Palliative care phase : inter-rater reliability and acceptability in a national study

Background:The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was developed in Australia about 20 years ago and is used routinely for communicating clinical status, care planning, quality improvement and funding.Aim:To test the reliability and acceptability of revised definitions of Palliative Care Phase.Design:Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase.Setting/participants:Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service.Results:A total of 102 nursing and medical clinicians participated, undertaking 595 paired assessments of 410 patients, of which 90.7% occurred within 2 h. Clinicians rated 54.8% of patients in the stable phase, 15.8% in the unstable phase, 20.8% in the deteriorating phase and 8.7% in the terminal phase...