The Palliative Outcome Scale (P.O.S.)
A Potential National Audit Tool for Palliative Care

Background and Work to Date

• As a result of funding for fifteen months from the National Audit Office of the NHS Executive, we have completed the initial stage of the development of a national tool to be used in the audit of palliative care.
• Such a tool was needed because there is currently no generic tool which can assess the outcomes (including the quality of life and care of patients and families) of palliative care.
• Existing tools and measures had usually been developed in only a small number of settings, were often designed for patients who were not in the palliative stage of illness but earlier stages and were able to complete complicated questionnaires, and often missed important components of palliative care - such as family needs.
• The project involved a systematic literature review of existing outcomes and quality of life measures; and then a collaboration between ten centres throughout England and Scotland to agree the format of, and pilot the P.O.S. The centres included inpatient hospice care, hospital palliative care teams, outpatient care, general practice and home care.
• The P.O.S. measure has taken components which have appeared to work well in earlier measures and includes aspects concerned with pain and symptom control, patient and family psychosocial needs and communication and information.
• The P.O.S. has been piloted now in over 400 patients over six months. Early testing suggests that it appears to be valid, can be used by patients and if patients become too unwell to complete the form, by trained staff. It is responsive to change, can detect service failings and successes, and is reliable in a small group of patients whose condition remains stable

Future Work

We would now like to further develop this tool for use more widely, particularly in general settings, such as hospitals and hospices. We believe that it has potential for a national audit tool to assess prospectively the palliative care for patients. We would develop a training package to accompany the tool, which would help staff to make better assessments of patients and their families, and monitor change. We would assess whether changes in practice occurred and whether these resulted in improvements of patients and families. We already have a register of services wishing to use the measure. The group of ten collaborating centres are keen to continue the project and will act as local foci for its further development if core funding were available.

[Go to Palliative Care Outcome Scale Registration Page]