Development and Validation of a Comprehensive Standardised Clinical Assessment Tool for Patient Needs (ACTI-PALLI)

Rationale for the study

In France, around 150000 people require palliative care every year. Since 2002, palliative care has been organized at several levels: palliative care units, palliative care mobile support teams, health network for palliative care and home-based hospital care. These structures have made possible for some patients in need of palliative care to be treated in appropriate service, in facility-based or community-based programs. With these important advances around palliative care, it appears important to assess the quality of care provided to patients. However, no generalizable study has been conducted in France, and no formal tool is available to help at this end.

In order to enhance the effectiveness of these services, it is important to conduct studies with the aim of developing the adapted and standardized tools that will enable assessment of quality for palliative care, as well as its determinants, for example the organization of structures, management of teams, etc. To this end, it is relevant to adopt a more holistic perspective and take into account the views of different concerned people, including the patients, their families and healthcare professionals, all while considering the organizational and management aspects.

The evidence from other countries has demonstrated the necessity of a rigorous, exhaustive and systematic evaluation as a requirement for any palliative program of quality. Many tools have since been developed to assess the multidimensional needs of patients, but none of these tools have been adapted to be used in the French palliative care settings.

Among of different tools used in palliative care, InterRAI Palliative Care (RAI-PC) has been chosen as the most reliable and complete tool. The RAI-PC allows a comprehensive evaluation of patients, as well as capabilities, preferences and needs. The medical, psychological, functional and social indicators are defined. This tool has been applied in the palliative care field in Canada and USA, but not yet in France. It has proven itself as an appropriate tool for needs assessment and evaluation of quality of care.

Goals of the project

This project aims to develop and validate a comprehensive and standardized instrument that will serve:

1. As a support to individual care, emphasizing the individual characteristics and needs of patients, informing planning care, outcome measurement, quality indicators, and case-mix classification.
2. As a standardized assessment tool adaptable to various palliative care structures

Study design

This study is a multicenter, prospective, observational study with representative stratified sample from different categories of palliative care services: palliative care units, palliative care mobile support teams, health network for palliative care and home-based hospital care. Twenty-three palliative structures, spread across the country are participating in this project.

The survey will involve the healthcare professionals of each center, trained on collecting information and using InterRAI instrument. Data collection involves patient clinical assessment, reviewing medical and nurse record and interview with family and professionals of healthcare.

Criteria for judgement

The quality of the tool will be judged in terms of satisfactory of psychometric properties, operational characteristics and clinical acceptability, adaptability of the tool to the needs of patients and its relevance in different palliative care structures.