• Malcolm Masso, Samuel Frederic Allingham, Maree Banfield, Claire Elizabeth Johnson, Tanya Pidgeon, Patsy Yates, and Kathy Eagar.
• Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia mmasso@uow.edu.au.
• Palliat Med. 2015 Jan 1;29(1):22-30.

BackgroundThe 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.AimTo test the reliability and acceptability of revised definitions of Palliative Care Phase.DesignMulti-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase.Setting/ParticipantsClinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service.ResultsA 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. Overall agreement between clinicians' rating of Palliative Care Phase was substantial (kappa = 0.67; 95% confidence interval = 0.61-0.70). A moderate level of inter-rater reliability was apparent across all participating sites. The results indicated that Palliative Care Phase was an acceptable measure, with no significant difficulties assigning patients to a Palliative Care Phase and a good fit between assessment of phase and the definition of that phase. The most difficult phase to distinguish from other phases was the deteriorating phase.ConclusionPolicy makers, funders and clinicians can be confident that Palliative Care Phase is a reliable and acceptable measure that can be used for care planning, quality improvement and funding purposes.© The Author(s) 2014.

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