (PROMs) for detecting symptoms and concerns in patients with advanced chronic heart failure (CHF). The Palliative care Outcome Scale (POS) and Integrated Palliative care Outcome Scale (IPOS) are specifically developed to capture the main symptoms and concerns of people severely affected by advanced disease. The aim of this study was to determine whether POS and IPOS captures the main symptoms and concerns selfreported by patients with advanced CHF. A secondary analysis of existing POS/IPOS data collected in three longitudinal studies was conducted. POS and IPOS start with an open-ended question for patients to report their main problems and concerns, followed by subsequent closed questions on a range of symptoms and other concerns. Descriptive statistics were used to report the results. The 102 participants from the three datasets had median age 81 years (SD ±9.84 years); 62% male; 87% white. A total of 107 concerns were reported in the first, open POS/IPOS question seeking the patient's main concerns. Of these, 83 (77%) were reflected in the subsequent IPOS/POS closed questions. The high correspondence between the freetext responses and the closed questions indicates that most issues are captured by the POS/IPOS items. In conclusion, the generic versions of POS and IPOS do capture the main problems and concerns of patients with advanced CHF. Minor adaptations and further psychometric validation of POS and IPOS are needed in this population.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

What are the main symptoms and concerns reported by patients with advanced chronic heart failure?—a secondary analysis of the Palliative care Outcome Scale (POS) and Integrated Palliative care Outcome Scale (IPOS)

Oriani¹,

Guo²,

Gadoud³

et al. 2019

Ann. Palliat. Med.

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“…POS is widely used in clinical care, audit, research, and training and it was validated in several languages (4,5). The POS measures have been used in different patients populations such as patients with cancer, respiratory, heart, renal or liver failure, and neurological diseases (6)(7)(8)(9)(10). POS-S was developed as an addition to POS to be used as a brief tool specifically focused on physical symptoms (11).…”

Section: Introductionmentioning

confidence: 99%

Psychometric properties of the Czech Integrated Palliative Outcome Scale: Reliability and content validity analysis

Vlčková

Hoschlova

Chroustova

et al. 2020

Preprint

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Background: Outcome measurement is an essential part of the evaluation of palliative care and the measurements need to be reliable, valid and adapted to the culture in which they are used. The Integrated Palliative Outcome Scale (IPOS) is a widely used tool for assessing personal-level outcomes in palliative care. The aim of this study was to provide Czech version of IPOS and asses its psychometric properties. Methods: Patients receiving palliative care in hospice or hospitals completed the IPOS. The reliability of Czech IPOS was tested with Cronbach alpha (for internal consistency), the intraclass correlation coefficient for total IPOS score and weighted Kappa (for test-retest reliability of individual items). Factor analysis was used for elucidating the construct (Exploratory Factor Analysis). Convergent validity was tested with correlation analysis (Spearman correlation) in a part of the sample, who completed also the Edmonton Symptom Assessment System (ESAS) and the Palliative Performance Scale (PPS). Results: The sample consisted of 140 patients (mean age 72; 90 women; 81 % oncological disease). The Cronbach alpha was 0.789; intraclass correlation was 0.88. The correlations of IPOS with ESAS was R= 0.4 and PPS R= -0.2. Exploratory factor analysis revealed a 2-factor solution on our data. The first factor covers emotional and information needs and the second factor covers physical symptoms. Conclusion: Czech IPOS has very good reliability regarding both internal consistency and test-retest reliability. Together with an item analysis results, we can conclude that the Czech adaptation of the tool was successful. The convergent validity needs to be assessed on the larger sample and the proposed 2-factor internal structure of the questionnaire has to be confirmed by using CFA.

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Comprehensive symptom assessment using Integrated Palliative care Outcome Scale in hospitalized heart failure patients

et al. 2022

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Aims Patients with heart failure (HF) may have variable unrecognized symptom burdens. We sought to investigate the details, determinants, and prognostic significance of symptom burden in hospitalized patients with HF. Methods and resultsWe prospectively evaluated consecutive hospitalized patients with HF as primary diagnosis at our institution using the Integrated Palliative care Outcome Scale (IPOS) both on admission and at discharge. The IPOS, which is a well-validated multi-dimensional symptom assessment scale among advanced illness, consists of 17 questions for enquiring about physical symptoms (10 items), emotional symptoms (4 items) and communication and practical issues (3 items) using a 5-point Likert scale (0 [best]-4 [worst] points). Clinically relevant symptoms were defined as ≥2 points for each IPOS item. Worsening symptom burden was defined as the total IPOS score at discharge being poorer than that on admission. Of 294 patients (mean age: 77.5 ± 12.0 years, male: 168 patients, New York Heart Association class IV: 96 patients, mean left ventricular ejection fraction [LVEF]: 44%, and median N-terminal pro B-type natriuretic peptide [NT-proBNP] level: 4418 ng/L), the median (IQR) total IPOS score on admission was 19 (12, 27) and they were widely distributed (minimum: 0maximum: 52). The total IPOS score on admission was not correlated with the HF severity, including LVEF (Spearman's ρ = À0.05, P = 0.43), NT-proBNP levels (Spearman's ρ = 0.08, P = 0.20) or in-hospital mortality prediction model (GWTG-HF risk score) (Spearman's ρ = 0.01, P = 0.90). Total IPOS scores significantly decreased during hospitalization as a whole (median [IQR]: 13 [6, 21] at discharge; P < 0.001 vs. those on admission). All of the four emotional symptoms (patient anxiety, depression, family anxiety and feeling at peace) remained in the top 5 of clinically relevant symptoms at discharge, whereas none of 10 physical symptoms were nominated. Worsening symptom burden was noted in 28% of the patients during hospitalization, and was independently associated with higher all-cause mortality after discharge (hazard ratio: 2.28, 95% confidence interval: 1.02-5.09; P = 0.044) even after adjustment by age and HF mortality prediction model (MAGGIC risk score). Conclusions We revealed that hospitalized patients with HF had multi-dimensional symptom burdens which varied among individuals and were not correlated with the disease severity. Emotional symptoms, such as anxiety and depression, were the main clinically relevant symptoms at discharge. A worsening IPOS score was noted in a quarter of patients with HF and was associated with a poor prognosis, suggesting the importance of holistic symptom assessment during the course of hospitalization for HF.

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Feasibility and acceptability of a patient-reported outcome intervention in chronic heart failure

Cited by 50 publications

References 54 publications

What are the main symptoms and concerns reported by patients with advanced chronic heart failure?—a secondary analysis of the Palliative care Outcome Scale (POS) and Integrated Palliative care Outcome Scale (IPOS)

What are the main symptoms and concerns reported by patients with advanced chronic heart failure?—a secondary analysis of the Palliative care Outcome Scale (POS) and Integrated Palliative care Outcome Scale (IPOS)

Psychometric properties of the Czech Integrated Palliative Outcome Scale: Reliability and content validity analysis

Comprehensive symptom assessment using Integrated Palliative care Outcome Scale in hospitalized heart failure patients

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