Validation of a core outcome measure for palliative care in Africa: the APCA African Palliative Outcome Scale
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RESEARCH
Open Access
Validation of a core outcome measure for palliative care in Africa: the APCA African Palliative Outcome Scale Richard Harding1*, Lucy Selman1, Godfrey Agupio2, Natalya Dinat3, Julia Downing4, Liz Gwyther5, Thandi Mashao6, Keletso Mmoledi3, Tony Moll7, Lydia Mpanga Sebuyira8, Barbara Panjatovic9, Irene J Higginson1
Abstract Background: Despite the burden of progressive incurable disease in Africa, there is almost no evidence on patient care or outcomes. A primary reason has been the lack of appropriate locally-validated outcome tools. This study aimed to validate a multidimensional scale (the APCA African Palliative Outcome Scale) in a multi-centred international study. Methods: Validation was conducted across 5 African services and in 3 phases: Phase 1. Face validity: content analysis of qualitative interviews and cognitive interviewing of POS; Phase 2. Construct validity: correlation of POS with Missoula-Vitas Quality of Life Index (Spearman’s rank tests); Phase 3. Internal consistency (Cronbach’s alpha calculated twice using 2 datasets), test-retest reliability (intraclass correlation coefficients calculated for 2 time points) and time to complete (calculated twice using 2 datasets). Results: The validation involved 682 patients and 437 family carers, interviewed in 8 different languages. Phase 1. Qualitative interviews (N = 90 patients; N = 38 carers) showed POS items mapped well onto identified needs; cognitive interviews (N = 73 patients; N = 29 carers) demonstrated good interpretation; Phase 2. POS-MVQoLI Spearman’s rank correlations were low-moderate as expected (N = 285); Phase 3. (N = 307, 2nd assessment mean 21.2 hours after first, SD 7.2) Cronbach’s Alpha was 0.6 on both datasets, indicating expected moderate internal consistency; test-retest found high intra-class correlation coefficients for all items (0.78-0.89); median time to complete 7 mins, reducing to 5 mins at second visit. Conclusions: The APCA African POS has sound psychometric properties, is well comprehended and brief to use. Application of this tool offers the opportunity to at last address the omissions of palliative care research in Africa.
Background The lack of clinical and research activity to enhance care of the dying among those HIV-infected is a global challenge. Despite two million deaths during 2007, with emerging international data reporting high mortality even as access to therapy increases, very little scientific attention is paid to improving the experience of death and dying [1]. The burden of progressive, life-limiting disease in SubSaharan Africa is reflected in the epidemiology of HIV * Correspondence: [email protected] 1 King’s College London, Dept Palliative Care, Policy & Rehabilitation, King’s College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London SE5 9RJ, UK
[2,3] and cancer [4]. In sub-Saharan Africa during 2007 there were 22.5 million people living with HIV infection; 1.7 million adults and children became infected with HIV; and 1.6 million died of AIDS [1]. Ba
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