• Malcolm Masso, Samuel Frederic Allingham, Claire Elizabeth Johnson, Tanya Pidgeon, Patsy Yates, David Currow, and Kathy Eagar.
• Centre for Health Service Development (CHSD), Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia mmasso@uow.edu.au.
• Palliat Med. 2016 May 1; 30 (5): 479-85.

BackgroundThe Palliative Care Problem Severity Score is a clinician-rated tool to assess problem severity in four palliative care domains (pain, other symptoms, psychological/spiritual, family/carer problems) using a 4-point categorical scale (absent, mild, moderate, severe).AimTo test the reliability and acceptability of the Palliative Care Problem Severity Score.DesignMulti-centre, cross-sectional study involving pairs of clinicians independently rating problem severity using the tool.Setting/ParticipantsClinicians from 10 Australian palliative care services: 9 inpatient units and 1 mixed inpatient/community-based service.ResultsA total of 102 clinicians participated, with almost 600 paired assessments completed for each domain, involving 420 patients. A total of 91% of paired assessments were undertaken within 2 h. Strength of agreement for three of the four domains was moderate: pain (Kappa = 0.42, 95% confidence interval = 0.36 to 0.49); psychological/spiritual (Kappa = 0.48, 95% confidence interval = 0.42 to 0.54); family/carer (Kappa = 0.45, 95% confidence interval = 0.40 to 0.52). Strength of agreement for the remaining domain (other symptoms) was fair (Kappa = 0.38, 95% confidence interval = 0.32 to 0.45).ConclusionThe Palliative Care Problem Severity Score is an acceptable measure, with moderate reliability across three domains. Variability in inter-rater reliability across sites and participant feedback indicate that ongoing education is required to ensure that clinicians understand the purpose of the tool and each of its domains. Raters familiar with the patient they were assessing found it easier to assign problem severity, but this did not improve inter-rater reliability.© The Author(s) 2015.

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