POS news and updates

11th March 2019

The Palliative care Outcome Scale (POS) is a family of tools to measure symptoms.  The tools measure patients’ physical symptoms, psychological, emotional and spiritual, and information and support needs. They are a validated instrument used in clinical care, audit, research and training.

POS was developed in 1999 for use with patients with advanced disease. The aim was to improve outcome measurement by evaluating many essential and important outcomes in palliative care. The Support Team Assessment Schedule (STAS), developed in 1986, was the precursor to POS. STAS was constructed to evaluate the work of palliative care support teams and consisted of 17 items, to be rated from 0 (best) to 4 (worst) by a professional caring for the patient.

POS builds on some of the strengths of the STAS, such as clinical application and ease of use. Importantly, POS also allows patients to self-complete the assessments. POS is therefore a patient-reported outcome measure when the patient version of POS is used.  Importantly, POS takes less than 10 minutes to complete by staff or patients.

Since first launched, POS has been tested and improved by researchers around the world. POS now consists of ten items which assess physical symptoms, emotional, psychological and spiritual needs, and information support.  These are scored individually and overall give a profile score. An additional question asks patients to list their main problem/s. A global network of researchers and clinicians continues to collaborate with the creator of POS, Professor Irene J Higginson, to ensure that POS remains an outcome measure of choice.  POS measures are thus specifically developed for use among people severely affected by diseases such as cancer, respiratory, heart, renal or liver failure, neurological diseases or combinations of these conditions.

The POS measures are now widely used globally in Europe, Australia, Asia, Africa and America. POS is available in 13 languages in addition to English: Chinese (traditional), Chinese (simplified), Dutch, French, German, Italian, Japanese, Norwegian, Portuguese, Portuguese (Brazil and Portugal), Punjabi, Spanish (Spain and Argentina) and Urdu. There are a further three translations in progress:  Swedish, Greek and Arabic and the POS team estimate these will be available in 2020.

Further information and downloadable tools are available here:  www.pos-pal.org

IPOS

IPOS  is a further development of the Palliative care Outcome Scale. Welcomed by patients and professionals as a more streamlined measure and brief, it still captures patients’ most important concerns – both in relation to symptoms, but also extending to information needs, practical concerns, anxiety or low mood, family anxieties, and overall feeling of being at peace.

IPOS is now available in 8 languages: French (Switzerland), German, Italian, Japanese, Polish, Portuguese (Portugal), Swedish, Turkish (Cyprus), Czech and Korean (South Korea).  A further 14 translations and cultural adaptations of IPOS are in progress around the world.

These are also available at www.pos-pal.org

MyPOS

The MyPOS is a myeloma-specific version of the Palliative care Outcome Scale.  The questionnaire measures myeloma-specific quality of life issues and is intended for use in clinical care. The questionnaire development was funded by Myeloma UK and St Christopher’s Hospice. Myeloma UK wanted a more specific measure that reflects upon what is particularly important to quality of life for people affected by myeloma.

The questionnaire was developed on the basis of an extensive systematic literature review, semi-structured qualitative interviews and focus groups. The preliminary version was tested via cognitive interviews and then further validated in a large national sample of 380 people with myeloma of different disease stages. Preliminary validation showed that the MyPOS reflects quality of life, is reliable and valid, and is able to distinguish between subgroups of people, i.e. those on and off treatment and those with high or low performance status.

MyPOS is available in 4 languages in addition to English:  Czech, German, Japanese and Korean (South Korea). German (Switzerland) and Welsh are in progress and will be completed in 2020.

MyPOS is also available at www.pos-pal.org

IPOS DEM

IPOS-Dem is a proxy-completed measure for people with dementia living in care homes. It is derived from IPOS, and developed for use by unqualified care staff working in care home settings. IPOS-Dem is designed to support systematic assessment of care home residents with dementia and incorporates common symptoms and problems experienced by this population. It is accompanied by an instruction manual on its use to support routine assessment of residents with dementia. Dutch, German and Japanese translations of IPOS-Dem are in progress (completion estimated in 2021).

IPOS Renal

IPOS-Renal has been developed as a result of demand from clinicians to merge IPOS and POS-S Renal. IPOS-Renal is a short measure (11 questions), combining the most common symptoms renal patients experience plus additional items from IPOS on concerns beyond symptoms, such as information needs, practical issues, family anxiety. IPOS has been validated in a mixed population of those with cancer and non-cancer diagnosis, including renal patients, and shows good content and construct validity, reliability, and responsiveness to change (results being prepared for publication).A Danish translation of IPOS Renal is in progress and will be available in 2020.

APCA POS

An APCA African POS (developed in collaboration with the African Palliative Care Association) has been validated across different sites in Africa. Translation work is progressing for Malawi and Sierra Leone (Krio) with an estimated completion date of 2020.

C-POS is a new measure for paediatric palliative care developed by the Centre for Global Health Palliative Care at the Cicely Saunders Institute.  It is due to be published in 2019.

Latest POS publications

  • Veronese et al (2019) in their study on translation and cognitive testing of the Italian IPOS among patients and healthcare professionals report that Italian IPOS is valid for use in clinical settings (https://doi.org/10.1371/journal.pone.0208536).
  • Sakurai et al (2019) in their study assessed the reliability and validity of Japanese IPOS in cancer patients. They concluded that Japanese IPOS is a valid and reliable tool and is useful in assessing physical, psychological, social and spiritual symptoms and in measuring outcomes of adult cancer patients in Japan (https://doi.org/10.1093/jjco/hyy203)